title: Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation.
abstract: We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient's condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery.
authors.affiliation: Reproductive Research Section, Center for Advanced Genetics, Carlsbad, CA, USA.; Department of Obstetrics and Gynecology, Saddleback Memorial Medical Center, Laguna Hills, CA, USA.; Molecular and Applied Biosciences Department, Faculty of Science & Technology, University of Westminster, London, UK.
authors.forename: E Scott
authors.identifier: 0000-0001-7334-1031
authors.initials: ES
authors.lastname: Sills
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Gianpiero D
authors.initials: GD
authors.lastname: Palermo
keywords: Essure removal; Fragmentation; Hysteroscopy; Laparoscopy; Migration