Patient selection and operative techniques for essure removal: The university of California, Davis experience

Clinicians may encounter requests for Essure device removal due to unintended pregnancy, chronic pain, nickel hypersensitivity, or improper placement diagnosed after routine hysterosalpingogram to confirm tubal occlusion. The pre-operative evaluation includes a thorough history of the reasons for Essure removal and details of the Essure procedure. In addition to reviewing the medical, surgical, and gynecologic history, we perform a physical examination that is pertinent to the presenting symptoms. The main imaging modalities to evaluate pain after Essure placement are pelvic ultrasound and hysterosalpingogram. Women with suspected hypersensitivity to nickel or nitinol should undergo skin patch testing to confirm the allergy. Treatment options for women who request Essure device removal include leaving the devices in place with medical management of the presenting complaints, surgical removal of devices, or hysterectomy. Case reports and case series describe successful surgical removal of Essure devices using hysteroscopic removal, laparoscopic salpingectomy or salpingostomy, and wedge resection. Outcomes after Essure device removal are generally favorable, with most women reporting improvement in pelvic pain and nickel hypersensitivity reactions after Essure removal. Appropriate counseling and patient selection before Essure placement and after choosing removal of Essure devices may improve patient outcomes.