Nonpalpable implant removals at centre of experience in France: a cohort study

Abstract

Objective(s)

Management and localisation strategies to remove nonpalpable contraceptive implants may be difficult. We aimed to evaluate our imaging modalities to identify deep implant and patient outcomes related to removal.

Study design

In this retrospective study, we reviewed all cases referred to our specialised centre for nonpalpable contraceptive implants from January 2018 to August 2022.

Results

Out of the cohort studied, 47 female subjects exhibited nonpalpable implants. The implant was nonpalpable for thirty-six patients (76,6%) immediately after the insertion whereas it was not palpable several months after the insertion for eleven patients (23.4%). Twelve patients (25.5%) had one or more failed removal attempts before referral.

All 47 implants were successfully visualised via ultrasound in the upper arm: 40 implants (85.1%) were located in the subdermal tissue, 4 (8.5%) were intrafascial and 3 (6.4%) were intramuscular. Depth of the implant was 4.0 mm [1.7 − 12.0]. No clinical factors were statistically associated with differences in depth or location (subdermal vs subfascial). Removal procedures were mainly under local anaesthesia in 74.5% of cases in an outpatient setting. There were two Clavien-Dindo grade 1 complications (one case of cutaneous scar dehiscence and one transient postoperative neuropathic complaint in the upper arm resolved within 3 months under analgetics)

Conclusions

Identification of deep implants requires following the ultrasound modality protocol. Ultrasound detection makes easy and safe implant removal. Training programs for the insertion as well as for the removal of correct and incorrect inserted implants should be continued and developed all around the world.

摘要

目的

管理和定位不可触及的避孕植入物可能存在困难。我们旨在评估使用影像学方法识别深层植入物的效果, 并分析与取出相关的患者结果。

研究设计

在这项回顾性研究中, 我们回顾了2018年1月至2022年8月期间转诊至我们不可触及避孕植入物专业中心的所有病例。

结果

在研究的队列中, 47名女性受试者存在不可触及的植入物。36名患者(76.6%)在植入后立即无法触及植入物, 而11名患者(23.4%)在植入数月后无法触及植入物。12名患者(25.5%)转诊前曾1次或1次以上移除失败。47枚植入物均在上臂超声下成功显影: 40个植入物(85.1%)位于皮下组织, 4个(8.5%)位于筋膜内, 3枚(6.4%)位于肌肉内。植入物深度为4.0 mm [1.7 ∼ 12.0]。没有临床因素与深度或位置(皮下与筋膜下)差异具有统计学意义。门诊手术中74.5 %的病例以局部麻醉为主。Clavien-Dindo 1级并发症2例, (1例皮肤瘢痕裂开, 1例术后上臂一过性神经病理性疼痛,经镇痛3个月后缓解)。

结论

深部植入物的识别需要遵循超声模态方案。超声检测使植入物取出变得简单、安全。应在世界各地继续开展和发展有关植入的培训方案, 以及关于正确和不正确植入物的移除的培训方案。

Keywords:

• Nexplanon® removal
• etonogestrel implant
• localisation
• ultrasound
• contraceptive implant

ClinicalTrials.gov identifier

NCT05932537

Disclosure statement

G. Chene has served as consultants and members of advisory boards for Organon. The other authors (P. Akl, A. Gjorgjievska-Delov, E. Cerruto, S. Morret, E. Nohuz) declare no conflict of interest to disclose.

Data availability statement

Data are available upon reasonable request.