Essure and Adiana Tubal Sterilization
Essure and Adiana are hysteroscopic sterilization methods that block the fallopian tube.
Essure Sterilization Procedure
Essure sterilization is a new hysteroscopic tubal occlusion method that became approved for use in the United States in November 2002.
Essure is a coiled spring device that is inserted through the uterine cavity into the tubal openings using a hysteroscope. This can be done as an office procedure. The Essure micro-insert consists of a stainless steel inner coil, a super-elastic outer coil, and polyethylene fibers wound in and around the inner coil. When released, the outer coil expands to anchor the micro-insert in the fallopian tube. As the device expands to fill the tubal opening, it gradually becomes scarred in place and forms a barrier so that sperm cannot reach the egg. The device extends from the uterine cavity, through the interstitial segment of the tube within the uterine muscle, and into the isthmic segment of the fallopian tube outside of the uterus. A hysterosalpingogram (HSG) is performed three months later to ensure the fallopian tubes are completely blocked and that the woman can begin relying on Essure to prevent pregnancy. Because of the scar formation, reversal of Essure can not be achieved by simply removing the coils. To reverse the Essure method of tubal sterilization, the fallopian tube must be cut beyond the reach of the Essure device and then implanted into a new opening in the uterus.
Adiana Sterilization Procedure
Adiana is another new hysteroscopic sterilization procedure. It was approved for use in the US by the FDA in July 2009. Adiana uses radio frequency energy and a polymer microsinsert that together result in tubal blockage in the interstitial segment of the fallopian tube that is within the uterine muscle.
With the Adiana procedure, a catheter is positioned immediately inside the opening of the patient's fallopian tube using a hysteroscope. The catheter applies low-level radiofrequency (RF) energy to remove the thin layer of cells that line a 1 cm section of the inside of the fallopian tube. A soft polymer matrix implant, that is smaller than a grain of rice, is then inserted into the tubal opening. As scar tissue grows into the inplant, tubal blockage occurs. The area of the tube that is affected is smaller than with the Essure device. The portion of the tube outside the uterus is not affected. Similar to Essure, a confirmatory hysterosalpingogram (HSG) is performed three months later to ensure the fallopian tubes are completely blocked and that the woman can begin relying on Adiana for permanent contraception. Adiana reversal is also performed by the technique of tubouterine implantation.
Tubal ligation procedures
Common types of tubal ligation procedures include:
- Pomeroy Tubal Ligation
- Tubal Rings and Clips
- Monopolar and Bipolar Tubal Coagulation
- Parkland and Irving Procedures
- Essure and Adiana (Hysteroscopic Procedures)