Korean J Obstet Gynecol.  2010 Jun;53(6):506-511. 10.5468/kjog.2010.53.6.506.

Removal of non-palpable Implanon(TM) by ultrasound guidance

• Kim SY
• Huh JS
• Chang MY
• Hong Y
• Choi BR
• Baek JH
• Seo K

• KMID: 2273890
• DOI: http://doi.org/10.5468/kjog.2010.53.6.506

Abstract

OBJECTIVE
This study was designed to analyze outcome of removal of non-palpable Implanon(TM) by ultrasound guidance.
METHODS
This is retrospective study of patients who were referred from local clinic where removal of non-palpable Implanon(TM) had been failed. The cases were 32 patients who visited to Yonsei University Gangnam Severance Hospital between March 2004 through March 2009.
RESULTS
Implanons(TM) were localized on ultrasound in all 32 cases. 18 cases were located in subcutaneous layer, 10 cased were located in fascial layer, 4 cases were located in muscle layer. All cases were successfully removed. The average length of time required for removal was 19.3 minutes. There was no complication except one patient, who had mild median nerve injury.
CONCLUSION
Ultrasound guidance removal was safe and effective procedure to remove non palpable Implanon(TM).

Keyword

Removal of non-palpable Implanon(TM); Ultrasound guidance

MeSH Terms

Humans
Median Nerve
Muscles
Retrospective Studies

Figure

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  Figure 1 Locating an Implanon™ with lineal probe of ultrasound sonography and 22 G needle.

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  Figure 2 Injection of local anesthetic at site and insertion of 22 G long needle.

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  Figure 3 Skin incision and entry of forceps toward Implanon™.

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  Figure 4 Forceps removal of Implanon™ from the arm.

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  Figure 5 Implanon™ was seen just proximal to the incision site at deep subcutaneous layer. Implanon™ shows echogenic nature at deep subcutaneous layer near the axilla portion.

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  Figure 6 Implanon™ is located at muscular fascia.

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  Figure 7 Unusual thin small diameter tubular structures are noted at just superior aspect of muscular fascia area.

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  Figure 8 Longitudinal view of Implanon™ in biceps muscle.

Reference

1. IMPLANON® [Internet]. c2009. cited 2008 Sep 24. Kenilworth, NJ: Schering-Plough Corporation;Available from: www.implanon-usa.com.

2. Levine JP, Sinofsky FE, Christ MF. Assessment of Implanon insertion and removal. Contraception. 2008. 78:409–417.

3. Gun M, Gluis D, Andrews T. Ultrasound appearance and removal of Implanon under ultrasound guidancea pictorial essay. ASUM Bulletin. 2002. 15:10–12.

4. Lantz A, Nosher JL, Pasquale S, Siegel RL. Ultrasound characteristics of subdermally implanted Implanon contraceptive rods. Contraception. 1997. 56:323–327.

5. Persaud T, Walling M, Geoghegan T, Buckley O, Stunell H, Torreggiani WC. Ultrasound-guided removal of Implanon devices. Eur Radiol. 2008. 18:2582–2585.

6. Adams K, Beal MW. Implanon: a review of the literature with recommendations for clinical management. J Midwifery Womens Health. 2009. 54:142–149.

7. Makarainen L, van Beek A, Tuomivaara L, Asplund B, Coelingh Bennink H. Ovarian function during the use of a single contraceptive implant: Implanon compared with Norplant. Fertil Steril. 1998. 69:714–721.

8. Wenzl R, van Beek A, Schnabel P, Huber J. Pharmacokinetics of etonogestrel released from the contraceptive implant Implanon. Contraception. 1998. 58:283–288.

9. Lipetz C, Phillips CJ, Fleming CF. The cost-effectiveness of a long-acting reversible contraceptive (Implanon) relative to oral contraception in a community setting. Contraception. 2009. 79:304–309.

10. Sinofsky FE, Pasquale SA, Levine JP, Christ MF, Alexander NJ. Assessment of ease of Implanon insertion and removal. Obstet Gynecol. 2003. 101:suppl 1. 13S.

11. Zheng SR, Zheng HM, Qian SZ, Sang GW, Kaper RF. A randomized multicenter study comparing the efficacy and bleeding pattern of a single-rod (Implanon) and a six-capsule (Norplant) hormonal contraceptive implant. Contraception. 1999. 60:1–8.

12. Darney PD, Klaisle C, W. D.M. The "pop-out" method of Norplant removal. Adv Contracept. 1992. 8:188–189.

13. Piessens SG, Palmer DC, Sampson AJ. Ultrasound localisation of non-palpable Implanon. Aust N Z J Obstet Gynaecol. 2005. 45:112–116.

14. Edwards JE, Moore A. Implanon. A review of clinical studies. Br J Fam Plann. 1999. 24:3–16.