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Laparoscopic removal of Essure device techniques, perioperative findings and evaluation of patient's satisfaction: A case series. J Gynecol Obstet Hum Reprod 2023; 52:102567. [PMID: 36868503 DOI: 10.1016/j.jogoh.2023.102567] [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: 01/08/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To evaluate perioperative outcomes and symptom resolution in women undergoing Essure removal. METHODS Single centre cohort study at a large University Teaching Hospital in the UK. Symptoms and Quality of life (QoL) were assessed using a standardised questionnaire administered at 6-months and up to 10-years following removal of Essure® devices. RESULTS 61 women underwent surgical removal of Essure® devices representing 61/1087 (5.6%) of all women undergoing this hysteroscopic form of sterilization. Patients who had Essure® removal were more likely to have a previous caesarean section [38% vs 18%; OR 0.4, 95% CI 0.2-0.6; P <0.001]. The main indication for removal was pelvic pain (49/61, 80%). Removal was achieved by laparoscopic bilateral salpingectomy/cornuectomy (44/61,71%) or hysterectomy (17/61, 28%). At surgery, perforated device was seen in 4/61 (7%) cases. 26/61 (43%) of patients had concomitant pelvic pathology; 12/26 (46%) had fibrous adhesions, 8/26 (31%) endometriosis, 4/26 (15%) adenomyosis, and 2/26 (8%) had endometriosis and adenomyosis. 10 patients underwent further procedure following removal for ongoing symptoms. 55/61 women (90%) responded to the post removal symptom questionnaire. Most respondents to the quality of life survey 42/55 (76%) reported total or some improvement. 42/53 (79%) had total or some improvement in pelvic pain, 9/13 (69%) in mental health and 10/12 (83%) in bleeding. CONCLUSION Surgical removal of Essure® devices appears to improve symptoms thought to be attributable to the presence of these uterine implants in most women. However, patients should be counselled that one in five women may experience persistent or even worsening symptoms.
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Catinon M, Roux E, Auroux A, Trunfio-Sfarghiu AM, Lauro-Colleaux C, Watkin E, Sournies G, Vincent M. Confirmation of the systematic presence of tin particles in fallopian tubes or uterine horns of Essure implant explanted patients: A study of 18 cases with the same pathological process. J Trace Elem Med Biol 2022; 69:126891. [PMID: 34749033 DOI: 10.1016/j.jtemb.2021.126891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/27/2021] [Accepted: 10/31/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine associations between local and systemic symptoms and the wear of the tin weld of Essure implants. DESIGN study of a series of cases. SETTINGS Two French hospitals. PARTICIPANTS Eighteen patients explanted by hysterectomy and salpingectomy for removal of their Essure implants between September 2019 and July 2020, have had a common anatomopathological process. MAIN OUTCOME MEASURES anatomopathological examination by optical microscopy and mineralogical analysis of the fallopian tube or uterine horn with scanning electron microscopy coupled with energy dispersive X-ray (SEM-EDX). Evaluation of local and systemic symptoms with a questionnaire. Examination of blood metal assays (nickel, chromium, and tin). RESULTS anatomopathological examination highlights foreign body granulomas, fibrosis, adenomyosis, nonspecific inflammation, cysts and myomas in the Fallopian tubes, uterine horns, or both and mentions the presence of foreign bodies in seven cases. SEM-EDX analyses showed, systematically, the presence of tin particles integrated in the wall near the weld, generally in clusters, and with a size ranging from about one micron to several dozen microns. The questionnaire shows that the most frequent local symptoms were pelvic pain, urinary disorders, bleeding, and pains during intercourse. The most common systemic symptoms were: asthenia, visual disturbances, amnesia, giddiness, dorsal pains, headaches, and joint pains. The majority of local and systemic symptoms decreased after explantation, but sometimes incompletely. Before explantation, high levels of nickel, tin and chromium were observed in 11/17, 1/7 and 2/17 patients. After explantation, tin levels were high in 3/11 patients. CONCLUSIONS our new anatomopathological process systematically demonstrates the presence of tin particles in tissue near the weld. These particles could be responsible for granulomatous inflammations as well as local symptoms. Many of the systemic symptoms are consistent with chronic organotin poisoning but further studies are needed to find out whether tin from the solder can be converted to organotin in the patients' bodies.
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Affiliation(s)
- M Catinon
- Minapath Developpement, Insavalor CS : 52132, 69603, Villeurbanne, France
| | - E Roux
- Minapath Developpement, Insavalor CS : 52132, 69603, Villeurbanne, France
| | - A Auroux
- IRCELYON UMR 5256, CNRS, Université Claude Bernard Lyon 1, 69626, Villeurbanne, France
| | | | - C Lauro-Colleaux
- Laboratoire Technipath, 41 allée des Cyprès, 69760, Limonest, France
| | - E Watkin
- Laboratoire Cypath, 201 Route de Genas, 69100, Villeurbanne, France
| | - G Sournies
- Natecia Service de gynécologie, 28 Avenue Rockfeller, 69008, Lyon, France
| | - M Vincent
- Minapath Developpement, Insavalor CS : 52132, 69603, Villeurbanne, France.
