Despite recent negative lay press and a boxed safety warning from the Food and Drug Administration, Essure tubal microinserts continue to be a popular method of permanent contraception. It is imperative for patients to understand that this method of contraception cannot be reversed, and thereafter, the only method to achieve pregnancy would be via in vitro fertilization. Furthermore, preoperatively, patients must be counseled that placement of the Essure tubal microinserts may be associated with pelvic pain, abnormal bleeding, and even allergic reaction.
Even with our best effort to properly inform our patients as to the risks and benefits of permanent sterilization via Essure tubal microinserts, secondary to undesired side effects, patients desire their removal. This can be a challenging endeavor for the practitioner, especially if the women is not interested in hysterectomy.
Dr. Charles E. Miller
To discuss tips and tricks for the safe removal of Essure tubal microinserts, I have recruited an excellent group of minimally invasive gynecologic surgeons for this edition of the Master Class in Gynecologic Surgery: Sarah Cohen, MD, MPH, of Brigham and Women’s Hospital, Boston; Mark Levie, MD, of Montefiore Medical Center, New York; and Amanda Yunker, DO, of Vanderbilt University, Nashville. Here, they present their thoughts as to how these microinserts should be removed safely and efficiently. Reading through these excerpts of their recommendations, one will quickly see a commonality in their thought processes and approaches.
Dr. Miller is clinical associate professor at the University of Illinois at Chicago and past president of the AAGL. He is a reproductive endocrinologist and minimally invasive gynecologic surgeon in metropolitan Chicago; director of minimally invasive gynecologic surgery at Advocate Lutheran General Hospital, Park Ridge, Ill.; and the medical editor of this column. He reported having no financial disclosures related to this column.