Hysteroscopic permanent tubal sterilization using a nitinol-dacron intratubal device without anaesthesia in the outpatient setting: procedure feasibility and effectiveness.
BACKGROUND
Hysteroscopic permanent tubal sterilization has recently been introduced, resulting in a non-invasive, safe and effective technique. The aim of this study was to assess the feasibility of outpatient hysteroscopic tubal sterilization using a nitinol-dacron intratubal device without anaesthesia and to assess patient procedure compliance.


METHODS
We untertook a prospective study of 36 consecutive cases of outpatient hysteroscopic tubal sterilization using a nitinol-dacron intratubal device without anaesthesia. Tubal sterilization was performed by placing the device with the aid of a 5.2-mm continuous-flow operative hysteroscope. At the end of the procedure women were asked to rate the pain experienced on a visual analogue scale (VAS) (0, no discomfort to 100, severe discomfort). Successful device placement was assessed after 3 months by hysterosalpingography and diagnostic hysteroscopy.


RESULTS
Successful bilateral placement was obtained in 32 patients (88.9%); in one (2.8%) the placement was monolateral; and in three (8.3%) the procedure failed. Mean operating time was 8.6 +/- 5.3 min. A mean VAS of 36.1 +/- 23.9 was recorded.


CONCLUSIONS
The nitinol-dacron intratubal device is safe, appears to be effective long-term, is non-invasive and can be used in the outpatient setting without anaesthesia. Low-level discomfort was experienced by the patients. Limitations of its use include that it is not effective immediately, it is irreversible, it requires special equipment and training, and it is difficult to use in cases of uterine anomalies. We conclude that this method may be offered to all woman asking for permanent tubal sterilization, particularly those who refuse or have contraindications for anaesthesia.
Litta
P
P
Department of Gynecological Science and Human Reproduction, University of Padua School of Medicine, Via Giustiniani No. 3, 35128 Padua, Italy.
Cosmi
E
E
Sacco
G
G
Saccardi
C
C
Ciavattini
A
A
Ambrosini
G
G
D000328:Adult; D000497:Alloys / Q000737:chemistry*; D000758:Anesthesia; D004867:Equipment Design; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D008875:Middle Aged; D010045:Outpatients; D010146:Pain; D010147:Pain Measurement; D010349:Patient Compliance; D017060:Patient Satisfaction; D011093:Polyethylene Terephthalates / Q000737:chemistry*; D011446:Prospective Studies; D013246:Sterilization, Tubal / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D000497:Alloys; D011093:Polyethylene Terephthalates; C013616:nitinol