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Re: hysteroscopic sterilizationFrom: Hugo D Ribot Jr (hribot@mindspring.com)Tue Jan 30 20:46:56 2007
>· Have you used the product? Yes
>· If you have – what has been the pro/cons of using it? Pros: - Fast - Easy for anyone with a modicum of hysteroscopic hand eye coordination - Well tolerated by the patients in an office setting with appropriate premedication AND good paracervical block - Much better reimbursement than a hospital tubal sterilization under anesthesia - Virtually no down time for the patient - Better time management to bring this procedure into an office setting than going to the hospital and being at the mercy of their O.R. schedule - Avoids risk of inserting laparoscopic instruments into abdominal cavity Cons: - timing of the procedure is critical; must do it either very shortly following menses or with several weeks of premedicating with birth control pills or DepoProvera so as to have a thin, "non-fluffy" endometrium for good visualization of the ostia - sometimes even with premedicating can encounter fluffy endometrium which gets waterlogged if the hysteroscopy takes more than 5-10 minutes, leading to difficulty visualizing (let alone cannulating) the tubal ostium. - a small % of patients have large cavities or oddly situated tubal ostia which are difficult to cannulate, leading to a failure to achieve bilateral placement in ~ 5%
>· Do you offer it to all patients looking to have a sterilization procedure?
What percentage accepts?
> 90%
>· Do you think that in the future most sterilization procedures with be done hysteroscopically?
>· Is there any other information that you think is relevant?
>· Do you have access to a hysterscope in the office setting?
-- Hugo D. Ribot Jr., M.D., FACOG Cartersville, Georgia Private practice since 1990 3 MDs/3 CNMs
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