***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 compare patient satisfaction , discomfort , procedure time , success rate and adverse events of  hysteroscopic  ( ESSURE , Conceptus Inc , San Carlos , USA ) versus laparoscopic sterilisation 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 STUDY OBJECTIVE To compare hysteroscopic female sterilization procedures performed in-office versus a hospital operating room ( OR ) among newly trained physicians . DESIGN Multisite hospital operating rooms and physician offices . PATIENTS Women desiring permanent hysteroscopic sterilization . INTERVENTION Hysteroscopic female sterilization with the Essure system . MEASUREMENTS AND MAIN RESULTS Procedure time ( scope in/scope out time ) , device placement rates , and incidence of complications and adverse events were compared . There was no significant difference in scope time between the 2 setting s. There was no significant difference in placement rates , although the placement rate was somewhat higher in-office ( 91 % vs 88 % ) . There were no complications among any of the procedures , and the incidence of minor adverse events was extremely low in both setting s ( OR=2 % , in-office=1 % ) . CONCLUSION There is no clear advantage to performing hysteroscopic sterilization in a hospital OR . Hysteroscopic sterilization can be performed safely and efficiently in an office setting OBJECTIVE : To estimate the efficacy of paracervical block compared with saline for pain relief during office hysteroscopic sterilization . METHODS : This study was a r and omized , placebo-controlled study of women desiring hysteroscopic sterilization . A paracervical block of 1 % lidocaine or normal saline was administered before office hysteroscopic sterilization . Patients and investigators were blinded to assignments . A pre hoc power analysis determined that 40 women would be required per arm to detect a difference of 0.9 cm on a visual analog scale . Pain was recorded on a visual analog scale at multiple procedure time points . Individualized st and ardized pain scores were constructed by weighted reporting of objective and subjective sensation . RESULTS : A total of 103 consecutive women were eligible , and 80 women were r and omized , with 40 per group . Thirty-seven ( 93 % ) in each group had successful placement . The lidocaine group showed significantly lower pain scores for tenaculum placement ( mean±st and ard deviation : 0.97±1.28 compared with 3.00±2.41 , P<.001 ) traversing the external cervical os ( 1.46±1.71 compared with 3.77±2.68 , P<.001 ) and internal os ( 1.79±2.11 compared with 4.10±2.77 , P<.001 ) . There was no significant observed difference with device placement in tubal ostium ( 3.15±2.69 compared with 3.74±2.73 , P=.33 ) . Multivariable linear regression analysis demonstrated a relationship of pain to procedural time ( P=.047 ) and to group assignment ( P<.01 ) . CONCLUSION : Paracervical block with 1 % lidocaine provides effective pain relief for cervical manipulations during office hysteroscopic sterilization , but does not reduce the pain associated with upper uterine/tubal manipulation when placing the devices . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00811187 . LEVEL OF EVIDENCE : OBJECTIVE To evaluate the results of hysteroscopic placement of an intratubal device for permanent birth control in 85 women in an outpatient setting . DESIGN Prospect i ve , observational study . SETTING Private university hospital . PATIENT(S ) Eighty-five premenopausal women who asked for tubal sterilization by hysteroscopy between July 2002 and July 2003 . INTERVENTION(S ) Hysteroscopic placement of titanium-dacron intratubal devices in an outpatient setting . MAIN OUTCOME MEASURE(S ) Procedure feasibility without anesthesia , success rate of device implantation , patient satisfaction , and confirmation of correct placement . RESULT ( S ) Successful placement was achieved in 81 patients ( 95 % ) . Mean time elapsed between the start of hysteroscopy , placement of devices , and removal of optics was 9 minutes ( range , 1 - 35 minutes ) . No intraoperative or postoperative complications were detected . Of 81 patients , 75 ( 93 % ) had  abdominal x-ray performed  at the third month ; bilateral correct placement was confirmed in all of them . CONCLUSION ( S ) Essure is a safe , effective , and minimally aggressive procedure with satisfactory patient acceptance that does not require anesthesia or hospitalization . It seems to be a good alternative to laparoscopic tubal sterilization Objective To estimate the risk of intraoperative or postoperative complications for  interval laparoscopic tubal sterilizations .  