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Miguet-Bensouda C, Parant F, Grenet G, Cerruto E, Nohuz E, Chene G. Clinical improvement after Essure® devices removal: a systematic review. EUR J CONTRACEP REPR 2023:1-11. [PMID: 37466355 DOI: 10.1080/13625187.2023.2236741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Essure® implant is a permanently implanted minimally invasive birth control device for women (female sterilisation) widely used between 2002 and 2018. Many adverse events were reported by patients. Increasingly removal procedures have been performed in symptomatic patients. However, there is a lack of in-depth studies on clinical improvement after Essure® removal. We aimed to review all clinical studies about symptoms and quality of life (QoL) after removal procedures. MATERIALS AND METHODS A review of literature in electronic search in Medline and Embase databases from January 2002 to January 2022 using the following keywords: Essure; Essure removal; quality of life; symptomatology improvement. RESULTS Out of 764 articles in the initial database, 18 clinical studies were eligible for inclusion in our literature review. Overall clinical improvement rates after removal ranged from 21% to 98%. All symptoms were less frequent after Essure® removal, although with large discrepancies between studies. Lack of improvement was reported between 1% to 15% of patients. Rate of patients with improvement of QoL after removal ranged from 58 to 98%. The pain was reported as significantly reduced after the surgery. CONCLUSIONS In the available literature, Essure® removal in symptomatic patients may improve symptoms and quality of life. This should be discussed in the benefits and risks ratio before deciding on the best option of management.
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Affiliation(s)
- Chloe Miguet-Bensouda
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
| | - Francois Parant
- Trace Element Analysis Laboratory, Biochemistry Department, CBAPS, Centre hospitalier Lyon-Sud, Chemin du Grand-Revoyet, University hospital of Lyon, Pierre-Benite, France
| | - Guillaume Grenet
- Department of Pharmacotoxicology, University Hospital of Lyon, Lyon, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
| | - Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
- Claude Bernard university of Lyon 1, Lyon, France
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van Erp MAJM, Maassen LW, van Gastel DM, Koks CAM, Bongers MY, Veersema S. Essure removal surgery: Are preoperative transvaginal ultrasound and pelvic X-ray necessary? Eur J Obstet Gynecol Reprod Biol 2023; 286:102-106. [PMID: 37235926 DOI: 10.1016/j.ejogrb.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The objective of this study was twofold. (1) To investigate the predictive characteristics of transvaginal ultrasonography for hysteroscopy necessity in Essure removal surgery. (2) To investigate the additional predictive value of a preoperative pelvic radiograph to transvaginal ultrasonography for hysteroscopy necessity. STUDY DESIGN Retrospective cohort study, performed in an academic and a non-academic teaching hospital in the Netherlands. 71 women who underwent Essure removal surgery with a perioperative hysteroscopy and who had a preoperative pelvic X-ray and transvaginal ultrasound were included. Four experts first predicted hysteroscopy necessity based on transvaginal ultrasound description and secondly based on transvaginal ultrasound combined with the preoperative pelvic radiograph. Sensitivity, specificity, positive predictive value and negative predictive value of the predictive tests were calculated. RESULTS Based on transvaginal ultrasound, the mean predictive characteristics for experts were: sensitivity 89.7% (range 66.7%-100%), specificity 37.4% (range 17.6%-67.7%), positive predictive value 18.8% (range 13.2%-29.5%) and negative predictive value 95.1% (range 86.1%-100%). After adding the pelvic radiograph to the transvaginal ultrasound descriptions, the results were: sensitivity 66.7% (range 53.3%-80%), specificity 72.6% (range 56%-97.3%), positive predictive value 23% (range 14.3%-26.9%) and negative predictive value 94.1 % (range 90.3%-98.4%). For three experts sensitivity decreased after adding the pelvic radiograph. For all experts specificity increased. CONCLUSION It is difficult to preoperatively decide if the fourth marker of the Essure outer coil can be excised during hysteroscopy. The addition of pelvic radiography to transvaginal ultrasound is not beneficial. It is recommended to perform a hysteroscopy during Essure removal surgery.
