***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the safety , effectiveness , and reliability of a tubal occlusion microinsert for permanent contraception , as well as to document patient recovery from the placement procedure and overall patient satisfaction . METHODS A cohort of 518 previously fertile women seeking sterilization participated in this prospect i ve , phase III , international , multicenter trial . Microinsert placement was attempted in 507 women .  Microinserts were placed bilaterally into the proximal fallopian tube lumens under hysteroscopic visualization in outpatient procedures . RESULTS Bilateral placement of the microinsert was achieved in 464 ( 92 % ) of 507 women . The most common reasons for failure to achieve satisfactory placement were tubal obstruction and stenosis or difficult access to the proximal tubal lumen . More than half of the women rated the average pain during the procedure as either mild or none , and 88 % rated tolerance of device placement procedure as good to excellent . Average time to discharge was 80 minutes . Sixty percent of women returned to normal function within 1 day or less , and 92 % missed 1 day or less of work . Three months after placement , correct microinsert placement and tubal occlusion were confirmed in 96 % and 92 % of cases , respectively . Comfort was rated as good to excellent by 99 % of women at all follow-up visits . Ultimately , 449 of 518 women ( 87 % ) could rely on the microinsert for permanent contraception . After 9620 woman-months of exposure to intercourse , no pregnancies have been recorded . CONCLUSION This study demonstrates that hysteroscopic interval tubal sterilization with microinserts is well tolerated and results in rapid recovery , high patient satisfaction , and effective permanent contraception OBJECTIVE To evaluate women 's satisfaction and tolerance of hysteroscopic sterilization .  DESIGN Prospect i ve analysis of case series . SETTING Gynecology department in a teaching hospital . PATIENT(S ) A total of 1,630 women who underwent hysteroscopic sterilization by placement of Essure microinserts ( Conceptus , Inc. , Mountain View , CA ) from January 2003 to June 2006 . INTERVENTION(S ) Transvaginal ultrasound examination , pelvic x-ray examination , and hysterosalpingography 3 months after sterilization with Essure microinserts .  Satisfaction was assessed by a visual analog scale . Adverse effects and tolerance also were recorded . MAIN OUTCOME MEASURE(S ) Transvaginal ultrasound and pelvic x-ray confirmation of correct localization of microinserts and patient 's satisfaction and tolerance after a 3-month follow-up . RESULT ( S ) The rate of successful insertion was 99 % . Most of women returned to their daily activities on the same day of insertion , and 86.5 % considered the procedure painless or scarcely painful . All the patients were highly satisfied after hysteroscopic sterilization : 91 % of subjects by visual analog scale ( on a 0 to 10 scale ) rated the method at 10 ( high satisfaction degree ) , and none of the subjects rated it under 8 . For patients , the most valuable aspects of the procedure were absence of surgery room ( 52.7 % ) , method 's quickness and comfort ( 19.9 % ) , and permanent sterilization ( 18.2 % ) . More than 97 % of the patients said that they would recommend the procedure to others . CONCLUSION ( S ) This study provides evidence that Essure microinserts can be placed in a usual gynecologic consultation room in st and ard conditions without any type of anesthesia or sedation and are associated with great overall patient satisfaction . Women also have high tolerance for the procedure and describe minor postoperative pain OBJECTIVE To determine the feasibility and patient satisfaction of female sterilisation using the Essure system in an outpatient hysteroscopy clinic without conscious sedation or general anaesthesia . DESIGN Prospect i ve cohort study . SETTING Outpatient hysteroscopy clinic in a large teaching hospital . POPULATION Women undergoing outpatient hysteroscopic sterilisation using the Essure system for permanent fertility control . METHODS Demographic and procedural data were prospect ively collected from 112 consecutive women undergoing outpatient hysteroscopic sterilisation without sedation or general anaesthesia .  A hysterosalpingogram ( HSG ) was performed routinely in all women 3 months after the procedure to confirm bilateral tubal occlusion . Postal question naires were sent at this time enquiring about patient satisfaction and experience with the outpatient procedure . Multivariable logistic regression was used to identify factors independently predictive of successful completion of the procedure . MAIN OUTCOME MEASURES Technical feasibility , predictive factors for technical success ( operator , body mass index , uterine size , axis , menstrual phase and cervical stenosis ) , complications , tubal occlusion on HSG , patient satisfaction and procedure-related experience . RESULTS Successful bilateral tubal placement of the Essure microinserts  was achieved in 103/112 ( 92 % , 95 % CI 85 - 96 % ) women . Nonsecretory