OC22.05: 3D TVS and hysterosalpingo‐sonography with gel foam (HyFoSy): one single examination in the assessment of tubal sterilisation occlusion by Essure device

Abstract

The aim of this study was to evaluate by 3D-TVS, in patients who underwent Essure hysteroscopic tubal sterilization, the device position and the tubal occlusion assessed by 3D-HyFoSy using an ExEm foam gel as contrast medium. This prospective study included 44 women who underwent hysteroscopic tubal sterilization by Essure microinsert placement between June 2012 and January 2014. Placement of the microinserts was performed in outpatient setting following standard produced 'recommendations. At least 3 months after the procedure, all patients underwent 3D-TVS and successively HyFoSy. The device position was evaluated on 3D-TVS coronal section and classified as perfect, proximal and very distal according the classification proposed by Legendre (2010). 2D-3D real-time HyFoSy was performed to confirm tubal occlusion by the absence of gel foam passage through the tubes and around the ovaries. Side effects and pain level during and after the procedures were also evaluated. On 44 patients a total of 87 tubes with Essure device were evaluated. On the coronal view, the position of devices was seen as perfect in 6(6.9%) cases, proximal in 54(62.8%) and very distal in 27(30.2%) cases. During HyFoSy bilateral tubal occlusion was observed in 38 cases. In the 6 cases tubal patency was detected (5 unilateral and 1 bilateral tubal patency). Of the 7 patent tubes the devices had a proximal positon in 4 tubes, very distal in one tube and an inadequate position mostly in side the uterine cavity in one case. In case of perfect device position non tubal patency was observed. A pain score >5 on VAS was recorded only in 3 patients during the procedure. 3D-TVS-HyFoSy provides the visualization of Essure microinserts' tubal position and at the same time an accurate assessment of tubal occlusion. It should be considered a reliable tool for evaluating tubal obliteration status after hysteroscopic sterilization.