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Catinon M, Roux E, Auroux A, Balter V, Fellah C, Trunfio-Sfarghiu AM, Sournies G, Vincent M. Identification of inorganic particles resulting from degradation of ESSURE® implants: Study of 10 cases. Eur J Obstet Gynecol Reprod Biol 2020; 250:162-170. [PMID: 32446147 DOI: 10.1016/j.ejogrb.2020.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Approximately 750,000 women worldwide have undergone ESSURE hysteroscopic sterilization since 2002. In 2015, an increase in adverse effects was noted, with gynaecological and systemic symptoms reported. Scanning electron microscopy (SEM) analysis of fallopian tube and uterine horn tissues and implants, after hysterectomy or salpingectomy, revealed the presence of inorganic particles resulting from implant degradation. STUDY DESIGN Ten patients (age 42-53 years) were included in this study. Of these, eight patients had undergone hysterectomy and two patients had undergone salpingectomy. Mean exposure time was 85.5 months (standard deviation 26.8 months, range 34-105 months). Mineralogical analyses were performed on 13 tissue biopsies and four implants by SEM coupled with energy dispersive x-ray spectrometry. RESULTS In five of the 10 patients, tin particles were observed in fallopian tube or uterine horn tissues with inflammatory cell reactions. In the other five cases, iron, chromium, nickel or platinum particles were observed. For implants, major deterioration of the weld zone was observed with either destroyed appearance or the presence of an organic coating containing numerous particles. DISCUSSION AND CONCLUSION Analysis of the preclinical studies performed by the manufacturer suggests that degradation of the tin weld plays a major role in these adverse events, with increasing leaching and corrosion between 3 and 6 months for an intratubal insert that si designed to remain in an woman's body for her entire life. For patients with gynaecological symptoms (e.g. pain, metrorragies) needing explantation, these findings raise the question of a causal relationship between tin particles from implant degradation and the inflammatory tissue response. For patients with systemic symptoms (e.g. blurred vision, headache, asthenia, myalgia), the hypothesis that these symptoms may be related to the formation of organotin (chemical compounds based on tin with hydrocarbon substituents) in the body has yet to be proven. Tin levels in blood have to be measured before and after explantation. To the authors' knowledge, this is the first study to report significant degradation of the ESSURE implant weld, evidenced by the detection of tin particles in the uterine tissue of patients and comparison of the welding zone between unused and used implants.
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Affiliation(s)
| | | | | | - Vincent Balter
- Ecole Normale supérieure de Lyon 'laboratoire de géologie', Lyon, France
| | - Clémentine Fellah
- Ecole Normale supérieure de Lyon 'laboratoire de géologie', Lyon, France
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Pathologic findings in fallopian tubes of women with chronic pelvic pain after Essure placement. Contraception 2020; 102:133-136. [PMID: 32353358 DOI: 10.1016/j.contraception.2020.04.010] [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: 01/28/2020] [Revised: 03/29/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pelvic pain has been associated with Essure, a permanent contraceptive implant. Here we describe histopathologic findings in long-term Essure users with chronic pelvic pain. METHODS We descriptively evaluated and compared histopathologic features of hysterectomy specimens removed for a primary diagnosis of chronic pelvic pain from women with (n = 3) and without (n = 3) prior placement of Essure coils (mean of 8.6 years prior). RESULTS Interstitial fallopian tubes of Essure patients demonstrated fibrosis. Two cases had flattening of ampullary epithelial folds. Tubes of Essure users showed no acute inflammation, but 2/3 showed focal chronic inflammation. All patients had additional findings, such as endometriosis, adenomyosis or leiomyomas, that could be associated with pain. CONCLUSIONS Given the minimal and bland inflammation in Essure cases, symptoms may more plausibly be ascribed to confounding gynecologic conditions or other mechanisms.
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Maassen LW, van Gastel DM, Lentjes EGWM, Bongers MY, Veersema S. Intracavitary deposits on Essure® hysteroscopic sterilization devices: A case report. Case Rep Womens Health 2018; 15:3-5. [PMID: 29593992 PMCID: PMC5842963 DOI: 10.1016/j.crwh.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/10/2017] [Indexed: 11/16/2022] Open
Abstract
Objective To study the composition of intracavitary deposits on Essure® hysteroscopic sterilization devices. Design Case report. Setting Reproductive Medicine and Gynecology department of a University Hospital. Patient(s) A 39 years old patient presenting with a request for surgical removal of Essure® sterilization devices. Diagnostic hysteroscopy showed a crystal like white deposit attached to one of the devices. Intervention Diagnostic hysteroscopy and surgical removal of Essure® devices was performed. The deposits were collected and infrared spectroscopy analysis was performed. Main Outcome Measure Chemical composition of the deposits attached to the device. Result(s) Infrared spectroscopy of the material showed patterns conclusive with calcite (calcium carbonate, CaCO3). Conclusion Until now, it is not clear if there is a relationship between reported complaints and formation of calcite deposits on Essure®. Capsule Infrared spectroscopy of deposits on Essure® devices showed a pattern conclusive with calcite. The relationship between reported complaints and the formation of calcite deposits on Essure® remains unclear. A white, strongly attached deposit was observed on Essure sterilization devices. Infrared spectroscopy of this deposit showed a pattern conclusive with calcite. A relationship between reported complaints and the deposits remains unclear. Future research should focus on the genesis of the deposits, to determine its clinical relevance.
