Hysteroscopic sterilization: away with the laparoscope?

In a review of the literature the history, present state of the art and possible future developments of hysteroscopic sterilization is given. In the Netherlands two systems are now available: Ovabloc® and Essure®. Although not yet as extensively evaluated as laparoscopic sterilization the pregnancy rate does not seem to be higher and the (major) complication rate appears to be significantly lower. According to this review hysteroscopic sterilization is an attractive alternative method of sterilization and is probably clearly indicated in cases of (relative) contra-indications to laparoscopy: obesity, intra-abdominal adhesions, haemorrhagic diathesis and cardiopulmonary disease. As long as X-rays are still advised in hysteroscopic sterilization techniques, this requirement remains the main disadvantage when compared with the laparoscopic approach, but otherwise one could indeed conclude: away with the laparoscope in sterilization!