title: Removal of a Nonpalpable Etonogestrel Implant With Preprocedure Ultrasonography and Modified Vasectomy Clamp.
abstract: BACKGROUND
  Deep etonogestrel contraceptive implant placements still occur despite design modifications to the implant inserter. We present a method for outpatient removal of a nonpalpable etonogestrel implant using preprocedure ultrasonography for implant localization followed by removal with a modified vasectomy clamp, a modification of the "U" technique for six-capsule levonorgestrel implant removal.
  
  
  METHODS
  In women with a nonpalpable etonogestrel implant containing barium sulfate, we obtain a radiographic examination to confirm the implant's presence in the upper extremity. Using an 18-MHz linear ultrasound transducer, we identify and mark the implant location on the patient's arm, noting the depth. We remove the implant with local anesthesia in the office using a modified vasectomy clamp through a 5-mm or less skin incision directly over the implant.
  
  
  RESULTS
  All three patients referred to our office with nonpalpable etonogestrel implants had successful removal using this technique.
  
  
  CONCLUSIONS
  Nonpalpable contraceptive implants can be removed in the office using a modified vasectomy clamp after localization with high-frequency ultrasonography. Given the relative infrequency of nonpalpable implant removals, regional expert sites with health care providers experienced in difficult removals should be created for patient referrals.
authors.affiliation: Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Chen
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Creinin
mesh_terms: D000328:Adult; D001132:Arm / Q000000981:diagnostic imaging*; D003271:Contraceptive Agents, Female; D017135:Desogestrel; D020878:Device Removal / Q000295:instrumentation / Q000379:methods*; D004343:Drug Implants; D005260:Female; D006801:Humans; D014463:Ultrasonography
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; C044815:etonogestrel; D017135:Desogestrel