Techniques for removal of the Essure hysteroscopic tubal occlusion device.

Objective: To present two case reports of techniques for removal of the Essure (Conceptus, Inc., Mountain View, CA) hysteroscopic tubal occlusion device.
Design: Case report.
Setting: University-affiliated teaching hospital.
Patient(s): Two women requesting removal of Essure devices because of persistent pelvic pain up to 6 weeks after placement.
Intervention(s): Hysteroscopic and laparoscopic removal of the Essure microinserts. No institutional review board approval was obtained because the procedures were not part of a study protocol.
Main Outcome Measure(s): Effective removal of the Essure device and resolution of pelvic pain symptoms.
Result(s): Successful removal of the device was achieved in both patients. In one case, the procedure was performed entirely by hysteroscopy. In the other case, a laparoscopic approach was required because of a lack of visualization of the device. Pain symptoms resolved within 2 weeks of removal in both patients.
Conclusion(s): These are the first reported cases of successful removal of the Essure tubal occlusion devices up to 6 weeks after placement. This procedure can be safely performed with the use of hysteroscopy if the inserts are clearly visualized. Laparoscopy is an alternative when the device is completely within the fallopian tube. Further study is needed to assess the functionality of the tube after the procedure, as well as feasibility of removal beyond 6 weeks.