phase of the menstrual cycle ( P = 0.04 ) and a clinical ly normal-sized uterus ( P = 0.003 ) were independently predictive for successful completion of the outpatient procedure on multivariable modelling . There were no major procedure-related complications recorded , but transient vasovagal reactions occurred in 5/112 ( 5 % ) women . Of the original cohort of 112 women with successful procedures , 84 women were 3 months postprocedure and had undergone a HSG . Bilateral tubal occlusion was confirmed in 83/84 ( 99 % , 95 % CI 94 - 100 % ) women at 3 months and in 100 % at 6 months . Seventy-six of 84 ( 91 % ) had returned the question naires , and 70/73 ( 96 % , 95 % CI 88 - 99 % ) were satisfied with their overall experience of the procedure including radiological follow up , with most reporting being ' very satisfied ' ( 64/73 , 88 % , 95 % CI 78 - 94 % ) . CONCLUSIONS Outpatient hysteroscopic sterilisation using the Essure system without sedation or general anaesthesia is a successful and safe procedure associated with high rates of patient satisfaction . If practical , women should be scheduled to have their procedures in the proliferative phase of the menstrual cycle to optimise successful placement of Essure devices , especially if the uterus is clinical ly enlarged The use of multiple clips for the occlusion of the Fallopian tubes has been reported in interval laparoscopic sterilization , but the circumstances leading to the performance of the multiple-clip procedure and its effects on safety and efficacy have not been carefully studied . A data set from international multi-center clinical trials of Filshie clips and Wolf ( Hulka ) clips was used to examine the possible reasons for performing this procedure for 102 women . Their complications , complaints , and surgical and post-surgical events before discharge and during one month of follow-up were compared with those of the 408 women whose tubes were occluded by single clip .  Results indicate that multiple clips were most often used when surgical difficulties ( and to a much lesser degree , tubal and /or mesosalpingeal injury ) were encountered during the sterilization procedure . No increased risk of short-term complications or complaints ( including pelvic pain ) was found at one-month follow-up for those patients who received multiple clips Background : Over 100,000 women worldwide have been sterilized by insertion of quinacrine into the uterus to induce tubal scarring . Concern has been expressed about possible carcinogenicity , and specifically the risk of uterine cancer . Methods : From 2001 through 2006 , we conducted a population -based , case – control study of gynecologic cancers in 12 provinces in northern Vietnam , where relatively large numbers of women had received quinacrine .  Cases of incident cervical , ovarian , and uterine cancer were identified at provincial hospitals or at referral hospitals in Hanoi . For each case , 3 age- and residence-matched controls were r and omly selected from the population registries of the case 's home community . Results : The prevalence of  quinacrine exposure was 1.2 % among cases and 1.1 % among controls . For cervical cancer , analysis of 606 cases ( 9 exposed ) and their 1774 matched controls ( 18 exposed ) produced an odds ratio of 1.44 ( 95 % confidence interval = 0.59–3.48 ) ( adjusted for several covariates including human papillomavirus risk score ) . For ovarian cancer , based on 262 cases ( 3 exposed ) and 755 controls ( 8 exposed ) and adjusted for age and number of years of ovulation , the odds ratio was 1.26 ( 0.21–5.45 ) . For uterine cancer , none of the cases — including 23 cases of leiomyosarcoma — was exposed to quinacrine . The 95 % confidence interval , based on 161 cases ( none exposed ) and 470 controls ( 7 exposed ) and adjusted only for age , was 0–1.85 . Conclusion : We found no evidence of a relationship between quinacrine sterilization and gynecologic cancer 
    Output:
    
RCTs of clips versus electrocoagulation contributed no data to the review .One year after sterilisation , failure rates were low ( < 5/1000 ) for all methods .There were no deaths reported with any method , and major morbidity related to the occlusion technique was rare .
Although technical failure occurred more frequently with clips ( Peto OR 0.18 , 95 % CI 0.08 to 0.40 ; participants = 2198 ; studies = 1 ; moderate- quality evidence ) ; operative time was shorter with clips than partial salpingectomy ( MD 4.26 minutes , 95 % CI 3.65 to 4.86 ; participants = 2223 ; studies = 2 ; I² = 0 % ; high- quality evidence ) .We found little evidence concerning women 's or surgeon 's satisfaction .
Tubal sterilisation by partial salpingectomy , electrocoagulation , or using clips or rings , is a safe and effective method of contraception .
Failure rates at 12 months post-sterilisation and major morbidity are rare outcomes with any of these techniques .
Minor complications and technical failures may be more common with rings than clips .
Electrocoagulation may be associated with less postoperative pain than the modified Pomeroy or tubal ring methods .