The Evolution of Permanent Birth Control

Initially, when women wanted permanent sterilization Obstetricians and Gynecologists performed tubal ligation (“having your tubes tied”). That procedure involved either general or regional anesthesia in a hospital setting and anywhere from 1-3 incisions, with at least 2-3 day downtime to recover.

The initial device brought to market for this procedure used a metal coil that needed to spring open to block the tubes (ESSURE). I have used this device to block tubes on several patients. As a gynecologic surgeon, I am always open to the use of new products that benefit the patient, which is why our office is such a big proponent of daVinci Robot Assisted surgery.

My issue with ESSURE has always been two fold, one it leaves two metal springs permanently inside the patient and two limits your ability to perform other needed procedures in the future that use electrocautery (a tool used to limit bleeding when performing other surgery). Let me give you real life examples of how these issues come into play.

A new patient comes to see me with the sudden onset of severe doubling over pelvic pain on the right side, her pelvic sono shows nothing but she cannot stand up. Her only surgery was gallbladder removal 6 months earlier. I take her to the operating room for Laparoscopy and only find a small metal surgical clip right where she describes the pain. The clip fell off or was dropped during her previous gallbladder surgery and landed on a nerve inside her lower abdomen. I removed the clip and she woke up completely pain free.

A patient operated on by another surgeon has had significant post-operative pain following removal of an ovary and tube. This leads to two additional surgeries in attempt to relieve pain that was not present before the first surgery. I ordered a CT scan, which revealed multiple surgical clips at the site of her previous surgery. It is true that many physicians believe metal clips are harmless to the patient, despite the fact we have other ways to doing the same surgery. I removed 14 clips from the patient via laparoscopy and the pain resolved.

What I am saying, is why use metal when other surgical tools can do the same thing? My colleague told a story of a patient here in Dallas who had ESSURE performed and then had persistent pelvic pain afterwards. The surgeon chose to go in and remove the ESSURE, which is no easy procedure as the spring expands inside the uterus and thru the tube. That surgeon used electrocautery to remove the ESSURE. As a result the electrical current traveled along the metal coils and then into a nerve in her leg. She has permanent nerve damage in her leg.

If you are interested in more info on Essure, feel free to go to our website, where a patient video and other information can be found. You may schedule an in office consultation, with me to discuss any questions regarding this or any other women’s health issue you may have.

Jonathan Weinstein, MD, FACOG

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