Abstract
ObjectivesThe aim of this study was to assess the feasibility, performance, and complications of a non-surgical, minimally-invasive procedure of deep contraceptive implant removal under continuous ultrasound guidance.MethodsThe ultrasound-guided procedure consisted of local anesthesia using lidocaine chlorhydrate 1% (10 mg/mL) with a 21-G needle, followed by hydrodissection using NaCl 0.9% (9 mg/mL) and implant extraction using a Hartmann grasping microforceps. The parameters studied were the implant localization, success and complication rates, pain throughout the intervention, volumes of lidocaïne and NaCl used, duration of the procedure, and size of the incision. Between November 2019 and January 2021, 45 patients were referred to the musculoskeletal radiology department for ultrasound-guided removal of a deep contraceptive implant and were all retrospectively included.ResultsAll implants were successfully removed en bloc (100%). The mean incision size was 2.7 ± 0.5 mm. The mean duration of the extraction procedure was 7.7 ± 6.3 min. There were no major complications (infection, nerve, or vessel damage). As a minor complication, 21 patients (46.7%) reported a benign superficial skin ecchymosis at the puncture site, spontaneously regressing in less than 1 week. The procedure was very well-tolerated, with low pain rating throughout (1.0 ± 1.5/10 during implant extraction).ConclusionsMinimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, effective, and safe. In the present cohort, all implants were successfully removed, whatever the location, with short procedural time, small incision size, low pain levels, and no significant complications. This procedure could become a gold standard in this indication.Key Points• Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, which led to a success rate of 100% whatever the location (even close to neurovascular structures), with only a small skin incision (2.7 ± 0.5 mm).• The procedure was safe, quick, without any major complications, and very well tolerated in terms of pain.• This minimally invasive ultrasound-guided procedure could become the future gold standard for the removal of deep contraceptive implants, as an alternative to surgical extraction, even for implants in difficult locations such as subfascial ones or those close to neurovascular structures.
Highlights
In the USA and other western countries, hormonal implant is one of the main contraceptive methods, especially for 20–39-year-olds [1]
Invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, which led to a success rate of 100% whatever the location, with only a small skin incision (2.7 ± 0.5 mm)
Nineteen implants (42.2%) were located within 3 mm of a neurovascular structure (Fig. 4), without significant difference according to supra- or sub-fascial location (8 supra- versus 11 sub-fascial; p = 0.76)
Summary
In the USA and other western countries, hormonal implant is one of the main contraceptive methods, especially for 20–39-year-olds [1]. The percentage of women who have used it has more than doubled between 2002 (2.1%) and 2017 (5.6%) [2, 3] Worldwide, it is used by about 23 million women [4]. It is used by about 23 million women [4] It is one of the most effective means of contraception, with a Pearl index of 0.05 [5]. Nexplanon® is a flexible nonbiodegradable 4 cm × 2 mm rod containing 68 mg etonogestrel and radio-opaque barium sulfate [6], with a duration of 3 years. It should be inserted subcutaneously on the medial side of the upper arm. There have been cases of migration to pulmonary arteries via upper-limb veins [11,12,13]
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