Patients were followed for 4 to 26 months with no reported pregnancies; cisplatin mechanism of action 85% of patients reported satisfaction with the outcomes. In one study by Vilos and colleagues,17 80 patients underwent Essure placement prior to or after Thermablate EAS ablation. Of these, nine women underwent Essure placement followed by Thermablate EAS endometrial ablation. There were no complications noted. All microinserts were placed successfully and at 3 months one tube was patent. At 3 to 12 months follow-up, 30% of patients reported amenorrhea, 50% reported spotting or hypomenorrhea, 7% reported eumenorrhea, and 10% reported menorrhagia. The overall satisfaction rate was 85%. Donnadieu and associates18 conducted a retrospective study in which 12 women underwent Essure placement immediately before Gynecare ThermaChoice ablation.

At 3 months, proper positioning of the microinserts was confirmed by contrast three-dimensional ultrasound in all women. No pregnancies were reported at 18-month follow-up. Complications In a case report by Jansen and colleagues19 and Del Pozo and G��mez20 from 2007, the authors describe a patient with Essure microinserts in situ who was treated by thermal balloon ablation 9 months after Essure placement for AUB. Three months after the ablation, the patient developed bilateral cornual abscesses. She was treated with doxycycline and metronidazole and underwent a laparotomy with bilateral salpingectomy and appendectomy. On laparotomy bilateral abscesses were noted in both intramural parts of the tubes, which extended to the cornua of the uterus and the tip of a normal-appearing appendix.

Microinserts were located in the center of each abscess. Cultures were positive for Haemophilus influenzae. On histology there was chronic inflammation and fibrosis and the appendix was infected and contained a small intraluminal abscess. The patient recovered without further complications. The authors discuss the possibility of asymptomatic endometritis and consequent bilateral abscess formation at the site of foreign bodies after the endometrial ablation. Hydrothermal Ablation HTA is performed by placing a hysteroscope into the uterine cavity under direct visualization; heated isotonic saline is then circulated into the cavity using gravity.21 The circulating fluid reaches temperatures of 90��C, which can potentially cause thermal injury to surrounding structures if there is leakage of fluid.

Prehysterectomy Studies Coad and colleagues9 looked at seven women previously scheduled for hysterectomy for benign conditions who underwent unilateral Essure microinsert placement immediately followed by Hydro ThermAblator? (Boston Scientific, Natick, MA). The contralateral tubes served as controls. During endometrial ablation, thermal imaging monitored serosal temperatures. Following immediate hysterectomy, the uteri were stained for thermal fallopian tube injury and adjacent Drug_discovery endomyometrial ablation.