Essure is designed as a hysteroscopically placed permanent birth control. Removal of the Essure microinsert can be a technically challenging procedure. Requests for removal are uncommon but do occur. Although hysteroscopic and laparoscopic removal has been reported, there is limited information available describing appropriate surgical technique.
There have been six patients requesting Essure removal at our institution (one approximately 2 years after placement). Based on this experience, we have developed specific counseling points and surgical principles for laparoscopic removal: avoid injection of a hemostatic solution into the fallopian tube; avoid excessive traction on the coils; avoid cauterization of the outer coil; follow the Essure coil into the interstitial end of the fallopian tube to ensure complete removal of the insert; perform a salpingectomy rather than a salpingostomy.
By taking into account these principles, key preoperative counseling points can be discussed, and laparoscopic Essure removal years after placement can be accomplished in a safe and deliberate fashion.
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Published online: January 04, 2013
Accepted: November 26, 2012
Received in revised form: November 26, 2012
Received: July 16, 2012
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.