New technology is making it possible for obstetrician/gynecologists to perform more and more minimally invasive procedures in the office. In my experience, doing transcervical occlusion and endometrial ablation together, on an outpatient basis, has benefits for both patient and physician.

The how and why of the combined procedures

The FDA recently approved combined use of the uterine balloon therapy system for endometrial ablation and transcervical occlusion with microinserts for permanent birth control. The technique requires neither incisions nor general anesthesia and can be performed simply, safely, and effectively in the office. In fact, transcervical occlusion was designed for that setting. The best candidates for the combined procedure are women who have abnormal, benign bleeding and have completed childbearing but want to avoid hysterectomy.

The process is quite straightforward. On the night before and the day of the procedure, the patient takes pain medication. In most cases, cervical dilation is not necessary, but misoprostol can be given if you suspect cervical stenosis. A paracervical block is administered and then, under hysteroscopic guidance, the microinserts are placed and endometrial ablation is performed. The patient is discharged with a prescription for a mild narcotic and routine post-procedure instructions for hysteroscopy/ablation.

Benefits for patient and physician

In my experience with more than 20 cases of combined sterilization and endometrial ablation, patients are very satisfied with it. Results of a questionnaire I ask women to fill out 1 month after the procedure suggest that they find it quick and simple. Some 95% of the patients I've surveyed say they experienced only mild discomfort for a short time and were back to normal daily activities within a day after the procedure. All of the women I've treated have said they would recommend it to a friend or family member.

For the ob/gyn, this in-office technique conserves a precious commodity: time. The combined procedures can be scheduled in a block of, perhaps, one afternoon or evening per week. While the paracervical block is taking effect, I find I can make phone calls or even schedule short office visits with other patients.

I have encountered no obstacles in obtaining reimbursement for combined sterilization and endometrial ablation, but insurance coverage does vary throughout the country. My experience suggests that performing the procedure in the office costs about $2,000 less than in the hospital.

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