From zapping fibroids to sterilisation, the quick fix op women can have in their tea break

Safer, faster... the new technique that may transform gynaecological surgery

Pioneering procedure: Maxine was home hours after having sterilisation treatment

Pioneering procedure: Maxine was home hours after having sterilisation treatment

Six years ago, Maxine O’Reilly and her husband reluctantly decided they would not have any more children. Following the birth of their son, they had tried for several years for another child, without success.

‘Of course I was sad when I didn’t get ­pregnant — but we accepted it,’ says ­Maxine. ‘And at 35, I was getting to feel I was too old to have another baby “by accident”.

‘By then I’d set up my own hairdressing business and felt I was starting on a phase of life that didn’t include a new baby.’

Three years ago, she went to see her GP about her contraceptive options. ‘I’m ­allergic to the Pill and didn’t like the idea of the coil or other hormonal treatments.

‘It seemed drastic but when the GP ­mentioned sterilisation it looked like the best option. I’d never considered it before — after all, I assumed I’d need a general anaesthetic, which is always worrying, have a painful scar and have to stop working for a few weeks.’

In fact, when she was referred to Birmingham Women’s Hospital, Maxine was offered a pioneering form of sterilisation that can be performed as a ten-minute outpatient procedure. 

Not only was there no wound, but she didn’t suffer anything more than a slight crampy feeling afterwards. And — unusually for a gynaecological operation — she was awake throughout the procedure.

As a result, she was able to drive home to Solihull from hospital within hours.

Having booked a couple of days off work in case she needed time to recover, she was well enough to enjoy an unexpected break rather than having to take it easy. ‘I couldn’t believe how well it went,’ she says.

The pioneering treatment was possible thanks to a new technique for gynaecological conditions. The minimally-invasive procedure is being used for a variety of conditions, including fibroids.

'There's no doubt at all this procedure is significantly safer than conventional sterilisation as well as being more effective'

When it comes to sterilisation, the technique is performed using special implants known as Essure. The Essure procedure is popular in Europe, Australia and the U.S. It’s easy to see why, says Wai Yoong, a gynaecologist at North ­Middlesex Hospital.

‘This is such a simple, safe ­procedure that is minimally ­invasive and requires no anaesthetic or surgical incisions — and therefore makes sterilisation a desirable option for women who have completed their families.’

A six-year study that ­followed 645 women given Essure found none became pregnant, compared to one in 200 women who conceive after conventional sterilisation.

Mr Yoong started to offer Essure 18 months ago and says it is the most popular form of sterilisation in his hospital.

Another enthusiast is Sian Jones, a consultant gynaecologist at Bradford Royal Infirmary.

‘Because there is no need for cutting or entering the abdominal cavity, there’s no doubt at all this procedure is significantly safer than conventional sterilisation as well as being more effective,’ she says.

A conventional operation involves general anaesthetic — using laparoscopic keyhole ­surgery, the fallopian tubes are sealed with a clip. With Essure, a tiny fibrous implant is inserted into the fallopian tubes using a hysteroscope — a narrow, telescopic camera that is placed in the same way as a speculum, the instrument used for a cervical smear, but with less discomfort.

The implant is a type already widely used in surgical procedures; it works by irritating the inside of the fallopian tubes.

This causes scar tissue to form, blocking the fallopian tubes.

As well as the safety and convenience it offers, the new technique saves money, says Jonathan ­Frappell, President of the British Society of Gynaecological ­Endoscopy and a gynaecologist at Derriford Hospital, Plymouth.

‘At £700, the cost is favourable in comparison to conventional ­sterilisation, which costs £1,000. Add to that significant further savings by avoiding the need for an anaesthetist and beds in the recovery ward.’

Essure got the stamp of approval from the National Institute for Health and Clinical Excellence (NICE) in 2009. Yet only a handful of hospitals in Britain offer it — with less than 10 per cent of the 15,000 sterilisations carried out every year using this method.

In fact, sterilisation is just one of a growing number of gynaecological procedures that can be carried out using hysteroscopy. These include endometrial ablation — to treat endometriosis — as well as the removal of polyps and fibroids.

No regrets: The mother-of-one couldn't believe how easily her treatment went

No regrets: The mother-of-one couldn't believe how easily her treatment went

Thousands of women undergo these procedures under a general anaesthetic, and yet many could have the procedure done using a much less invasive, safer — and cheaper — technique.

‘Hysteroscopy is an excellent method of providing gynaecological procedures that any specialist practitioner with the right training can perform,’ says Sian Jones, who is in charge of national training in hysteroscopy for gynaecological nurses.

So why isn’t it being used more widely? Part of the problem is that few people know about it.

‘Just because hysteroscopy sterilisation has NICE approval doesn’t mean hospitals automatically start using it,’ says Mr Yoong. A major problem is that NHS managers won’t fund it. Sian Jones wants to provide Essure, but her health authority won’t fund it.

‘There are lots of doctors who have been trained to use Essure, but can’t offer them because there’s no funding,’ she says.

There is a squeeze on outpatient services, says Mr Frappell.

‘The view seems to be that outpatient procedures should be cut because they will inevitably be for less serious conditions.

‘This is a perverse incentive that makes no sense at all, ignoring as it does the major developments in hysteroscopy.’

'Too often patients are simply not being given the choice that they deserve’

Another impediment to this non-invasive surgery is resistance among some surgeons, says Justin Clark, a gynaecologist at Birmingham Women’s Hospital.

‘What worries me is that some ­surgeons seem to prefer to ­operate on women who are asleep under a general anaesthetic,’ he says.

‘Wherever possible, we should avoid a general anaesthetic as expensive and risky.’ ­Hysteroscopic sterilisation is not without risks, including perforation of the uterus and nerve damage.

But women themselves are ­adamant that avoiding a general anaesthetic is worthwhile.

When Michele Guest, 31, a mother of two, underwent a ­hysteroscopic sterilisation, she was able to compare notes with a friend who had a laparoscopic procedure.

‘It’s taken her weeks to recover while I arrived at the hospital at 12.30pm and was discharged by 2pm and felt perfectly well,’ says Michele. ‘It seems crazy that there is this different approach depending on which hospital you attend.

‘The whole procedure was good for me.’

For Mr Clark, hysteroscopy is a no brainer.

‘It saves the NHS money and is better for the patient, who can drop off the children at school and pop into hospital to have the procedure and be home before the children are back from school.

‘But too often patients are ­simply not being given the choice that they deserve.’

Some names have been changed.


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