Obstet Gynecol Sci.  2016 Jul;59(4):337-341. 10.5468/ogs.2016.59.4.337.

Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation

• Sills ES
• Palermo GD

• KMID: 2329059
• DOI: http://doi.org/10.5468/ogs.2016.59.4.337

Abstract

We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient's condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery.

Keyword

Essure removal; Fragmentation; Hysteroscopy; Laparoscopy; Migration

MeSH Terms

Colon
Contraceptive Devices*
Fallopian Tubes
Female
Fluoroscopy*
Humans
Hysteroscopy
Laparoscopy
Middle Aged
Polyethylene
Polyethylene

Figure

• 

  Fig. 1 (A) Laparoscopic view of right adnexa post-Essure placement, showing normal uterine exterior (U) and perforation of right Fallopian tube (R) by nitinol coil fragment. The inner (polyethylene terephthalate) rod had migrated out of the pelvis, lodging near proximal colon (not visualized during laparoscopy). (B) Proximal margin of divided left Fallopian tube (L), with outer nitinol coil (arrow) and inner polyethylene terephthalate rod demonstrating missing terminal marker (circle).

• 

  Fig. 2 Intraoperative fluoroscopic views before (A) and after (B) secondary dissection to retrieve Essure fragment situated in left cornu. Hypermobility of the lateral right fragment during surgery is also noted (arrow).

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