Surgical Management for Removal of Essure Device

Abstract

Video Objective To present two surgical cases of laparoscopic removal of Essure hysteroscopic sterilization device via salpingectomy with and without cornuectomy. Setting One 37-year-old woman with heavy menstrual bleeding, joint pain, and fatigue reported by rheumatology to have a nickel allergy who desired Essure removal and one 51-year-old woman with pelvic pain and multiple co-morbidities who desired Essure removal. Both patients underwent surgical management for the removal of Essure at an academic medical center. Interventions In this surgical video, we present two cases of women desiring Essure implant removal secondary to adverse effects from the device. The first case describes the step by step approach to removal of an intact Essure implant by laparoscopic salpingectomy. The second case describes an approach to removal of Essure by salpingectomy with cornuectomy which is particularly helpful when the endometrial cavity has been previously ablated as in second case, or if there was a complicated insertion with perforation. Additionally, we describe the Essure implant composition in detail, describing how intact removal is imperative as fracturing of the device may lead to further complications or adverse effects. Conclusion Laparoscopic salpingectomy with and without cornuectomy are safe and effective procedures for the intact removal of Essure and are feasible alternatives to hysterectomy for women who desire removal of Essure.