Is laparoscopic sterilisation an anachronism?
Article first published online: 11 OCT 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 119, Issue 12, pages 1545–1546, November 2012
How to Cite
Moss, E., Hirschowitz, L. and Singh, K. (2012), Is laparoscopic sterilisation an anachronism?. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 1545–1546. doi: 10.1111/j.1471-0528.2012.03488.x
- Issue published online: 11 OCT 2012
- Article first published online: 11 OCT 2012
- Accepted 4 July 2012.
We read with interest the recent study by Povedano et al.,1,2 and accompanying commentary by Clark, regarding the outcome of the Essure® sterilisation system. The authors of the study should be congratulated for their work, which clearly shows that outpatient hysteroscopic sterilisation is an effective technique associated with low postoperative morbidity. We would, however, like to highlight an important aspect omitted from Mr Clark’s commentary on the future direction of female sterilisation, namely that of the mounting evidence that high-grade serous ‘ovarian’ cancers are likely to be tubal in origin. An inverse relationship between ovarian cancer and tubal ligation was reported 20 years ago,3 and over the past decade there is increasing evidence identifying tubal epithelium as the likely site of origin of the most common and lethal subtype of ovarian cancer, high-grade serous carcinoma.4 The survival from ovarian cancer has altered little over the past three decades, despite the introduction of many new chemotherapeutic agents, refinement of surgical techniques and concerted efforts for early diagnosis. Screening, either in general or high-risk populations, has yet to be shown to be effective,5 and as such primary prevention must remain our key aim. Indeed, in British Columbia a more radical approach is being taken with a campaign for bilateral salpingectomy to be performed as the method of choice of sterilization, rather than tubal ligation, with the aim of reducing the incidence of high-grade serous carcinoma by removing the site from which most ovarian cancers originate.6 Although we accept that this approach is controversial and would be associated with greater operative morbidity, as compared with an outpatient hysteroscopic sterilisation, we feel that consigning the laparoscopic sterilisation to history in favour of a hysteroscopic approach because of the short-term advantages may have unforeseen long-term consequences. In women’s health it is important that changes in practice are not taken in isolation without considering possible future implications, and we would advise that long-term follow up data on all women undergoing this new sterilisation procedure would be essential so that any effect on the incidence of ovarian cancer can be detected at the earliest opportunity.
- 6British Columbia Cancer Agency. Ovarian cancer researchers request practice changes to protect against ovarian cancer (deaths could be reduced by 50 percent over 20 years). 2010 News http://www.bccancer.bc.ca/ABCCA/NewsCentre/NewsArchive/2010-News-Releases/Ovarian+cancer+researchers+request+practice+changes+to+protect+against+ovarian+cancer.htm;2010. Accessed 30 June 2012.