title: Techniques for removal of the Essure hysteroscopic tubal occlusion device.
abstract: OBJECTIVE
  To present two case reports of techniques for removal of the Essure (Conceptus, Inc., Mountain View, CA) hysteroscopic tubal occlusion device.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  Two women requesting removal of Essure devices because of persistent pelvic pain up to 6 weeks after placement.
  
  
  METHODS
  Hysteroscopic and laparoscopic removal of the Essure microinserts. No institutional review board approval was obtained because the procedures were not part of a study protocol.
  
  
  METHODS
  Effective removal of the Essure device and resolution of pelvic pain symptoms.
  
  
  RESULTS
  Successful removal of the device was achieved in both patients. In one case, the procedure was performed entirely by hysteroscopy. In the other case, a laparoscopic approach was required because of a lack of visualization of the device. Pain symptoms resolved within 2 weeks of removal in both patients.
  
  
  CONCLUSIONS
  These are the first reported cases of successful removal of the Essure tubal occlusion devices up to 6 weeks after placement. This procedure can be safely performed with the use of hysteroscopy if the inserts are clearly visualized. Laparoscopy is an alternative when the device is completely within the fallopian tube. Further study is needed to assess the functionality of the tube after the procedure, as well as feasibility of removal beyond 6 weeks.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. blannon@bidmc.harvard.edu
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Lannon
authors.forename: Shiao-Yu
authors.initials: SY
authors.lastname: Lee
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003273:Contraceptive Devices / Q000009:adverse effects; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D013246:Sterilization, Tubal / Q000295:instrumentation*