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Affiliation(s)
- L W Maassen
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - D M van Gastel
- Máxima Medical Centre Veldhoven, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - E G W M Lentjes
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M Y Bongers
- Máxima Medical Centre Veldhoven, De Run 4600, 5504 DB Veldhoven, The Netherlands.,Maastricht University, Department of Obstetrics and Gynaecology, Grow school of Oncology and Developmental Biology, Universiteitssingel 40, 6229 Maastricht, The Netherlands
| | - S Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Chudnoff SG, Nichols JE, Levie M. Hysteroscopic Essure Inserts for Permanent Contraception: Extended Follow-Up Results of a Phase III Multicenter International Study. J Minim Invasive Gynecol 2015; 22:951-60. [DOI: 10.1016/j.jmig.2015.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 10/23/2022]
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Adelman MR, Dassel MW, Sharp HT. Management of Complications Encountered With Essure Hysteroscopic Sterilization: A Systematic Review. J Minim Invasive Gynecol 2014; 21:733-43. [DOI: 10.1016/j.jmig.2014.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/20/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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Incidence and risk factors for chronic pelvic pain after hysteroscopic sterilization. J Minim Invasive Gynecol 2014; 22:390-4. [PMID: 24952343 DOI: 10.1016/j.jmig.2014.06.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE To investigate the incidence of and preoperative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure microinserts. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING University medical center. PATIENTS A total of 458 patients who underwent hysteroscopic sterilization using Essure between January 1, 2005, and June 30, 2012. INTERVENTION Hysteroscopic sterilization using Essure. MEASUREMENTS AND MAIN RESULTS The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and of persistent pain at 3 months after the procedure was 4.2%. The range of presence of pain was 1 to 469 days (mean, 56 days). Of patients who developed chronic pelvic pain after the procedure, 75% reported it within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (odds ratio, 6.81; 95% confidence interval, 2.95-15.73) and chronic pain (odds ratio, 6.15; 95% confidence interval, 2.10-18.10) after hysteroscopic sterilization. CONCLUSIONS Pelvic pain may develop after hysteroscopic sterilization. Patients with a diagnosis of preexisting chronic pain may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure placement will resolve within 3 months.
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Arjona Berral JE, Rodríguez Jiménez B, Velasco Sánchez E, Povedano Cañizares B, Monserrat Jordan J, Lorente Gonzalez J, Castelo-Branco C. Essure®and chronic pelvic pain: A population-based cohort. J OBSTET GYNAECOL 2014; 34:712-3. [DOI: 10.3109/01443615.2014.920795] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Analysis of Adverse Events With Essure Hysteroscopic Sterilization Reported to the Manufacturer and User Facility Device Experience Database. J Minim Invasive Gynecol 2013; 20:825-9. [DOI: 10.1016/j.jmig.2013.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022]
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Albright CM, Frishman GN, Bhagavath B. Surgical aspects of removal of Essure microinsert. Contraception 2013; 88:334-6. [DOI: 10.1016/j.contraception.2012.11.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/26/2012] [Accepted: 11/26/2012] [Indexed: 12/01/2022]
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Contraception permanente par pose hystéroscopique d’implants tubaires. ACTA ACUST UNITED AC 2012; 40:434-44. [DOI: 10.1016/j.gyobfe.2012.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/10/2012] [Indexed: 11/20/2022]
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Brown WW. An unusual complication of hysteroscopic sterilization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:707-709. [PMID: 21527621 DOI: 10.7863/jum.2011.30.5.707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Hysteroscopic tubal sterilization: a systematic review of the Essure system. Fertil Steril 2010; 94:16-9. [DOI: 10.1016/j.fertnstert.2009.02.080] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 02/16/2009] [Accepted: 02/25/2009] [Indexed: 11/19/2022]
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Mahmoud MS, Fridman D, Merhi ZO. Subserosal misplacement of Essure∗ device manifested by late-onset acute pelvic pain. Fertil Steril 2009; 92:2038.e1-3. [DOI: 10.1016/j.fertnstert.2009.07.1677] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 07/22/2009] [Indexed: 11/29/2022]
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Bigolin S, Fagundes DJ, Rivoire HC, Fagundes ATN, Fagundes ALN. Transcervical hysteroscopic sterilization using cyanoacrylate: A long-term experimental study on sheep. J Obstet Gynaecol Res 2009; 35:1012-8. [DOI: 10.1111/j.1447-0756.2009.01075.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Connor VF. Essure: A Review Six Years Later. J Minim Invasive Gynecol 2009; 16:282-90. [DOI: 10.1016/j.jmig.2009.02.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 02/08/2009] [Accepted: 02/18/2009] [Indexed: 10/20/2022]
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