Amanda Yunker

Hysteroscopic sterilization success in outpatient vs office setting is not affected by patient or procedural characteristics.

STUDY OBJECTIVE To determine factors associated with hysteroscopic sterilization success and whether it differs between the operating room and office settings. DESIGN Retrospective cohort analysis (Canadian Task Force classification II-2). SETTING Major university medical center. PATIENTS Six hundred thirty-eight women who underwent hysteroscopic sterilization between July 1, 2005, and June 30, 2011. MEASUREMENTS AND MAIN RESULTS Data collected included age, body mass index, previous office procedures, previous cesarean section, and presence of myomas or retroverted uterus. Place of surgery, experience of surgeon, insurance type, bilateral device placement, compliance with hysterosalpingography, and confirmation of occlusion were also recorded. Bivariate analysis of patient characteristics between groups was performed using χ(2) and independent t tests, and identified confounders and associated variables. Multivariate analysis was performed using logistic regression to assess for association and to adjust for confounders. Procedures were performed in the operating room (57%) or in the office (43%). There was no association between success in bilateral device placement or occlusion and any patient characteristic, regardless of surgery setting. Private insurance, patient age, and performance of procedures in the office setting were positively associated with likelihood of compliance with hysterosalpingography. CONCLUSION Successful device placement and tubal occlusion are independent of patient age, body mass index, or setting of the procedure. Association between insurance type and completing hysterosalpingography illustrates an important public health problem. Patients who fail to undergo hysterosalpingography to confirm tubal occlusion may unknowingly be at risk of pregnancy and increased risk of ectopic pregnancy.

Gynecologic Surgery in the Pediatric and Adolescent Populations: Review of Perioperative and Operative Considerations.

Gynecologists are often consulted on pediatric and adolescent patients who may require a surgical treatment for a gynecologic diagnosis. This patient population can present an interesting challenge for a nonpediatrician. It is helpful to review the differences in anatomy, alterations in drug dosing, surgical limitations, and counseling and consent requirements in this patient population before proceeding with a surgical treatment. This is a review of preoperative, intraoperative, and postoperative considerations for gynecologic surgery in the pediatric and adolescent patient population.

Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts

Purpose of review To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization. Recent findings Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of ‘the probabilities of rates or events’ of adverse outcomes associated with Essure placement. Summary Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.

Minimally Invasive Surgery and Chronic Pelvic Pain

Objective: The minimally invasive surgical treatment options for many chronic pelvic pain disorders are reviewed, including treatments for endometriosis, ovarian remnant syndrome, pelvic congestion, post-ablation pain, pelvic adhesions, and uterine retroversion. Design: A systematic review of the literature referring to surgical treatments of chronic pelvic pain, with emphasis on articles published after 1990. Data Sources: Medline searches for terms including the specific chronic pain syndromes and “surgery,” “treatment,” or “management.” Eligibility Criteria: Trials, prospective and observational studies, and reviews assessing the treatment efficacy of surgical modalities employed in the treatment of chronic pelvic pain conditions were considered. Only English-language articles were included. Results: The indications, efficacy, risks, and benefits of minimally invasive treatments for each chronic pelvic pain condition are discussed. Conclusion: There are well-defined minimally invasive surgical treatment options for each chronic pelvic pain condition reviewed. There are limitations of available literature, both in level of evidence and quantity. Most studies are confounded by the multifactorial nature of chronic pelvic pain.