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                                                                 EXHIBIT 10.9(d)

                            FOURTH AMENDMENT TO LEASE

THIS FOURTH AMENDMENT TO LEASE (hereinafter "Amendment") is made this ___ day of
August 2000, by and between McCANDLESS LIMITED, a California limited partnership
(Landlord") and NOVACEPT, a California corporation formerly known as Envision
Surgical Systems, Inc. ("Tenant").

                                    RECITALS

         A. Tenant currently leases from Landlord approximately eleven thousand
four hundred and sixty-one (11,461) square feet of space (the "Premises") of
which approximately eight thousand six hundred and fifty (8,650) square feet of
space is located at 1047 Elwell Court, Palo Alto, California (the "1047 Elwell
Space") and approximately two thousand eight hundred and eleven (2,811) square
feet of additional space is located at 1056 Elwell Court, Palo Alto (the "1056
Elwell Space") pursuant to that certain lease dated August 26, 1993 as amended
by the First Amendment To Lease dated July 8,1996, the Second Amendment To Lease
dated May 13, 1998 and the Third Amendment To Lease dated July 13, 1999
("Lease").

         B. The term of the Lease expires on August 31, 2000 and Tenant desires
to extend the term of the Lease for one additional month.

         C. Landlord is willing to so extend the term of the Lease on the terms
and conditions set forth herein,

NOW THEREFORE, in consideration of the above recitals and the mutual covenants
and agreements contained herein and other good and valuable consideration the
receipt and sufficiency of which are hereby acknowledged, the parties hereby
agree as follow:

         1. Term. The term of the Lease is hereby extended for one (1)
additional month, so that the term of the Lease shall extend to and include
September 30, 2000. The period commencing on September 1, 2000 and ending on
September 30, 2000 is referred to herein as the Fourth Extended Term.

         2. Basic Rent. Commencing on September 1, 2000, the monthly basic rent
as described in Paragraphs 4 (a) and 5 of the Lease shall increase from
$25,787.25 per month to $45,844.00 per month. The calculation for such increased
basic rent is reached by multiplying 11,461 square feet by $4.00 per square
foot.

         3. Common Area Charges. Tenant shall continue to pay its proportionate
share of common area charges as set forth in paragraphs 5 (b) and 16 of the
Lease and paragraph 5 of the Second Amendment To Lease.

         4. Brokers. Each party represents that it has not had any dealings with
any real estate broker, finder or other person with respect to this Amendment
and that there are no leasing commissions to be paid by Landlord or Tenant in
connection with this transaction. Each party hereto shall hold harmless the
other party from all damages, loss or liability resulting from any claims that
may be asserted against the other party by any broker, finder or other person
with whom such party has dealt, or purportedly has dealt, in connection with
this transaction.

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         5. Restatement of Other Lease Terms. Except as specifically modified
herein, all other terms, covenants and conditions of the Lease including
Tenant's obligation to pay common area charges, shall remain in full force and
effect.

IN WITNESS WHEREOF, the parties hereto have executed the Agreement as of the day
and year first above written.

                  LANDLORD:

                  McCANDLESS LIMITED,
                  a California limited partnership

                  By: /s/ [ILLEGIBLE]
                     -----------------------------
                  Sandra Simons, as Trustee under the Charles S. McCandless and
                  Jean A. McCandless Inter Vivos Trust Agreement dated January
                  25, 1977, a General Partner

                                     8-4-00
                           ---------------------------
                                     (Date)

                  TENANT:

                  NOVACEPT, a California corporation formerly known
                  as Envision Surgical Systems, Inc.

                  By: /s/ D. R. NATHE
                  --------------------------------------------------
                                    (Signature)

                      D.R. Nathe
                  --------------------------------------------------
                                   (Printed Name)

                      V.P. Operations
                  --------------------------------------------------
                                       (Title)

                                        8-4-00
                  --------------------------------------------------
                                        (Date)

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