The 'Modified U' technique: a refined method of Norplant removal

Norplant removal has been much more difficult for many physicians than might have been anticipated. Dr Untung Praptohardjo of Indonesia recently developed the "U" technique, speeding the time required to remove the six Norplant implants to an average of 7 minutes. In his technique, a unique oval-ring-tipped forceps with an internal diameter of 2.2 mm is used to reach through a 4-mm incision to firmly grasp each of the implants. The incision is made parallel to the implants between the lower tips of implants 3 and 4. The "U" technique requires grasping the implant within 4 mm to 5 mm of its tip. This preliminary paper describes the "Modified U" technique, which allows the physician who is removing the implants to grasp them anywhere along their shaft, not just near the tip. The Modified U technique involves the use of an improved ring-tipped forceps with a circular tip rather than the oval tip used in the "U" technique. This instrument, called Norgrasp, is a modification of the vas deferens fixation forceps used in the no-scalpel vasectomy (NSV) technique. In another adaptation of NSV instruments, an NSV dissecting forceps (a sharpened, curved hemostat) is used to free the implants from their tissue envelope and quickly deliver them through the skin incision. Using the Modified U technique, the time required to remove Norplant implants in 20 patients in the United States has ranged from 8 to 13 minutes. Improperly placed implants are readily removed with this technique. The Modified U technique requires a minimal incision and offers both the physician and the patient a speedy, positive removal.