title: Hysteroscopic tubal sterilization: a systematic review of the Essure system.
abstract: OBJECTIVE
  To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method.
  
  
  METHODS
  The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008.
  
  
  METHODS
  The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare.
  
  
  METHODS
  Women over 30 years, who had been sterilized by the Essure method.
  
  
  METHODS
  Hysteroscopic tubal sterilization using Essure system.
  
  
  METHODS
  Efficacy/effectiveness, adverse events, costs.
  
  
  RESULTS
  Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed.
  
  
  CONCLUSIONS
  The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.
authors.affiliation: Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland. ritva.hurskainen@hus.fi
authors.forename: Ritva
authors.initials: R
authors.lastname: Hurskainen
authors.forename: Sirpa-Liisa
authors.initials: SL
authors.lastname: Hovi
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.forename: Riitta
authors.initials: R
authors.lastname: Grahn
authors.forename: Katriina
authors.initials: K
authors.lastname: Kukkonen-Harjula
authors.forename: Merja
authors.initials: M
authors.lastname: Nord-Saari
authors.forename: Marjukka
authors.initials: M
authors.lastname: Mäkelä
mesh_terms: D000818:Animals; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*