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Affiliation(s)
- Mirthe A J M van Erp
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Liselotte W Maassen
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Danielle M van Gastel
- Research School Grow Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Carolien A M Koks
- Maxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Research School Grow Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Maxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Sebastiaan Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Chene G, Cerruto E, Merviel P, Agostini A, Crochet P, Giraudet G, Capmas P, Fernandez H, Graesslin O. Surgical techniques for the removal of Essure ® microinserts: a literature review on current practice. EUR J CONTRACEP REPR 2021; 26:404-412. [PMID: 34096440 DOI: 10.1080/13625187.2021.1925883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the different techniques for Essure® microinserts removal and to assess the risk of fracture of the device and the intra- and post-operative complications in relation to surgical technique variants. METHODS Electronic search in Medline, Scopus and Embase databases using the following keywords: Essure; Essure removal; Essure surgical technique. RESULTS Out of 95 articles in the initial database, 17 studies were eligible for inclusion in our literature review. Several surgical techniques have been described in which the most frequent were laparoscopic salpingectomy (LS), laparoscopic cornuectomy (LC), laparoscopic or vaginal hysterectomy (LH, VH) with en-bloc salpingectomy. There were more fractures of the device with the LS procedure (6.25%) followed by the LC technique (2.77%), while there was no fracture with hysterectomy. However, peri-and post-operative complications were more severe and frequent with hysterectomy in comparison with the LC and LS procedures (respectively 8.1% Clavien Dindo grade 3 for the hysterectomy group, 1.11% for the LC procedure and 0.69% for the LS technique). CONCLUSION Due to the lack of standardised surgical treatment guidelines, a system of care networks for symptomatic patients with adverse effects related to Essure® headed by specialised centres may offer a suitable and high-quality management with the appropriate removal techniques within two objectives: limiting the risk of fracture (with an en-bloc removal of the Essure® microinserts) and avoiding intra- and post-operative complications.
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Affiliation(s)
- G Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France.,Claude Bernard university of Lyon 1, Lyon, France
| | - E Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
| | - P Merviel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
| | - A Agostini
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, La Conception Hospital, Aix Marseille Université, Marseille, France
| | - P Crochet
- Department of Obstetrics and Gynecology, Hospital Arnaud de Villeneuve, University of Montpellier, Montpellier, France
| | - G Giraudet
- Department of Gynecology, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - P Capmas
- Department of Gynecology, Bicetre Hospital, GHU Sud, AP-HP, Le Kremlin Bicetre, France
| | - H Fernandez
- Department of Gynecology, Bicetre Hospital, GHU Sud, AP-HP, Le Kremlin Bicetre, France
| | - O Graesslin
- Department of Gynecology, Institut Mère Enfant Alix de Champagne, University hospital of Reims, Reims, France
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Horsten DL, van Gastel DM, Maassen LW, Koks CAM, Veersema S, Bongers MY. Perioperative findings and complications in Essure® removal surgery. Eur J Obstet Gynecol Reprod Biol 2021; 263:1-6. [PMID: 34129961 DOI: 10.1016/j.ejogrb.2021.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze perioperative findings and complications in surgical removal of Essure® microinserts. STUDY DESIGN A prospective cohort study of 274 patients who underwent surgical removal of Essure® microinserts. Outcomes of the surgical procedures and complications were entered into a digital case report form (CRF) by the surgeon and registered in an online database. Results were analyzed through IBM SPSS Statistics using descriptive statistical methods. RESULTS During laparoscopic inspection in 15.4 % of fallopian tubes (n = 80) a chicken wing sign (the fallopian tube folding over the most distal part of the microinsert) was seen. Partial tubal perforation and total tubal perforation with migration of the microinsert out of the fallopian tube were seen in respectively 1.9 % (n = 10) and 0.2 % (n = 1) of cases. The microinserts were removed by laparoscopic tubotomy and extraction, followed by bilateral salpingectomy in 91.2 % of cases. In 7.3 % of cases (n = 20) a hysterectomy and bilateral salpingectomy was performed for additional indications than solely Essure® removal. Four microinserts were taken out entirely by means of hysteroscopy (1.5 %). We did not see major surgery related complications, however we found a risk of minor complications during or after surgery of respectively 1.6 % (n = 4) and 3.9 % (n = 10). CONCLUSIONS During laparoscopic inspection, abnormalities were seen in 22.8 % (n = 119) of fallopian tubes, of which the chicken wing sign was the most common. Partial and total tubal perforation with migration of the microinsert were rare. The complication rate of Essure® removal surgery in our prospective study is low and complications are minor, without any major complication. However, while counseling patients with a request for surgical removal of Essure® microinserts, these results should be mentioned.
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Affiliation(s)
- Dieuwertje L Horsten
- Department of Obstetrics and Gynecology, Máxima Medical Centre, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands.
| | - Daniëlle M van Gastel
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - Liselotte W Maassen
- Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Carolien A M Koks
- Department of Obstetrics and Gynecology, Máxima Medical Centre, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands.
| | - Sebastiaan Veersema
- Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
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