Surgical techniques for the removal of Essure^® microinserts: a literature review on current practice

Abstract

Purpose

To evaluate the different techniques for Essure^® microinserts removal and to assess the risk of fracture of the device and the intra- and post-operative complications in relation to surgical technique variants

Methods

Electronic search in Medline, Scopus and Embase databases using the following keywords: Essure; Essure removal; Essure surgical technique.

Results

Out of 95 articles in the initial database, 17 studies were eligible for inclusion in our literature review. Several surgical techniques have been described in which the most frequent were laparoscopic salpingectomy (LS), laparoscopic cornuectomy (LC), laparoscopic or vaginal hysterectomy (LH, VH) with en-bloc salpingectomy. There were more fractures of the device with the LS procedure (6.25%) followed by the LC technique (2.77%), while there was no fracture with hysterectomy. However, peri-and post-operative complications were more severe and frequent with hysterectomy in comparison with the LC and LS procedures (respectively 8.1% Clavien Dindo grade 3 for the hysterectomy group, 1.11% for the LC procedure and 0.69% for the LS technique).

Conclusion

Due to the lack of standardised surgical treatment guidelines, a system of care networks for symptomatic patients with adverse effects related to Essure^® headed by specialised centres may offer a suitable and high-quality management with the appropriate removal techniques within two objectives: limiting the risk of fracture (with an en-bloc removal of the Essure^® microinserts) and avoiding intra- and post-operative complications.

移除Essure^®微型宫内节育器的手术技术：一篇关于当前实践的文献综述 摘要

目的：评估不同技术移除微型宫内节育器, 评估宫内节育器折断的风险以及与手术方式变化相关的术中和术后并发症

方法：在Medline、Scopus和Embase数据库中检索以下关键词：Essure；Essure移除；Essure手术方式。

结果：在初始数据库中的95篇文章中, 有17篇研究符合纳入我们的文献综述的条件。一些手术方式已经被描述, 其中最常见的是腹腔镜输卵管切除术(LS), 腹腔镜宫角切除术(LC), 腹腔镜或阴道输卵管子宫全切术(LH, VH)。LS手术后折断较多（6.25%）, LC技术后折断（2.77%）, 而子宫切除术后无折断。然而, 与LC和LS手术相比, 子宫切除术的术中和术后并发症更严重、更频繁(ClavienDindo3级分别为：子宫切除术组8.1% , LC手术为1.11%, LS术为0.69%)。

结论：由于缺乏标准化的手术治疗指南, 由专业中心牵头的针对与Essure^®相关的有不良反应患者的护理网络系统, 可提供合适的、高质量的管理, 并采用最合适的切除术, 实现两个目标：减少折断风险(整体取出Essure^®微型宫内节育器)和避免术中和术后并发症。

Keywords:

• Essure
• laparoscopy
• salpingectomy
• cornuectomy
• hysterectomy
• Essure removal
• surgical techniques

Disclosure statement

No potential conflict of interest was reported by the author(s).