Vaginal Hysterectomy with Salpingectomy for Essure Insert Removal

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures
• Reproductive Health

Background:

• Essure inserts, a permanent birth control method, have been associated with complications requiring removal.
• Vaginal hysterectomy is a surgical option for women with gynecological conditions.
• Simultaneous removal of Essure inserts during hysterectomy presents a surgical challenge.

Purpose of the Study:

• To assess the feasibility of performing an en-bloc salpingectomy during vaginal hysterectomy for Essure insert removal.
• To evaluate the safety and efficacy of this combined surgical approach.

Main Methods:

• A prospective observational study was conducted involving women scheduled for vaginal hysterectomy and Essure removal.
• The surgical technique involved en-bloc removal of each hemiuterus with the ipsilateral fallopian tube.
• Twenty-six procedures were performed at a single center.

Main Results:

• En-bloc removal of the uterus and fallopian tube was feasible in all 26 cases, allowing intact Essure insert removal.
• No cases required conversion to laparoscopy or laparotomy due to feasibility or complications.
• Minor complications included one bladder injury (Clavien-Dindo grade 1) and two grade 2 complications (metrorrhagia and acute urinary retention).

Conclusions:

• Vaginal hysterectomy with en-bloc salpingectomy is a feasible and effective surgical approach for removing intact Essure inserts.
• This technique offers a viable surgical option for women undergoing hysterectomy for Essure removal.
• The vaginal route can be utilized for Essure insert removal during hysterectomy, minimizing fragmentation risks.