Laparoscopic salpingectomy and removal of Essure hysteroscopic sterilisation device: a case series

Abstract

Objectives: Tubal sterilisation using Essure is a minimally invasive technique for permanent contraception, with high rates of patient satisfaction. However, some women subsequently choose removal of the inserts, due to side effects such as pelvic pain, abnormal bleeding, dyspareunia or allergic dermatitis. This case series presents the management of eight women who underwent laparoscopic removal of Essure inserts in conjunction with salpingectomy. We describe our surgical technique, its underlying principles and immediate surgical outcomes.

Methods: Eight patients were identified as having undergone removal of Essure inserts, via an electronic search of the surgical procedures database. A retrospective review of case records was undertaken. The primary outcome was safety and feasibility of the laparoscopic salpingectomy approach. Secondary outcome measures included implant fracture rate, operative time, blood loss and length of patient stay.

Results: All eight women were able to undergo laparoscopic salpingectomy and removal of the Essure inserts without the need for laparotomy or hysterectomy. There were no incidences of fracture or incomplete removal of the insert. Immediate postoperative recovery was uncomplicated in all eight women; the mean length of stay was 17 h. One patient had a small bowel serosal tear attributed to laparoscopic entry.

Conclusion: This case series suggests that laparoscopic salpingectomy for removal of Essure inserts is safe and feasible. We acknowledge that the numbers were small. However, consistent use of a laparoscopic approach in these eight patients indicates that this procedure is a feasible and suitable alternative to hysterectomy.

摘要：

目的:使用Essure进行输卵管绝育是一种微创的永久性避孕技术, 患者满意度很高。然而, 由于盆腔疼痛、异常出血、性交困难或过敏性皮炎等副作用, 一些女性随后选择切除植入物。本病例系列介绍了8例妇女的治疗方法, 她们在输卵管切除术的同时进行了腹腔镜下Essure植入物切除术。我们描述了我们的手术技术, 其基本原理和即时的手术结果。

方法:通过对外科手术程序数据库的电子检索, 确定8例患者接受了Essure植入物的切除。对病例记录进行回顾性审查。主要结果是腹腔镜输卵管切除术的安全性和可行性。次要结果指标包括植入物骨折率、手术时间、失血量以及病人的住院时间。

结果:8例女性均能进行腹腔镜下输卵管切除手术并切除Essure植入物, 无需开腹或子宫切除术。没有发生骨折或不完全切除植入物的情况。所有8例患者术后即刻恢复, 情况并不复杂;平均住院时间为17小时。一名患者因腹腔镜入路出现小肠浆膜撕裂。

结论:本组病例表明腹腔镜下输卵管切除术用于切除Essure植入物是安全可行的。我们承认这个数字很小。然而在这8名患者中均使用腹腔镜的方法,表明该手术是一种可行的、合适的子宫切除术的替代方案。

Keywords:

• Essure
• hysteroscopic sterilisation
• laparoscopic salpingectomy
• removal

Disclosure statement

No potential conflict of interest was reported by the authors.