Essure Offers Easier Sterilization
Approach the ostia as closely as possible, waiting until the ostium occupies most of the hysteroscope's screen.
The Essure catheter includes visual cues to guide you, including a flat black positioning marker.
Before you deploy the microinsert by depressing the button on the handle, check the position of the catheter by looking for the marker just outside the tubal ostia. You should also see the distal tip of the orange release catheter in the same visual field.
Reducing tubal spasm will greatly improve the ease of placement. Wait a few seconds for a spasm to pass, then approach the tube very closely and gently rotate the device inside the tube.
Once the procedure is complete, patients should remain in the office for about 45 minutes before returning home. Some can return to work and daily activities immediately; virtually all will be back to their normal routines within 24 hours.
Almost always, ibuprofen is the strongest medication required for postprocedural pain.
The procedure is exceedingly safe. There is a small risk (less than 1%) of tubal perforation at the time of the procedure; however, no interventional therapy is required.
Likewise, the risks of infection, bleeding, and uterine perforation are extremely low.
Schedule patients for a return visit in 3 months for an HSG, during which you will inspect the tubes for evidence of tissue ingrowth. In the meantime, stress the importance of using an alternative form of contraception, as sterilization cannot be guaranteed until tubal occlusion can be confirmed.
When performing the postprocedure HSG, use minimal volume and pressure. Doing so serves two purposes: avoiding unnecessary patient discomfort, and minimizing the chance of a false-positive result because of high-pressure instillation.
If you refer patients to a radiologist for HSGs, emphasize the importance of these key points. When capturing images, the clinician should ensure proper occlusion by magnifying the cornual region of each implanted tube.
With proper technique, competency in this procedure can be achieved quickly. I have found patient satisfaction to be very high.
The ease and efficacy of the procedure, lack of necessity for general anesthetic, and rapid patient recovery all combine to make Essure tubal occlusion a valuable technique for gynecologists to master.
Confirm visibility of both ostia before placing either microinsert.
The Essure microinsert is inserted into the tubal ostia at the level of the black marker.
The delivery catheter is retracted. The notch at the opening of the tubal ostia shows correct placement.
The delivery wire is retracted from the microinsert.
The microinsert is now firmly embedded in the fallopian tube. Photos courtesy Dr. Charles E. Miller
