ABSTRACT
OBJECTIVE: Since 2002, Conceptus company markets in France and Europe the Essure microinsert as permanent hysteroscopic intratubal sterilization, and organizes a meeting, a training and an assistance on a few cases. The data from this interview and the results of the first cases done with assistance of Conceptus instructors were collected prospectively between January 2004 to December 2006. The purpose is to make a state of the art about teaching hysteroscopy to gynaecologist surgeons in France and in Europe. PATIENTS AND METHODS: According to their statements about their knowledge of hysteroscopy practice, surgeons were classified in four groups. Group 1 included those who had a bad knowledge and a sporadic practice, group 2 those who had no formation and an empirical practice, group 3 those who had a regular practice and an incomplete formation or whose formation was in progress and group 4 those with fully-formed surgeons with a regular practice. RESULTS: One thousand one hundred and fourty-four women underwent hysteroscopic sterilisation with a global success rate of 92.13%. Were included 536 surgeons and 498 were evaluated. There were 80 (16.06%) surgeons in group 1, 149 (29.92%) in group 2, 121 (24.30%) in group 3 and 148 (29.72%) in group 4. Failure rates for each group were respectively 16.25%, 10.07%, 9.10% and 4.73% (p < or = 0.01). The presence of an instructor was associated with a fast improvement judging from the classification in a higher level group in 47.83%, 28.21% and 25% respectively for the groups 1 to 3 after the second visit and in 75%, 58.33% and 20% after the third visit. DISCUSSION AND CONCLUSION: It seems important to establish a modern and low-cost teaching program to improve surgeon's theoretical and practical formation in hysteroscopy in order to increase success rates and reduce possible complications. Theoretical formation has to include a good knowledge of the material and its use: diameter and form of the operative channel, obliquity of the scope, liquid of distension and kind of current used. Practical formation could be done at once with virtual models to get used with the manipulation of the scope and thanks to the use of different currents with the assistance of a trained surgeon.