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Essure Removal
Avoid Excessive traction

Essure-removal-surgeryWhen we first began performing Essure removal, we would remove the devices using manual traction.

As we gained more experience, we realized the best way to reduce the risk of breaking the Essure devices was to minimize excessive traction and avoid electrodissection.

We now perform en bloc resection of Essure micro-inserts during our Essure removal procedures and this minimizes the chance of fracturing the devices and the risk of leaving Essure fragments during removal.

Essure removal: Mini-laparotomy is our preference

Essure-removal-using-manual-tractionWe perform our Essure removal procedures under general anesthesia, as outpatient procedures, and through a mini-laparotomy abdominal incision. We feel this approach allows us better surgical control.

Although a minimally invasive laparoscopic or robotic approach is possible, we feel operating through a mini-laparotomy incision allows a more precise dissection of the Essure devices, allows us to avoid the use of excessive coagulation because we can maintain better hemostasis, and increases our tactile perception when palpating for the distal most tip of the inner coil.

Essure-removal-skin-incision

Skin incision in a thin patient used to remove Essure devices using the traction method. Skin incisions for en bloc coil dissection are slightly larger to allow better exposure and uterine tourniquet placement.

Moreover our approach allows us to operate quickly and efficiently without adding increased cost because of increased operating room time and increased equipment cost when using a robotic or laparoscopic approach.

Our patients are often covering most of the cost of Essure removal and we must be more mindful of the cost of Essure removal in our practice.

Although we do perform laparotomy, all of our surgical procedures are ambulatory. We keep our incisions as small as is safely prudent and in most cases the total length of our incision is similar, or slightly longer, to the total length of the three (3) to four (4) incisions made during minimally invasive surgery.

Essure removal: Minimizing traction

fragment-after-essure-removalInitially we would remove Essure coils with direct traction. To accomplish this we would locate the distal most portion of the Essure device with digital palpation.

Using sharp dissection with a scalpel, we would make an incision into the isthmic section of the fallopian tube and locate the lateral end of the Essure micro-insert.

Once the lateral end of the micro-insert was identified we would apply manual traction with a hemostat. Once the device would elongate, we would apply a second hemostat and using a ‘hand-over-hand’ technique we would gradually remove the Essure device using steady traction.

Piece-most-likely-to-fragment-during-essure-removalWe found larger forceps (i.e. Kelly forceps) to be more damaging to the micro-inserts and smaller forceps (i.e. Debakey) did not provide enough gripping strength.

This method worked well but we soon realized approximately 1 out of 10 patients would have a fracture of the outer coil at the proximal most portion during removal.

These patients would often be left with a small fragment of the proximal most rectangular radiographic marker. This platinum band is welded to the outer nitinol coil and seems to be a source of weakness in the outer coil.

Removing Essure: Reducing the risk of coil fracture

We feel manual extraction of the micro-insert device increases the risk of outer coil fracture. Manual extraction may be more appropriate for micro-inserts that do not have significant amounts of fibroelastic tissue in-growth.

En bloc surgical dissection allows for more intact coil removal along with surrounding fibroelastic tissue.

4 thoughts on “Essure Removal Advice: Avoid Excessive Traction”

  1. Anonymous says:

    Louisville ky

    1. Dr. Monteith says:

      We specialize in Essure reversal and Essure removal surgery. We can reverse Essure and give you the chance of pregnancy….or we can remove Essure and leave your tubes closed. The chance of pregnancy after Essure reversal is about 40%.

      More information: Essure reversal testimonials

      The cost for the Essure reversal procedure and the Essure removal procedure is the same… $7,500. We are located in Raleigh, North Carolina.

      Please be aware that starting April 1st 2019 the fee for Essure reversal surgery will increase to $7,900 and the scheduling fee will increase to $150. If you want to avoid the higher fees then you should schedule your surgery before April 1st or start a Reversal Prepayment Account.

      No other clinic or doctor has the experience we do. The chance of pregnancy after Essure reversal is about 40%. If you are having symptoms that started soon after Essure most patients report improvement after removal of the devices. We do have a surgery prepayment plan.

      More information: Successful Essure reversal with Dr Monteith

      We charge a total of $7,500 for Essure reversal/removal plus $125 to schedule surgery. If you use our prepayment plan then you can contribute any amount as you are able but you must have the surgery paid for by three years. We do work with two financing companies and we do have a prepayment plan.

      The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal

      Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about tubal reversal at our facility.

  2. LA says:

    Please provide the names & addresses of physicians near Oklahoma City, OK who perform Essure removals?

    1. Dr. Monteith says:

      I am not aware of any Essure reversal or removal specialist in your area. We do have many patients who travel from OK to have Essure removal with our center because of our experience.

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