58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants

Name of the Procedure:

Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants (also known as Hysteroscopic Sterilization or Tubal Sterilization with Implants).

Summary

Hysteroscopic sterilization is a minimally invasive surgical procedure that involves the insertion of a hysteroscope through the cervix into the uterus to view and cannulate both fallopian tubes. Permanent implants are placed within each tube to block them, preventing pregnancy.

Purpose

The procedure is designed to provide a permanent form of birth control (sterilization) by blocking the fallopian tubes, which prevents the sperm from reaching the eggs. The expected outcome is permanent infertility.

Indications

• Desire for permanent birth control by women who no longer wish to have children.
• Women who may be at increased risk for complications with other forms of sterilization (e.g., laparoscopy).

Preparation

• Patients may be instructed to avoid eating or drinking for several hours before the procedure.
• A pregnancy test is typically performed beforehand to ensure the patient is not pregnant.
• Patients may need to adjust certain medications as advised by their healthcare provider.

Procedure Description

1. The patient is given mild sedation or local anesthesia to minimize discomfort.
2. A hysteroscope is inserted through the cervix into the uterus to visualize the fallopian tubes.
3. Specialized instruments are used to cannulate each fallopian tube.
4. Permanent implants are carefully placed into the tubes to induce occlusion.
5. The hysteroscope is removed, and the patient is monitored for a short period before being discharged.

Duration

The procedure typically takes about 30 minutes to one hour.

Setting

Hysteroscopic sterilization is usually performed in an outpatient surgery center or a hospital.

Personnel

• Gynecologic surgeon or specialized physician
• Nursing staff
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Mild to moderate pain or cramping
• Vaginal bleeding or spotting
• Infection
• Perforation of the uterus or fallopian tubes (rare)
• Anesthesia-related risks
• Incomplete blockage, requiring additional procedures

Benefits

• Effective and permanent form of birth control
• Minimally invasive with no incisions required
• Quick recovery time

Recovery

• Patients can typically go home the same day.
• Mild cramping and spotting may occur for a few days.
• Avoid strenuous activities and sexual intercourse for a short period as advised by the surgeon.
• Follow-up appointment usually required after three months to confirm tubal occlusion with imaging.

Alternatives

• Laparoscopic tubal ligation: surgery that involves small abdominal incisions.
• Long-acting reversible contraceptives (e.g., IUDs, implants).
• Use of hormonal contraception.
• Non-hormonal barrier methods (e.g., condoms).

Patient Experience

During the procedure, patients may feel some discomfort and cramping. Post-procedure, mild pain and vaginal spotting are common but manageable with over-the-counter pain medications. Patients are usually back to normal activities within a few days.