Development of a novel method of female sterilization: I. The development of a novel method of hysteroscopic sterilization.
OBJECTIVE
For more than 100 years, gynecologists have attempted to effect sterilization via a transuterine approach. Our aim was to develop a safe, simple, rapid method of sterilization that could be performed in the outpatient clinic. The authors felt that a tubal screw based on a "self-tapping" screw would be less likely to become dislodged from the uterine cornu with time because multiple backward-pointing threads prevent it from being displaced.


METHODS
During the development of the technique, many changes had to be made to deliver the tubal screw effectively to the uterine cornu. These involved overcoming problems of poor cornual distension before screw application, effecting the requisite deflection toward the uterine cornu, performing the screwing action with a deflected applicator, and finally disimpacting the screw. Changes were made to the tubal screw, hysteroscope, method of uterine distension, method of deflection, screw applicator, and method of disimpaction.


CONCLUSIONS
The system that appears to be the most efficient consists of a 25F cystoscope with a variable bridge, a 4-mm 30-degree endoscope, and an unsealed spring applicator with bayonet mounting on the screw applied with the use of a pressure bag for uterine distension with saline solution.
Hart
Roger
R
Minimally Invasive Therapy Unit & Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, United Kingdom.
Magos
Adam
A
D005260:Female; D006801:Humans; D015907:Hysteroscopy; D013245:Sterilization, Reproductive / Q000295:instrumentation / Q000379:methods*