“I do a linear salpingotomy over the proximal portion of the fallopian tube where the device is, and use fine-tip forceps to tease the tissue apart and identify the device. You tease it out, regrasp it, tease it out, and regrasp it. It’s really important to pull in a straight line” so Essure doesn’t break. “It’s not necessary to cut deep into the cornea of the uterus. I get an x-ray on the table to ensure there’s no metal left,” Dr. Presthus said.
Women have to know that there are alternatives before they opt for Essure, and that it can be taken out if needed. “They don’t have to [just] live with their problems or have a hysterectomy. The discussion you have before the procedure is important,” he said.
Dr. Charles Monteith in Raleigh, N.C., and Dr. Mark Sanchez in Clearwater, Fla., prefer an open approach, operating through a small incision above the bikini line.
Dr. James Presthus
Both are long-time experts in reversing tubal ligations, and are in high demand lately to take out Essure, and sometimes even restore fertility. Fertility can be restored in about a third of patients, they said.
“If the device is removed within 3 months, it’ll come out fairly easily with traction,” Dr. Monteith said. After that, scarring locks it into place, “so we start dissection over the device and follow it down into the uterine cavity, and remove it intact” – without traction – “with the surrounding tubal muscularis. That’s worked well for us,” he said.
Dr. Monteith said he has removed or reversed Essure in about 200 women.
“Avoid electrocautery because it causes the nickel in the outer coil to burn, spark, and fracture. Also, have an appreciation for variable insertions of the device. We’ve seen the coils pushed too deeply” into the fallopian tube, and “we’ve seen them barely going in. You have to palpate them to know where they are” before taking them out, so as not to cut into them by accident, he said.
Dr. Sanchez, also a high-volume Essure surgeon, cuts down into the corneal segment of the uterus and slowly dissects out the coil. “You have to pay close attention to make sure you get all the bits of the coil out as much as possible.” From there, restoring fertility usually means reanastomosing the fallopian tubes and corneal reimplantation, he said.
Other surgeons have developed similar techniques (Contraception. 2013 Sep;88[3]:334-6.).
Dr. Presthus, Dr. Monteith, and Dr. Sanchez reported having no current connections to Bayer, and are not involved in legal action against the company.