Permanent Contraception by the Obstruction of Fallopian Tubes

A permanent contraception and sterilization system provides a minimally invasive, nonincisional alternative to bilateral tubal ligation, the traditional means of female sterilization.

The Adiana permanent contraception system enables a novel, two-step approach to permanent female sterilization. First, a catheter is positioned immediately inside the opening of the patient's fallopian tube using a hysteroscope, eliminating the need for any incisions. The catheter applies a very low level of bipolar radiofrequency (RF) energy to remove a thin layer of the cells lining a one-centimeter section of the interior of the fallopian tube. The catheter then delivers a soft polymer implant, smaller than a grain of rice, called a "matrix,” which remains within the prepared section of the fallopian tube. The procedure is then repeated on the other fallopian tube. The procedure is designed so that healthy tissue will grow into the matrix to create a complete blockage of each tube. A confirmatory dye test called a hysterosalpingogram (HSG) is conducted at three months post-procedure to ensure the fallopian tubes are completely blocked and that the woman can begin relying on the Adiana matrix for permanent contraception. The procedure generally requires only local anesthesia, and can be performed in a physician's office; patients are normally able to return to work or resume their everyday activities within a day. The Adiana permanent contraception system is a product of Hologic (Bedford, MA, USA), and it has received the European Community (CE) marking and approval by the U.S. Food and Drug Administration (FDA).

"Hysteroscopic sterilization gives women another choice in permanent sterilization,” said Andrew Baxter, M.D., a consultant and honorary senior lecturer in the department of obstetrics and gynecology at the Royal Hallamshire Hospital (Sheffield, UK). "It also allows them to avoid hospital admission, anesthetic and the discomfort and risks attached to laparoscopy.”

A hysteroscope is in fact a modification of a traditional resectoscope, used for transurethral resection of the prostate. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for a smaller outflow through the smaller channel. This results in the distention of the uterine cavity. After cervical dilation, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Other typical procedures include endometrial ablation, submucosal fibroid resection, and endometrial polypectomy.

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Royal Hallamshire Hospital