Hysteroscopic sterilisation of women in the outpatient department without any anaesthesia with the new Essure device

Hysteroscopic sterilisation of women in the outpatient department without

any anaesthesia with the new Essure device

M.P.H. Vleugels

Riverland Hospital Tiel, Tiel, The Netherlands

Female laparoscopic sterilisation has been offered as the standard last 3

decades. Complication rates of 5/1000 and failure rates meant by pregnancies 5–7/1000

are still very low and accepted. Nevertheless, admission, general anaesthesia,

one day stay in clinic is required combined with complaints of nausea, vomiting

and abdominal pains and scars of the skin. At least 2 days out off work are the

consequences. Keeping these disadvantages in mind a large group of women does

not take the decision for a sterilisation by laparoscopy. A new method of

hysteroscopic sterilisation has been introduced last 2 years. This method is

meant to be performed on the out patient clinic without anaesthesia and


The ‘Essure’ device consists of a tinitol-coil with dacron fibers in the

centre, causing a sterile reaction in the intramural part of the tubes within 3

months. We developed a protocol to sterilise patients without any anaesthesia on

the out patient department within less then 14 minutes in total. Using a 4.9 mm

Bettocchi CF hysteroscope without tenaculum and without a speculum, according to

the vagino-approach, the tubal ostia are located and the Essure device is

introduced on both sides. Patients, often accompanied with husband or friend

follow the procedure on the monitor while the doctor is explaining the

procedure. Patients take some tea or coffee and leave the clinic for their work

or other activities. After 3 months an ultrasound is performed , immediately

followed by a hysterogram to locate the devices and to proof obstructed tubes.

During the period of these 3 months additional anticonceptives have to be used

or continued. Failure of placement is 3% and after 2 years none pregnancy is

found in our group. Pain scores during placement are 2.2 on the VAS ,less then

during the menstrual periods. Phase II and III studies as well as world wide

follow-up of all correctly treated patients- >15000, did not resulted in one

pregnancy.This method is the perfect sterilisation to be performed on the Out

Patient Department for all those women who feared the clinical laparoscopic


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