Trends in Sterilization since the Introduction of Essure Hysteroscopic Sterilization

Shavell, Valerie I.; Abdallah, M.; Shade, George H.; Diamond, Michael P.; Berman, Jay M.

doi:10.1016/j.jmig.2008.08.017

Cited by 43 publications

(14 citation statements)

References 14 publications

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“…In closing, as a study, our analysis serves as a tool that strongly validates the statistical increase in hysteroscopic sterilization since 200224 and validates the assumption that, when provided with a choice, patients – like physicians – recognize the advantages and benefits of minimally invasive technologies.…”

Section: Resultssupporting

confidence: 61%

Preprocedure patient preferences and attitudes toward permanent contraceptive options

Chapa

Venegas²

2012

PPA

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ObjectiveTo determine patient preference for laparoscopic tubal occlusion or hysteroscopic tubal occlusion, two common sterilization interventions, and the acceptability of a postprocedure confirmation test for a hysteroscopic approach.Participants and methodsA total of 100 patients were offered two procedures. A description of each procedure was developed and read to each patient by a research nurse on site. Patients were then asked to respond to a questionnaire concerning options. Final informed consent, procedure review, and procedural date determination were provided by a physician upon completion of the questionnaire. Patients were not allowed to change their questionnaire responses after completion. No interviewer or physician input was allowed during the questionnaire. The study was completed in English or Spanish, as per patient request, by a bilingual/fluent speaker. Physicians completing informed consent were unaware of the questionnaire responses. Patients were not financially incentivized.ResultsOf 100 participants, 93 (93%) preferred hysteroscopic sterilization to laparoscopy. The reasons were as follows: fear of general anesthesia (24/93 [26%]), fear of incision (25/93 [27%]), cost (32/93 [34%]), and time (12/93 [13%]) to return to routine activity. All 93 viewed “office-based location” as the main advantage over laparoscopy; 88/93 (94.6%) considered a confirmation test to be a benefit of the procedure. After informed consent was obtained, one additional patient switched from a laparoscopic decision to hysteroscopy (total = 94/100); 89/94 (95%) hysteroscopic decisions underwent hysteroscopic sterilization; 4/6 (67%) laparoscopic decisions proceeded to that surgery. The remainder (N = 7) cancelled due to lack of financial resources.ConclusionA nonincisional, office-based approach to sterilization has high patient acceptability. Patients viewed a confirmatory test for tubal occlusion as a benefit after sterilization.

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Section: Resultssupporting

confidence: 61%

Preprocedure patient preferences and attitudes toward permanent contraceptive options

Chapa

Venegas²

2012

PPA

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“…As Essure® rates have increased, rates of other female sterilization procedures have decreased [2]. The procedure entails guiding a hysteroscope through the cervix to the opening of each fallopian tube, where a microinsert composed of nickel and steel coils is deployed.…”

Section: Introductionmentioning

confidence: 99%

“…There is a growing body of literature on the Essure® procedure, with a subset focused on placement rates that range between 81%–99% [2, 6–33]. One area of concentration in this literature is procedure-related, such as finding higher successful placement rates in the outpatient versus inpatient setting [22,26].…”

Section: Introductionmentioning

confidence: 99%

“…One area of concentration in this literature is procedure-related, such as finding higher successful placement rates in the outpatient versus inpatient setting [22,26]. Some researchers demonstrate an association between placement failure and an increased length of procedure, [2,34], but placement rates have not been significantly associated with time in the recovery area, performing a concomitant intrauterine surgical procedure [23,28], or provider experience [8,34]. Further, no association has been observed between placement rates and certain types of anesthesia or premedication [18,23,28,34] with the exception of decreased failure rates when anti-inflammatory agents are used to reduce tubal spasm [7,8,22].…”

Section: Introductionmentioning

confidence: 99%

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Tubal risk markers for failure to place transcervical sterilization coils

et al. 2012

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Background There is a growing body of literature on placement rates of the Essure® procedure, yet prior studies have not attempted to identify tubal-associated risk factors for placement failures. The current study examines risk markers associated with the inability to deploy the Essure® coils into the tubal lumen using the new ESS305 design. Study Design We used electronic medical record data to assess risk markers associated with the inability to place the Essure coils in the tubal lumen using the new ESS305 design. A total of 310 attempted procedures between June 14, 2007, and April 29, 2011 were analyzed. Results There were 18 tubal failures (5.8%) out of the 310 attempted procedures. A history of a prior sexually transmitted infection (STI) was associated with tubal failure (OR 2.64, 95% confidence interval (CI) 1.01–6.90; p=.048). Conclusions We speculate that the observed association between a prior STI and an inability to place the coil was due to a past history of pelvic inflammatory disease.

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“…Advantages of HS include that it is a non-incisional method, avoids abdominal entry (which may be especially important in women with adhesions or co-morbidities), can be performed as an office procedure, and avoids general anesthesia. A 6-year review of sterilization trends at a U.S. academic medical center from 2002–2006, showed a 50% decline in both laparoscopic sterilization (LS) and postpartum sterilizations and a corresponding 50% increase in HS (3). According to the manufacturer of Essure ® (Mountain View, CA), the most popular HS system, approximately 310,000 devices have been placed as of 2010 (4).…”

Section: Introductionmentioning

confidence: 99%

Reliability of Laparoscopic Compared With Hysteroscopic Sterilization at 1 Year

Gariepy

Creinin

Schwarz

2011

Obstetrics &Amp; Gynecology

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OBJECTIVE To estimate the probability of successful sterilization after hysteroscopic or laparoscopic sterilization procedure. METHODS An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure using laparoscopic sterilization, hysteroscopic sterilization in the operating room, and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources. RESULTS In the base case analysis, the proportion of women having a successful sterilization procedure on first attempt is 99% for laparoscopic, 88% for hysteroscopic in the operating room and 87% for hysteroscopic in the office. The probability of having a successful sterilization procedure within one year is 99% with laparoscopic, 95% for hysteroscopic in the operating room, and 94% for hysteroscopic in the office. These estimates for hysteroscopic success include approximately 6% of women who attempt hysteroscopically but are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts. CONCLUSIONS Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within one year. However, the risk of failed sterilization and subsequent pregnancy must be considered when choosing a method of sterilization.

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Trends in Sterilization since the Introduction of Essure Hysteroscopic Sterilization

Cited by 43 publications

References 14 publications

Preprocedure patient preferences and attitudes toward permanent contraceptive options

Preprocedure patient preferences and attitudes toward permanent contraceptive options

Tubal risk markers for failure to place transcervical sterilization coils

Reliability of Laparoscopic Compared With Hysteroscopic Sterilization at 1 Year

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