title: Development of a novel method of female sterilization: II. Retention of tubal screws in patients undergoing simultaneous laparoscopic sterilization.
abstract: OBJECTIVE
  This study was a long-term follow-up of patients in whom hysteroscopic tubal screws had been applied at the time of laparoscopic sterilization.
  
  
  METHODS
  Tubal screw application was performed before laparoscopic Filshie clip application. Follow-up ultrasonography was arranged 3, 6, and 9 months postoperatively to confirm retention. The tubal screws were removed hysteroscopically between 12 and 20 months after sterilization under local or light general anesthesia.
  
  
  RESULTS
  Thirty-five women agreed to take part in the study. For the purpose of analysis, these patients were divided into an initial group (cases 1-20, group A) and a later group (cases 21-35, group B). Twenty-three patients had 41 tubal screws inserted (18 women had bilateral screw application). Twenty tubal screws were removed from 13 patients between 9 and 20 months after insertion, one screw remained in situ, and 20 screws had previously been extruded. Life table analysis plots demonstrated a marked but nonsignificant difference (P = .163) in the duration of tubal screw retention between the initial patients (group A) and the later patients (group B): 46.7% versus 76.9% at 6 months and 33% versus 61.5% at 12 months (P = .09 and P = .11, respectively).
  
  
  CONCLUSIONS
  Our experience demonstrated improved application and retention with experience and refinement of the equipment; however, retention of the tubal screws, even in the later stages of development, was poor. A relatively noninvasive method of female sterilization remains the ideal, and further refinements are required.
authors.affiliation: Minimally Invasive Therapy Unit & Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, London, United Kingdom.
authors.forename: Roger
authors.initials: R
authors.lastname: Hart
authors.forename: Peter
authors.initials: P
authors.lastname: Scott
authors.forename: Meir
authors.initials: M
authors.lastname: Ruach
authors.forename: Adam
authors.initials: A
authors.lastname: Magos
mesh_terms: D005187:Fallopian Tubes / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D015993:Life Tables; D013246:Sterilization, Tubal / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D014463:Ultrasonography