Two Surgical Techniques for Essure Device Ablation: The Hysteroscopic Way and the Laparoscopic Way by Salpingectomy with Tubal Interstitial Resection.
STUDY OBJECTIVE
To describe 2 different surgical techniques for Essure removal on the same patient: the hysteroscopic and laparoscopic techniques.


DESIGN
An educational video approved by the local institutional review board (Canadian Task Force classification III).


SETTING
A university hospital (University Hospital of Strasbourg, Strasbourg, France).


PATIENT
A 46-year-old woman with many symptoms after Essure device implantation. An ultrasound found a right implant in the uterine cavity and a left intratubal implant.


INTERVENTIONS
The first step was the hysteroscopic removal of the right implant. We viewed the 2 internal and external spirals, allowing the gripping of the whole device without risking any fragmentation or tubal lesion. The second step was bilateral salpingectomy with resection of the left interstitial tubal portion. We longitudinally incised the antimesial edge of the fallopian tube 2 to 3 cm from the tubal serous to the implant contact. A circumferential incision was performed at the uterine horn to circumscribe the interstitial tubal portion. The implant was released from the surrounding tissue. It was gently pulled to completely extract it and avoid spiral fragmentation. Then, we performed a bilateral total salpingectomy. An X-ray of the implants and pelvis was performed to ensure complete removal of the device. We made an X-stitch in the uterine horn to avoid the risk of fistula.


CONCLUSION
More and more patients are asking for the removal of their implants. The surgical technique has to be adapted to the location of the implants and has to allow their complete removal to avoid leaving fragments that can cause the persistence of side effects.
['Tissot|Marion|M|', 'Petry|Solène|S|', 'Lecointre|Lise|L|', 'Faller|Emilie|E|', 'Baldauf|Jean-Jacques|JJ|', 'Akladios|Chérif|C|', 'Boisrame|Thomas|T|']
D020878:Device Removal D005187:Fallopian Tubes D005260:Female D005602:France D013509:Gynecologic Surgical Procedures D006801:Humans D015907:Hysteroscopy D010535:Laparoscopy D008875:Middle Aged D010388:Pelvis D058994:Salpingectomy D013246:Sterilization, Tubal D014463:Ultrasonography D014599:Uterus
Essure removal Cornuectomy Essure complications Hysteroscopic sterilization Laparoscopic salpingectomy