Concomitant NovaSure Endometrial Ablation and Essure Tubal Sterilization: A Review of 100 Cases

Journal of Obstetrics and Gynaecology Canada, 04/14/2011

Mircea CN et al. – Concomitant NovaSure radiofrequency globalendometrial ablation (NS-GEA)and Essure hysteroscopic sterilization (EHS) is a safe and efficient method of providing treatment for abnormal uterine bleeding and permanent female sterilization. The combined procedure can be safely moved from the operating theatre to an outpatient setting, completely independent of anaesthesia and day surgery services. Suction curettage should be considered before EHS. A small proportion of patients may develop post–procedureintrauterine synechiae that impaired the ability to document tubal occlusion by hysterosalpingogram.

Methods

  • Retrospective descriptive study of 100 women undergoing concomitant NS-GEA and EHS for abnormal uterine bleeding.
  • The combined procedure was completed using conscious sedation, in an outpatient setting.
  • Patients were asked to return 3 months post procedure to have proper microinsert positioning confirmed by hysterosalpingogram, ultrasound, and/or pelvic radiograph.

Results

  • An average of five micro-inserts were left trailing into the endometrial cavity.
  • The mean duration of the procedure was on average 17.1 minutes.
  • 87 patients returned for follow-up.
  • The combined procedure was successful in 80 of these 87 patients (92%) and not successful in 7 patients (8%).
  • To improve visualization of the tubal ostia, 25 patients had suction curettage after NS-GEA, with no significant increase in the procedure time (P = 0.927).
  • Technical difficulties included impaired visualization of the tubal ostia (7.4%), difficulty invisualizing or counting micro-inserts after placement (3.2%), and resistance to micro-insert placement (3.2%).
  • The procedure complications were intrauterine synechiae (5.7%), endometritis (2.3%), pain that required an emergency room visit (2.3%), and migration of micro-inserts with or without perforation (4.6%).

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