Methods We used a prospect i ve , multicenter cohort study of 9475 women who had interval laparoscopic tubal sterilization  to calculate the rates of intraoperative or postoperative complications . The relative safety of various methods was assessed by calculating overall complication rates for each major method of tubal occlusion . Method -related complication rates also were calculated and included only complications attributable to a method of occlusion . We used logistic regression to identify independent predictors of one or more complications . Results When we used a more restrictive definition of unintended major surgery , the overall rate of complications went from 1.6 to 0.9 per 100 procedures . There was one life-threatening event and there were no deaths . Complications rates for each of the four major methods of tubal occlusion ranged from 1.17 to 1.95 , with no significant differences between them . When complication rates were calculated , the spring clip method had the lowest method -related complication rate ( 0.47 per 100 procedures ) , although it was not significantly different from the others . In adjusted analysis , diabetes mellitus ( adjusted odds ratio [ OR ] 4.5 ; 95 % confidence interval [ CI ] 2.3 , 8.8 ) , general anesthesia ( OR 3.2 ; CI 1.6 , 6.6 ) , previous abdominal or pelvic surgery ( OR 2.0 ; CI 1.4 , 2.9 ) , and obesity ( OR 1.7 ; CI 1.2 , 2.6 ) were independent predictors of one or more complications . Conclusion Interval laparoscopic sterilization generally is a safe procedure ; serious morbidity is rare STUDY OBJECTIVE To compare the pain reported by patients during the Essure Micro-Insert sterilization procedure  using either intravenous conscious sedation or oral analgesia . DESIGN R and omized , double-blind , placebo-controlled trial ( Canadian Task Force classification I ) . SETTING Tertiary care ambulatory women 's clinic . PATIENTS Eighty women of reproductive age women requesting permanent sterilization . INTERVENTION Hysteroscopic placement of the Essure Micro-Insert permanent birth control system . MEASUREMENTS AND MAIN RESULTS Patients undergoing placement of the Essure Micro-Insert system for permanent contraception were r and omized to receive either intravenous conscious sedation , oral analgesia , or placebo . During the procedure , pain scores were recorded using a visual analog scale . Patients in the oral analgesia group reported slightly more pain during insertion of the hysteroscope and placement of the second micro-insert ; the groups were otherwise equivalent . They were also equivalent when all visual analog scale scores were combined . CONCLUSION Oral analgesia is an effective method of pain control during placement of the Essure Micro-Insert permanent birth control system OBJECTIVE To assess pain and patient satisfaction with office-based hysteroscopic sterilization .  DESIGN This prospect i ve , observational study was design ed to assess patient pain perception and satisfaction with  office-based hysteroscopic sterilization  using the Essure device ( Conceptus , Mountain View , CA ) . SETTING Faculty practice office at an inner-city urban medical center . PATIENT(S ) Women seeking hysteroscopic sterilization . INTERVENTION(S ) Office hysteroscopic sterilization under local anesthesia . MAIN OUTCOME MEASURE(S ) Pain assessed at the time of the procedure by a 0 - 10 visual scale and satisfaction by a 1 - 5 scale . RESULT ( S ) From June 2003 to June 2006 , 209 patients were recruited . The mean scores for average procedural pain , most procedural pain , and average menstrual pain were 2.6+/-2.1 , 3.3+/-2.5 , and 3.6+/-2.6 , respectively . St and ardized pain scores revealed that 149 subjects ( 70 % ) experienced average pain that was less than or equal to the pain experienced with their menses . Mean satisfaction rating for the procedure was 4.7+/-0.71 . CONCLUSION ( S ) Office-based hysteroscopic sterilization performed with local anesthesia alone is well tolerated , and patients are satisfied with this method for permanent sterilization Objective To compare becteriostatic saline and buffered lidocaine for cervical anesthesia to blunt the reported pain during brief suction curettage . Methods A double-blind r and omized clinical trial was conducted on women presenting for pregnancy termination procedures . Participants received either paracervical submucosal injections of bacteriostatic saline or 1 % buffered lidocaine just before cervical dilation . Self-reported pain intensity was assessed at three time points during and 30 minutes after the procedure . Results Fifty-two of 135 eligible women presenting for pregnancy termination procedures participated in the study . Pain intensity ratings in lidocaine and saline treatment subjects did not differ significantly at any point . Our study had a power of .094 to detect more than a 15 % difference on the 21-point box scale between the two solutions . Only one patient requested her block be repeated , and she had received lidocaine originally . Furthermore , of those women receiving lidocaine , 11 
    Output:
    
The available literature is insufficient to determine the appropriate analgesia or anesthesia for sterilization by hysteroscopy .
Compared to paracervical block with normal saline , paracervical block with lidocaine reduced pain during some portions of the procedure .
Intravenous sedation result ed in lower pain scores during insertion of the second tubal device .
However , neither paracervical block with lidocaine nor conscious sedation significantly reduced overall pain scores for sterilization by hysteroscopy