P30.03: Localization of essure microinserts with 3d transabdominal ultrasound after hysteroscopic sterilization

Abstract

To evaluate three-dimensional (3D) transabdominal ultrasound (US) as a minimally invasive confirmation test to localize Essure® microinserts 3 months after ambulatory hysteroscopic sterilization. This single-center prospective cohort study included all 66 patients who underwent hysteroscopic Essure® sterilization in a tertiary care hospital. 3D transvaginal and 3D transabdominal US were used to determine the position of the Essure® microinserts across the utero-tubal junction 3 months after the procedure. The microinserts were visualized without problems by 3D transabdominal ultrasound for 55 of the 66 patients (83%) and by 3D transvaginal US, for 62 (94%). The women whose implants were not visualized by the abdominal approach had either a retroverted uterus or a BMI > 30. Laparoscopic tubal sterilization was finally recommended to 5 women: 2 (3%) whose microinserts were not visualized and 3 (4.5%) whose microinserts were not correctly positioned according to both ultrasound approaches. Transabdominal 3D ultrasound is an interesting alternative for confirming correct placement of the Essure® microinserts. Despite visualization problems in cases of a retroverted uterus and BMI > 30, it provides better imaging of the uterine fundus. This technique is easy and reproducible and could replace the 3D transvaginal ultrasound in most cases. It is less invasive than 3D transvaginal US, pelvic X-Ray, or hysterosalpingography. Further studies are needed to confirm our results and validate transabdominal 3D US as a confirmation test after Essure® hysteroscopic tubal sterilization.