Objective: To assess the success rate, complications, and technical difficulties of concomitant NovaSure radiofrequency global endometrial ablation (NS-GEA) and Essure hysteroscopic sterilization (EHS).
Methods: We conducted a retrospective descriptive study of 100 women undergoing concomitant NS-GEA and EHS for abnormal uterine bleeding. The combined procedure was completed using conscious sedation, in an outpatient setting. Patients were asked to return three months post procedure to have proper micro-insert positioning confirmed by hysterosalpingogram, ultrasound, and/or pelvic radiograph.
Results: An average of five micro-inserts were left trailing into the endometrial cavity. The mean duration of the procedure was on average 17.1 minutes. Eighty-seven patients returned for follow-up. The combined procedure was successful in 80 of these 87 patients (92%) and not successful in seven patients (8%). To improve visualization of the tubal ostia, 25 patients had suction curettage after NS-GEA, with no significant increase in the procedure time (P = 0.927). Technical difficulties included impaired visualization of the tubal ostia (7.4%), difficulty in visualizing or counting micro-inserts after placement (3.2%), and resistance to micro-insert placement (3.2%). The procedure complications were intrauterine synechiae (5.7%), endometritis (2.3%), pain that required an emergency room visit (2.3%), and migration of micro-inserts with or without perforation (4.6%).
Conclusion: Concomitant NS-GEA and EHS is a safe and efficient method of providing treatment for abnormal uterine bleeding and permanent female sterilization. The combined procedure can be safely moved from the operating theatre to an outpatient setting, completely independent of anaesthesia and day surgery services. Suction curettage should be considered before EHS. A small proportion of patients may develop post-procedure intrauterine synechiae that impaired the ability to document tubal occlusion by hysterosalpingogram.