Initial experience with hysteroscopic tubal occlusion (Essure®)

Abstract

Objective To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). Methods This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Results Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method.Conclusions Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied.

Results of the Insertion of Hysteroscopic Sterilization Devices in a Brazilian Public Hospital

“…Such data are close to those presented by Sinha et al 5 The successful insertion rate of 85% was compatible with the values presented in previous studies, which present results ranging from 81% to 100%, with variable sample sizes. 7,17 The 99.5% imaging insertion success rate was consistent with the 90% range found in the review and meta-analysis of La Chapelle et al 17 including 37 studies regarding this same device. It is important to note, however, that there was a limitation to the analysis of these data, due to the loss of follow-up of one of the cases; the remaining three included cases were still awaiting HSG.…”

“…Data from the medical records of 904 patients were analyzed. There was an average of 3.3 pregnancies and 2.9 deliveries per patient, with a sample similar to that presented by Depes et al 7 The average age of the patients was 32.3 years (95%CI: 31.9--32.6), which was similar to the average of the study by Depes et al 7 (34.5 years), representing a sample of young patients. In similar studies conducted in Europe, the average age was higher, such as those presented by Franchini et al 8 (39.5 years), in a study conducted in Italy, and by Fernandez et al 9 (41 years), in a study conducted in France.…”

“…6 The patients in our study received 10 mg of diazepam and 600 mg of ibuprofen orally 30 to 60 minutes before the procedure, which is in line with the conduct adopted by most services. 1,3,5,7,9 The prescription of anti-inflammatory and antispasmodic drugs was justified in these studies in order to prevent tubal spasm.…”

A teoria do risco e as novas tecnologias associadas à saúde: uma análise sobre o procedimento de incorporação e o dispositivo Essure no Brasil

“…Certamente se trata de um procedimento muito mais rápido e simples quando comparado à tradicional cirurgia de ligadura laparoscópica, que, embora seja eficaz, trata-se de um procedimento invasivo e com possíveis riscos anestésicos e cirúrgicos. Razão pela qual Depes et al (23) [o] método Essure tem as vantagens de ser procedimento ambulatorial, sem necessidade de incisões ou anestesia. O paciente é liberado imediatamente após o posicionamento do dispositivo e é capaz de voltar ao suas atividades atuais no mesmo dia.…”

“…Caso a mulher se arrependa mais tarde, a fertilização in vitro pode ser realizada. (24) Após implantado, a paciente deve realizar acompanhamento médico obrigatório durante três meses a fim de confirmar que o Essure esteja na pelve e posicionado de modo apropriado. A empresa Bayer orienta as pacientes a utilizarem outros métodos contraceptivos durante três meses ou até a paciente retornar ao consultório médico e confirmar se o produto está corretamente posicionado.…”