Ultrasound-Guided Hydrodissection with Needle Stabilization: An Innovative Nerve-Sparing Approach to Remove a...

Area of Science:

• Minimally Invasive Surgery
• Ultrasound Guidance
• Neurology

Background:

• Migrated contraceptive implants present removal challenges and risks of neurovascular complications.
• Open surgery for deeply embedded implants near nerves can lead to significant postoperative morbidity.
• Previous attempts to remove the patient's implant resulted in deep migration and ulnar neuropathy.

Observation:

• A 38-year-old woman experienced severe ulnar neuropathy from a migrated etonogestrel implant after failed removal attempts.
• Ultrasound confirmed the implant's proximity to the ulnar nerve, and initial removal attempts worsened symptoms.
• Hydrodissection with 5% dextrose in water (D5W) was used to separate the implant from the nerve.

Findings:

• A novel technique combined ultrasound-guided D5W hydrodissection and needle stabilization for percutaneous implant removal.
• The procedure successfully removed a nerve-adherent implant without open surgery.
• The patient achieved immediate and complete resolution of neuropathic pain and paresthesia.

Implications:

• This minimally invasive approach offers a paradigm shift in managing nerve-adherent, migrated implants.
• Ultrasound-guided hydrodissection is safe and effective for removing implants adjacent to nerves.
• Combining D5W hydrodissection with needle stabilization avoids surgical morbidity and yields excellent long-term results.