title: Laparoscopic Cornuectomy as a Technique for Removal of Essure Microinserts.
abstract: The authors present a laparoscopic technique for complete removal of Essure microinserts (including nitinol coil and positron emission tomography fibers).
  
  
  
  Step-wise instruction using video. The study was granted a Research Ethics Board exemption because the Regina Qu'Appelle Health Region Research Ethics Board does not require ethics board approval for single case submissions.
  
  
  
  Tertiary care hospital.
  
  
  
  Patient requesting removal of Essure inserts because of post-placement discomfort.
  
  
  
  Recent concern regarding adverse outcomes (persistent pelvic pain, device malposition, nickel allergy) after Essure placement has led to a small percentage of women requesting removal of the coils. Laparoscopic salpingectomy and salpingostomy have been successfully used for removal. Hysteroscopic removal has been achieved up to 6 weeks after placement; however, because of the fibrosis-inducing mechanism of the inserts, there is theoretical concern regarding fragmentation or incomplete removal with a cut and pull approach.
  
  
  
  The authors used a laparoscopic surgical approach for removal of the Essure microinserts "en bloc" by performing a salpingectomy and mini-resection of the uterine cornua to the level of the endometrium. This approach ensures complete extraction of the Essure microinserts. The surgery was completed in a tertiary care hospital operating theatre with standard laparoscopic and electrosurgical instruments using a 10-mm infraumbilical port and two 5-mm ports in the left lower quadrant.
  
  
  
  En bloc resection of the fallopian tubes, uterine cornua, and Essure microinserts is a feasible laparoscopic approach to ensure complete removal of Essure microinserts. This approach is technically straightforward and can be achieved with minimal blood loss.
authors.affiliation: University of Saskatchewan Medical School, Regina General Hospital, University of Saskatchewan, Saskatchewan, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Thiel
authors.affiliation: Department of Obstetrics and Gynecology, Regina General Hospital, University of Saskatchewan, Saskatchewan, Canada.
authors.forename: Darrien
authors.initials: D
authors.lastname: Rattray
authors.affiliation: Department of Obstetrics and Gynecology, Regina General Hospital, University of Saskatchewan, Saskatchewan, Canada. Electronic address: john.thiel@usask.ca.
authors.forename: John
authors.initials: J
authors.lastname: Thiel
mesh_terms: D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D058994:Salpingectomy; D013246:Sterilization, Tubal / Q000295:instrumentation*; D014599:Uterus / Q000601:surgery*
keywords: Essure complications; Hysteroscopic sterilization; Laparoscopy