Technique for the Laparoscopic Removal of Essure Microinserts

Area of Science:

• Gynecologic surgery
• Minimally invasive procedures
• Female sterilization complications

Background:

• Essure (microinsert) sterilization is generally well-tolerated.
• Persistent pelvic pain is a rare complication, necessitating device removal in approximately 0.16% of cases.
• Laparoscopic and hysteroscopic removal are described for Essure microinserts.

Observation:

• A 30-year-old patient experienced persistent bilateral pelvic pain and menorrhagia after Essure insertion.
• Pelvic ultrasound revealed a small intramural uterine leiomyoma.
• The patient had failed treatment with a levonorgestrel intrauterine device and requested Essure removal.

Findings:

• Laparoscopic bilateral Essure microinsert removal and bilateral salpingectomy were successfully performed.
• Hysteroscopic removal of a levonorgestrel intrauterine device and endometrial ablation were also completed.
• The patient's pelvic pain and menorrhagia resolved completely post-procedure.

Implications:

• Laparoscopic Essure microinsert removal is a feasible and effective surgical option for managing device-related pelvic pain.
• This approach can help patients avoid hysterectomy when desiring fertility preservation or declining major surgery.
• Successful outcomes depend on a thorough understanding of Essure device components and precise surgical technique.