***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: The aim of this study was to evaluate the efficacy , safety and acceptability of two monthly transcervical applications of quinacrine 252 mg and ibuprofen 55.5 mg as pellets for non-surgical female sterilization . From August 1992 through October 1996 , a prospect i ve clinical study was conducted on 200 normal women seeking surgical sterilization voluntarily in the Family Planning Clinic of the Department of Obstetrics and Gynecology , Regency Hospital , Wonosobo , Central Java , Indonesia .  Quinacrine 252 mg and ibuprofen 55.5 mg were inserted transcervically , as pellets , using a Copper T IUD insertor in the proliferative phase of two consecutive menstrual cycles . The women were followed up 6 , 12 , 24 and 48 months after insertion . There were no major complications during the insertion procedures , and side-effects which occurred during the us e of the methods were transient . Cumulative life-table continuation rate per 100 women at four years was 0.91±0.02 ( SE ) . The pregnancy fail ure rate was 0.04 or 4.3 % . The results of this study indicate that intrauterine insertion of quinacrine pellets is a safe , acceptable and effective method of non-surgical female sterilization Objective To compare patient satisfaction , discomfort , procedure time , success rate and adverse events of  hysteroscopic  ( ESSURE , Conceptus Inc , San Carlos , USA ) versus laparoscopic sterilisation Approximately 200 women of American Society of Anesthesiologists class I and II physical status electing outpatient laparoscopic tubal sterilization with Yoon rings  were involved in a double-blind study to evaluate postoperative pain relief after intraoperative suprapubic infiltration of the fallopian mesosalpinx . The postoperative pain levels were lower after bilateral infiltration of 0.5 % bupivacaine beneath the site of ring application . Postoperative , suprapubic infiltration provided safe , prolonged and effective pain relief , allowed prompt ambulation and early discharge , and reduced the need for narcotic analgesics and postoperative analgesia 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 the reliability of pelvic X-ray and transvaginal ultrasound to localize Essure microinserts ( Conceptus , San Carlos , California ) after successful placement in both fallopian tubes 3 months after placement . DESIGN Prospect i ve , observational study . SETTING Gynecology departments at two teaching hospitals . PATIENT(S ) One hundred eighty-two patients who underwent hysteroscopic sterilization by placement of Essure microinserts between August 2002 and August 2004 . INTERVENTION(S ) Transvaginal ultrasound , pelvic X-ray , and hysterosalpingography ( HSG ) 3 months after sterilization with Essure . MAIN OUTCOME MEASURE(S ) Transvaginal ultrasound confirmation of correct localization of microinserts after a 3-month follow-up . RESULT ( S ) In 150 of 182 patients , confirmation of successful bilateral placement of two microinserts ( 300 devices ) was possible . In 9 patients it was not possible to identify both devices with ultrasound , or there was doubt about the extension of the device through the uterotubal junction . The other 291 devices were identified as being in a good position . CONCLUSION ( S ) Hysterosalpingography at the 3-month follow-up after successful placement of Essure microinserts can be replaced by transvaginal ultrasonography . A 3-month follow-up with HSG after the Essure procedure is only required after unsatisfactory placements . In those patients in whom transvaginal ultrasonography can not confirm satisfactory localization , a complementary pelvic X-ray should be performed 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 The present study examines the safety , effectiveness , and local tissue response for a new transcervical fallopian tube permanent contraceptive device , the STOP device ( Conceptus , Inc. , San Carlos , CA ) . DESIGN Nonr and omized prospect i ve evaluation of tubal occlusion and histologic response . SETTING Inpatient , university and university-affiliated medical centers in the United States and Mexico . PATIENT(S ) Premenopausal and perimenopausal women with benign indications for hysterectomy who were able to defer their hysterectomy for 1 to 13 weeks . INTERVENTION(S ) A transcervically placed microcoil ( STOP device ) was inserted into the fallopian tubes of women who were scheduled for hysterectomy , and the device was worn for 1 to 12 weeks . At hysterectomy , hysterosalpingography was done to determine tubal occlusion ; subsequently , the tubes containing the STOP devices were processed , sectioned , and evaluated to determine the histologic response . MAIN OUTCOME MEASURE(S ) Ability to place a device and evaluate tubal occlusion and tissue response . RESULT ( S ) Devices were placed in 33 women , representing 57 tubes ; the women wore the devices from 1 day to 30 weeks . Histology on 27 women ( 47 tubes ) showed an acute inflammatory and fibrotic response in the short term that , over time , became a chronic inflammatory response with extensive fibrosis . CONCLUSION ( S ) The localized tissue response and notable absence of any normal tubal architecture in the segment of the fallopian tube containing the STOP device supports the postulated mechanisms of action of the device . Prehysterectomy study findings suggest the usefulness of the STOP device for pregnancy prevention , this is being evaluated in long-term safety and effectiveness studies 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 Self-reported postoperative pain was reduced significantly ( P less than .05 ) for up to six hours in a group of ambulatory surgical patients with the application of 5 mL of 1 % etidocaine to the b and ed portion of each fallopian tube after laparoscopic tubal ligation with Falope Rings  in comparison to a control group receiving normal saline . The etidocaine group had less nausea and vomiting and smaller antiemetic and analgesic requirements than did the control group , though those results were not statistically significant Objective To compare objective ly the pain associated with tubal occlusion by Silastic rings versus electrocoagulation during laparoscopic tubal ligation under local anesthesia . Methods Consecutive patients scheduled for laparoscopic tubal ligation under local anesthesia were  r and omized  to Silastic rings ( N = 50 ) or electrocoagulation { N = 52 ) as the method of tubal occlusion . Sterilization was performed under local anesthesia in a st and ard fashion . Bupivacaine 0.5 % was used as the local anesthetic agent . Operative pain was measured based on intraoperative anesthesia requirements and a modified McGill pain question naire . This question naire was used to assess pain at 15 minutes , 1 hour , and 24 hours postoperatively . Results Demographics were similar for the two groups .  Operative time was shorter in the Silastic – ring group ( 16.7 versus 21.8 minutes ; P = .001 ) , and this group also required less intra 
    Output:
    
Electrocoagulation was associated with less morbidity including post-operative pain when compared with the modified Pomeroy and tubal ring methods , despite the risk of burns to the small bowel .
The small sample size and the relative short period of follow-up in these studies limited the power to show clinical or statistical differences for rare outcomes such as failure rates .