Essure Device Removal
How the Essure device control implant works
Essure is a permanent birth control implant. It is placed through the vagina and cervix into the uterine cavity and is flexible coils inserted into the fallopian tubes. The Essure device is 4-cm long (0.8 mm in diameter) with two parts: an inner coil made of stainless steel and polyethylene terephthalate (PET) fibers, the latter of which induces the fibrosis responsible for tubal occlusion, and an outer coil made of nitinol, a nickel-titanium alloy. Over a period of about three months, tissue forms around the inserts. The build-up of tissue creates a barrier that keeps sperm from reaching the eggs, thus preventing conception. Essure is considered permanent and therefore is not intended to need to be removed.
What are some of the reported Essure problems or Essure side effects possibly due to the device?
- Persistent pelvic pain
- Perforation of the uterus and/or fallopian tubes
- Intra-abdominal or pelvic device migration
- Abnormal or irregular bleeding
- Migraines
- Arthralgia
- Metallic taste
- Allergy or hypersensitivity reactions
What can be done for patients having problems possibly associated with their Essure?
Removal of the Essure device is possible through several techniques however patients must understand that symptoms may not improve after its removal. The consultation with Dr. Hawkins and evaluation is essential to ensure other possible causes of the discomfort and symptoms are also assessed. Many times, imaging is needed to locate the Essure devices and also rule out other anatomical causes of symptoms mainly irregular menstrual bleeding, and pelvic pain. A pelvic ultrasound can help identify other pathologies such as fibroids, adenomyosis, and ovarian cysts. Many times, it can also localize the Essure devices. If the devices are not seen on ultrasound an X-ray to localize it in the pelvis is necessary. A hysteroscopy may also be recommended to visualize the amount of Essure device that may be inside of the actual uterine cavity.
Because the devices were not designed to be removed, simply pulling them from the fallopian tubes either hysteroscopically (camera through the vagina and cervix) or abdominally is not recommended. Patients should be cautioned that if advised to do so, it can lead to broken devices, pieces left behind, and further complications. The only time such removal is feasible is within the first 3 months after placement.
Why is Dr. Hawkins the right doctor for Essure removal?
Dr. Hawkins is a fellowship-trained minimally invasive gynecologic surgeon. This means she spent 2 additional years training to do laparoscopic and robotic complex gynecologic procedures. Essure removal is certainly a complex gynecologic procedure. Dr. Hawkins and her team prefer to remove the Essure device en bloc inside of the tube in order to reduce the risk of leaving any particles behind. Depending on where the device is isolated; in the uterine cavity, cornua (a muscular portion of the uterus where the fallopian tube attaches), or fallopian tube alone, a combination of procedures may be recommended. Options for removal that Dr. Hawkins offers and recommends include…
- Hysteroscopic removal – if the device is easily visualized in the uterine cavity and removed within 3 months of placement.
- Hysteroscopy and Laparoscopy- to help plan the dissection of the Essure device and/or reassure that the entire device is removed.
- Laparoscopy – to resect out the entire Essure device from the cornua of the uterus or remove the fallopian tube alone if the device is completely in the last portion of the tube.
- Exploratory laparoscopy – to search for the device in the abdominal cavity and remove it. Many times, this necessitates the use of imaging tools during the operation to help locate the device in the abdominal cavity, so it can be found.
- Hysterectomy – removing the fallopian tubes and Essure device along with uterus (with or without ovaries). If other pathology is found or suspected of preoperative evaluation, a hysterectomy is sometimes recommended to increase the chances of complete symptom relief.
If there has been no prior attempt at removal prior to the procedure, Dr. Hawkins likes to confirm the removal of the Essure device by visualizing all parts of the device once removed and sending it to pathology for identification. Once confirmed during the procedure post-operative imaging is not necessary. If there is any concern for missing portions (usually when previous surgery claims to have removed a portion), post-operative imaging is completed for confirmation of complete removal.