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10.5005/jp-journals-10007-1104 WJOLS
REVIEW ARTICLE Hysteroscopic Sterilization
Hysteroscopic Sterilization

Bharathi Rajanna
Consultant, Department of Gynecology and Laparoscopy Surgery, Kempanna Nursing Home, Bengaluru, Karnataka, India

Abstract
Female sterilization is the most widely accepted contraception in the world today. From a practical perspective, gynecologists are at
constant drive to provide effective, safe, least discomfort/pain and economical contraception to the couple. With the advent of hysteroscopic
surgery innovation in the form of better optics, endoscopes, camera, equipment, and insufflation machines revolutionized the surgery.
This review will discuss the evolution of different hysteroscopic sterilization methods, including the past, present and upcoming devices.
However, concerns remain about the absolute irreversibility of the method of sterilization. Researchers have failed to find solution to
meet all the criteria. But this route obviates surgical incision and requires local anesthesia or intravenous sedation. The safety, tolerability
and efficacy of hysteroscopically placed device are discussed in depth. This article will certainly help the clinicians to keep abreast of
latest advances in contraception and practice in broader perspective despite the availability of limited literature.
Keywords: Transcervical sterilization, Micro-insert device, Hysterosalpingogram (HSG).

INTRODUCTION ND:YAG Laser

Blind attempts of electrocautery of uterotubal junction were Laser is delivered through a long, flexible quartz fiber.
reported as early as 1878. In 1916 Cooper and in 1927 Thermal injury to the depth of 5 mm is noted. The procedure
Schroeder suggested direct visualization of tubal ostia and was not cost-effective and trial was terminated due to high
attempted hysteroscopic sterilization by diathermy. Some patency rate of 74%.
plugs were applied which expelled. All methods were
withheld as private industry was not willing to spend Chemical Method
money. Almost 30 years later re-exploration to occlude
fallopian tube was undertaken with the advent of Quinacrine is a drug with multitude of applications. Its
technology. Dr Rafael Valle et al introduced STOP main effects are antiprotozoal, antirheumatic, and
intratubal device made up of stainless steel and coil sclerosing agent. This unique property of sclerosis was
amalgamate of steel and platinum. Upon deployment, it employed by Zipper et al to induce scar tissue at uterotubal
expands and anchors to fallopian tube. Inside the device, junction to create block. In earlier studies (Chile), the
Dacron was used to permit tissue growth and occlude the quinacrine was delivered as slurry with dilution of
tubes. The women indicated for hysterectomy at later date 125 mg/ml and 250 mg/ml, three deaths were reported
were picked for study design. due to sudden absorption through endometrial capillaries.
Historically, researchers have based their effects around Later modified 7 pellets of 36 mg of quinacrine are placed
one of the following strategies: into the uterus using a tube similar to Cu-T inserter in 2 to
• Mechanical and occlusive devices or plugs 3 doses one month apart in the proliferative phase of
• Injection of tissue sclerosants or adhesives menstrual cycle. Quinacrine is a mutagen. It acts by
• Diathermy. chelation of DNA forming quinacrine DNA complex.
It is generally well tolerated and can be associated with
PAST METHODS
cramping pain. Small number of women had salpingitis 3%,
Electrocautery menstrual disorder 2.7% and dysmennorrhea 2%.

An electrode is passed into the intramural portion of the Pellets offered a cumulative pregnancy rate of 4.6%.
tube under hysteroscopic guidance, and coagulatry Ten years of Vietnam study revealed a pregnancy rate of
current is applied for several seconds. Authors reported 12%. The most attractive part of quinacrine sterilization
patency rates as high as 20%. Poor effective rates, was cost effectiveness. No randomized controlled trials
thermal injury, and uterine perforation made this technique have been reported to date and there is controversy over
unsafe in current use. its use.

World Journal of Laparoscopic Surgery, September-December 2010;3(3):159-164 159