Two Surgical Approaches to the Removal of the Essure Contraceptive Device

Abstract

Study Objective We first review the Essure contraceptive device composition in order to aid in the understanding of proper removal. We present two safe and effective techniques for Essure removal and demonstrate the importance of individualizing and modifying the surgical approach based on intraoperative findings. Design Video presentation of techniques of Essure removal. Setting An ambulatory surgery center associated with an urban academic medical center. Patients or Participants Demonstration of presented techniques in a 35-year-old multiparous patient with bilateral Essure device in place for five years, complaining of pelvic pain and dyspareunia, desiring removal of the device. Interventions Laparoscopically, the Essure device was palpated in the right fallopian tube and a salpingostomy was created, revealing the Essure coils. The device was grasped and taking care to stabilize the proximal tube and avoid excess traction, the coils were extracted until all parts were accounted for. Attention was then turned to the left fallopian tube; the Essure device was not palpable and thus the decision was made to proceed with hysteroscopic removal. Hysteroscopically, the device was seen at the left tubal ostia and using grasping forceps the Essure device was removed from the tube. All components of the Essure device were accounted for and complete removal was ensured. Measurements and Main Results N/A Conclusion Successful removal of the Essure contraceptive device may be performed by a laparoscopic or hysteroscopic approach. The choice of technique may need to be modified based on surgical intraoperative findings. Therefore, familiarity with various surgical approaches in addition to knowledge of the structure of the Essure device is critical to ensure complete removal.