Hysteroscopic Sterilisation ESSURE TM

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Hysteroscopic Sterilisation ESSURE TM

• Sarah Wallage
• Gynae / SRH Consultant Aberdeen
• 2013

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What is Essure ?
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Vaginoscopy, 20 mins on table
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• Permanent
• IVF for subsequent pregnancy
• No effect on periods
• can have subsequent endometrial
  ablation
• Hysteroscopy not laparoscopy
• Not require GA
• Takes 3 months to work
• Confirmation test X ray / USS
• 15 need hysterosalpingogram ( HSG)

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Who can have EssureTM

• Not suitable after previous tubal surgery
• previous
  endometrial ablation
• nickel
  allergy ???
• 
  immunesuppressed 6/12 HSG
• Can offer if not suitable for lap sterilisation
• eg BMI gt30
• previous midline scar/
  abdominoplasty
• not fit for GA

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Essure TM

• 86-96 bilateral placement endometrium/ tubal
  spasm distortion
• lt2 perforation/ migration - need removal
• lt2 expulsion
• 11000 pregnancy rate after OK confirmation test
  ( 5yr data)
• Outpatient procedure if LA
• Back to normal within a day
• Must use contraception until confirmation test

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Aberdeen experience

• Funding- 200 HSG gt lap steri hosp cost
• No unplanned overnight stay
• Clinic / Theatre ??
• hysteroscope kit
• 2 nurses 1 operator
• recovery similar to IUD
• Cycle stage- need thin endometrium
• provera prep

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• Information- staff training / clerking proforma
• Preclinic pt info / GP awareness
• Demand? No increase in steri referrals 2012
• Success - only 37/48 placed- ostia not clear/
  tubal block
• Follow up - USS X ray often difficult to
  interpret
• almost all need HSG
• logistics/ staff /
  acceptability

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Summary

• Another option if reversible methods are
  unacceptable
• Similar to vasectomy no GA, recovery time and
  delay till effective
• Suitable for many women ineligible for lap steri
• Possible in specialised clinic setting
• Significant Failure rate for placing devices
• Confirmation test most need HSG

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