Design: Surgical educational video.
Setting: Tertiary care center at an academic institution- Division of minimally invasive gynecologic surgery. Operating room procedure performed with the patient in a supine position with Trendelenburg tilt.
Patients or Participants: Case description of a 42-year-old patient who underwent vaginal hysterectomy and bilateral salpingectomy for Essure® removal 7 years before presentation. She had persistent symptoms and imaging suggested bilateral pelvic device fragments.
Interventions: Imaging including abdominal Xray and computed tomography were done for surgical mapping.Successful laparoscopic removal of bilateral Essure® fragments was performed. Intraoperative fluoroscopy revealed complete device removal with no remaining fragments. This video discusses a rare case of tubal micro-insert fragmentation after a hysterectomy resulting in persistent symptoms and requiring laparoscopic removal of fragments. Tips and tricks for successful removal are shared.
Measurements and Main Results: No specific measurements were taken or reported.
Conclusion: Essure® en-bloc removal is recommended as fragmentation of the device may lead to persistent symptoms. Laparoscopic removal of fragments is possible after imaging studies for surgical mapping. The use of intraoperative fluoroscopy is recommended to guarantee complete device removal.
Leon, MG*1, Hui, M1, Mohr-Sasson, A1, Gutierrez, JF2. 1Department of Obstetrics, Gynecology & Reproductive Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; 2Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX