Ealing HospitalNHS Trust

Service Evaluation of Laparoscopic and Hysteroscopic SterilisationA S M A A A L - K U F A I S H I 1 , S E O S O O N S E A H 2 , T A N T O H L I C K 1

Department of Obstetrics & Gynaecology 1 and Anaesthetics 2 , Ealing Hospital NHS Trust, London, United Kingdom

INTRODUCTION Although hysteroscopic sterilisation was approved in 2001 and is found

to be safe and effective 1, its availability in the National Health Service is

limited. We introduced this procedure in 2010 as the second London

centre for ESSURE hysteroscopic sterilisation (EHS). We sought to

compare the service received by our patients undergoing both EHS and

laparoscopic Filshie clip sterilisation (LFCS) in our first year.

METHODSA retrospective cohort analysis of all female sterilisations performed over

a 1 year period was undertaken. Cases were identified by coding and

theatre bookings. Sterilisation at Caesarean section was excluded. Data

from patient records were entered into Microsoft Excel for analysis.

Table 1. Demographics and counselling recevied by women undergoing ESSURE hysteroscopic sterilisation and laparoscopic sterilisation.

References 1: National Institute for Health and Clinical Excellence (2009) Hysteroscopic sterilisation by tubal cannulation and placement of intrafallopian implants. IPG 315. London: National Institute for Health and Clinical Excellence. 2: Borley J, Shabajee N, Tan TL. A kink is not always a perforation; assessing Essure hysteroscopic sterilization placement. Fert Steril 2011; 95(7): 2429.

RESULTS A total of 42 female sterilisations were identified of which 7 were

excluded as they were performed during Caesarean section. Ten EHS and

25 LFCS were compared. There was no significant difference in the

demographics of the women. However, in contrast to EHS patients who

were all briefed on LARCs, ESSURE and vasectomy, women undergoing

LFCS were not always informed of these options (table 1).

All LFCS patients underwent general anaesthetic while about 40% of EHS

patient chose sedation rather than general anaesthetic. The number of

incisions was significantly lower in the EHS group than the LFCS group:

0.2 ± 0.6 vs 2.0 ± 0.2 (p < 0.0001). Blood loss in both group were not

significant but was lower in the EHS group: 5.0 ± 6.3 vs 28.0 ± 20.2 ml (p

= 0.0259). However, analysis was difficult as it was only documented in

60% of EHS and 20% of LFCS.

Three LFCS patients were admitted for pain control. No EHS patient was

admitted for pain control but 1 was admitted because of closure of day

surgery unit. One EHS patient was re-admitted 3 days later for 1 day with

suspected Fallopian tube perforation and underwent laparoscopy which

showed chronic pelvic adhesion but no perforation 2. One LFCS patient

was re-admitted twice, and another patient once for pain control.

No pregnancies were reported during the 3 month EHS follow-up. There

was however an ESSURE insert expulsion found in this series (figure 1).

Filshie clip placement was not verified as LFCS was not followed-up.

CONCLUSIONS Both forms of sterilisation are safe. However, patients undergoing EHS

may avoid surgical incision, blood loss and general anaesthetic. They are

also less likely to require admission or re-admission for pain control.

Patients undergoing LFCS may not be fully informed of their birth control

options and this maybe a reflection of a persistent lack of awareness of

the options available amongst patients and their clinicians.

EHS allows permanent contraception to be offered with lower morbidity

and in an outpatient or day case setting. This is both advantages for the

woman and the hospital.

Correspondence: tohlick.tan@nhs.net

Figure 1. Three dimensional ultrasound scan demonstrating an expelled ESSURE insert in the uterine cavity at 3 months (left), despite an uncomplicated insertion during the procedure (right).ESSURE hysteroscopic

sterilisationLaparoscopic Filshie clip

sterilisation p

n 10 25

Maternal age, yr 38.2 ±3.3 38.4 ± 4.1 0.9090

BMI, kg m-2 27.3 ±5.9 27.0 ±5.5 0.9031

Parity 3 (1-5) 3 (1-6) 0.6372

Discussed LARCs 10 [100%] 19 [ 76%]

Discussed LFCS 10 [100%] 25 [100%]

Discussed EHS 10 [100%] 5 [ 20%]

Discussed vasectomy 10 [100%] 17 [ 68%]