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Essure Coil Removal: Advice On How To Avoid Leaving Fragments

Essure Coil Removal
Increasing Chance of Intact Removal

Essure-coil-removal-in-middle

Dissection begins in the most superficial area where the device is observed.

Essure coil removal was previously performed at our facility by applying direct traction on the Essure micro-inserts.

Although this was simpler and faster than the procedure we now perform, manual traction on the coils frequently resulted in coil breakage and increased the chance of leaving residual Essure fragments.

We now perform a precise en bloc dissection of each Essure micro-insert.

Now our Essure coil removal surgeries are more likely to result in complete removal of each Essure micro-insert as well as any surrounding fibrosis.


Essure-coil-removal-hemostasis

Dissection starts in middle of coil and continues medially. Note the absence of blood in the area of dissection.

Essure coil removal: Dissect rather than pull

After adequate uterine tourniquet application, Essure coil removal can be performed with sharp dissection directly on the anti-mesenteric portion of the coil.

We perform sharp dissection with a #11 blade tip scalpel. This blade size provides more precise dissection immediately on and alongside the micro-inserts.

Dissection for Essure coil removal begins in the mid-to-distal portion of the Essure micro-insert device in the area of interstitial tube which is the most superficial. Often this is the area where the Essure devices are the most visible.

Essure-coil-removal-medial-aspect

Proximal ends of both inner and outer coil have been identified within the myometrium.

Using sharp dissection the Essure micro-insert device is followed medially as it travels through the interstitial myometrium and into the uterine cavity. Suction irrigation is performed during the dissection to maintain visibility in the area of dissection by removing any residual venous blood.

It is during the dissection of the interstitial segment of tube that awareness of anatomic variations becomes important. The Essure micro-insert can travel in different directions, at different depths, and can dive towards the endometrial cavity at different areas within the myometrium.

Occasionally the depth of the coil is superficial and occasionally the depth of the coil is deeper.

As dissection is performed it is helpful to stabilize the Essure micro-insert with a hand-held forceps (i.e. Debakey) to minimize rolling of the device. We stay on top of the device as much as possible and the purpose of this dissection is to track the micro-inserts into the uterine cavity.


Essure coil removal: En bloc removal

en-bloc-dissection-essure-devices-minimizes-essure-device-fracture

En bloc dissection of both Essure micro-inserts. Each device is intact and surrounded by tubal muscularis.

Once the proximal tip of the Essure device is identified then the medial most portion of the intra-tubal insert can be grasped and elevated with hand-held forceps.

The proximal tip of the micro-insert can be retracted laterally to allow more exposure underneath the device. Dissection can then be performed along the mesenteric side of the device towards the distal end of the intratubal micro-insert.

If necessary we will utilize electrosurgery at this time to provide additional hemostasis because the risk of coil fracture is minimal when the entire coil is visualized and the more difficult medial dissection has been completed.

The entire device can then be removed intact an en bloc with adjacent tubal muscularis and surrounding fibrosis. We now feel en bloc dissection is the most precise surgical technique that increases the chance of intact micro-insert removal.


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32 Comments

Leslie Pribanic Reply

Is there any conventional wisdom out there that cautions against using a morcellator to remove Essure devices?


    Dr. Monteith Reply

    The morcellator can shred the device and spread metal fragments inside your abdomen if it is not used correctly to remove Essure. It is best to avoid using the uterine morcellator so that does not happen.