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Surgical Management for Removal of Essure Device
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Open Communications 1: Basic Science/Research/Education (11:00 AM — 12:45 PM) 12:10 PM Endosee for Office Cystoscopy: A Single Site Experience Vardy MD,*,1 Vardy AS,2 Desai V3. 1Ob/Gyn, Icahn School of Medicine at Mount Sinai, in New York City, New York, NY; 2Tenafly High School, Tenafly, NJ; 3Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT *Corresponding author. Study Objective: Demonstrate the safety and efficacy of an FDA approved handheld hysteroscope used as a newly FDA cleared handheld cystoscope in the office. Design: Case series. Setting: Busy outpatient urogynecology office private practice. Patients or Participants: Thirty-nine consecutive women scheduled for office cystourethroscopy. Interventions: Patients undergoing office cystourethroscopy in a single outpatient urogynecology office site were evaluated using the Endosee device with saline infusion without anesthesia. Measurements and Main Results: Patient demographics, indications, findings, procedure length, volume of distention fluid, adequacy of the procedure and complications were analyzed. Digital images of all procedures were obtained and tabulated to illustrate the ability to diagnose a multitude of common bladder conditions in female patients with a variety common urogynecologic problems. 100% of procedures noted complete anatomic visualization and bilateral ureteral spillage. All patients were able to tolerate the procedure with no pre-procedure analgesia. Mean patient age 67.3 (SD=13.5, range 41-91), with common indications including hematuria (51.3%), urgency or incontinence (43.6%), recurrent UTI (20.5%), preoperative evaluation (10.3%). Average time of Endosee cystoscopy procedure was 206.5 seconds (SD=59.9) with average filling fluid volume 386.7 cc (SD=53.1). Procedure findings included trabeculations, hypervascularity, bladder stones, bladder and urethral polyps, hemangiomas, and cystitis cystica. One post-procedure day 2 fever was noted, culture negative who self-treated with Ciprofloxacin. Conclusion: Endosee, which is FDA cleared for cystourethroscopy, is a safe, effective, well-tolerated alternative for office assessment of the bladder in female patients. The ability to portably perform office cystoscopy in flexible settings may make this modality more accessible to practitioners, without the need for a dedicated cystoscopy room or expensive tower. Further study may be warranted to determine whether Endosee may lead to earlier and more accurate diagnosis for a multitude of bladder problems.
Open Communications 1: Basic Science/Research/Education (11:00 AM — 12:45 PM)
S21 Setting: The patient is a thirty-eight-year-old gravida two para two who previously underwent Essure tubal occlusion. Although she understood the permanent and irreversible nature of Essure coils, she presented with desire of another pregnancy. She was well informed that in-vitro fertilization would offer her the best chance to get pregnant. However, due to personal reasons, she absolutely wanted tubal re-implantation. Interventions: Laparoscopic bilateral cornuectomy, partial salpingectomy with removal of Essure coils and tubal re-implantation was performed. Postoperative management included oral antibiotics, removal of stents under hysteroscopy and hysterosalpingography. Conclusion: This is the first reported case of tubal re-implantation following hysteroscopic tubal occlusion using the proposed method. The surgical steps and technical tips discussed are safe, and may help patients with desire of pregnancy following Essure insertion who seek alternative options to assisted reproductive technology. Open Communications 2: Laparoscopy (11:30 AM — 12:45 PM) 11:30 AM Surgical Management for Removal of Essure Device Smith RB,* Mahnert N, Mourad J. Minimally Invasive Gynecologic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ *Corresponding author. Video Objective: To present two surgical cases of laparoscopic removal of Essure hysteroscopic sterilization device via salpingectomy with and without cornuectomy. Setting: One 37-year-old woman with heavy menstrual bleeding, joint pain, and fatigue reported by rheumatology to have a nickel allergy who desired Essure removal and one 51-year-old woman with pelvic pain and multiple co-morbidities who desired Essure removal. Both patients underwent surgical management for the removal of Essure at an academic medical center. Interventions: In this surgical video, we present two cases of women desiring Essure implant removal secondary to adverse effects from the device. The first case describes the step by step approach to removal of an intact Essure implant by laparoscopic salpingectomy. The second case describes an approach to removal of Essure by salpingectomy with cornuectomy which is particularly helpful when the endometrial cavity has been previously ablated as in second case, or if there was a complicated insertion with perforation. Additionally, we describe the Essure implant composition in detail, describing how intact removal is imperative as fracturing of the device may lead to further complications or adverse effects. Conclusion: Laparoscopic salpingectomy with and without cornuectomy are safe and effective procedures for the intact removal of Essure and are feasible alternatives to hysterectomy for women who desire removal of Essure.
12:17 PM Open Communications 2: Laparoscopy (11:30 AM — 12:45 PM)
Tubal Re-Implantation Following Hysteroscopic Tubal Sterilization Ngan TYT,*,1 Smith C,2 Thiel JA,3 Rattray DD1. 1Obstetrics and Gynecology, Regina General Hospital, Regina, SK, Canada; 2Obstetrics and Gynecology, Fraser Health Authority, Vancouver, BC, Canada; 3 Obstetrics and Gynecology, University of Saskatchewan, Regina, SK, Canada *Corresponding author.
Techniques to Master A Difficult Bladder Flap Melnyk A,*,1 Mansuria SM2. 1OBGYN, UPMC, Pittsburgh, PA; 2UPMC, Pittsburgh, PA *Corresponding author.
Video Objective: In this video, we demonstrate a novel laparoscopic technique of tubal re-implantation after hysteroscopic tubal sterilization with micro-inserts.
Video Objective: The purpose of this video is to review techniques utilized to decrease the risk of bleeding or bladder injury when encountering a difficult bladder flap.
11:37 AM
Open Communications 1: Basic Science/Research/Education (11:00 AM — 12:45 PM)
S21 Setting: The patient is a thirty-eight-year-old gravida two para two who previously underwent Essure tubal occlusion. Although she understood the permanent and irreversible nature of Essure coils, she presented with desire of another pregnancy. She was well informed that in-vitro fertilization would offer her the best chance to get pregnant. However, due to personal reasons, she absolutely wanted tubal re-implantation. Interventions: Laparoscopic bilateral cornuectomy, partial salpingectomy with removal of Essure coils and tubal re-implantation was performed. Postoperative management included oral antibiotics, removal of stents under hysteroscopy and hysterosalpingography. Conclusion: This is the first reported case of tubal re-implantation following hysteroscopic tubal occlusion using the proposed method. The surgical steps and technical tips discussed are safe, and may help patients with desire of pregnancy following Essure insertion who seek alternative options to assisted reproductive technology. Open Communications 2: Laparoscopy (11:30 AM — 12:45 PM) 11:30 AM Surgical Management for Removal of Essure Device Smith RB,* Mahnert N, Mourad J. Minimally Invasive Gynecologic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ *Corresponding author. Video Objective: To present two surgical cases of laparoscopic removal of Essure hysteroscopic sterilization device via salpingectomy with and without cornuectomy. Setting: One 37-year-old woman with heavy menstrual bleeding, joint pain, and fatigue reported by rheumatology to have a nickel allergy who desired Essure removal and one 51-year-old woman with pelvic pain and multiple co-morbidities who desired Essure removal. Both patients underwent surgical management for the removal of Essure at an academic medical center. Interventions: In this surgical video, we present two cases of women desiring Essure implant removal secondary to adverse effects from the device. The first case describes the step by step approach to removal of an intact Essure implant by laparoscopic salpingectomy. The second case describes an approach to removal of Essure by salpingectomy with cornuectomy which is particularly helpful when the endometrial cavity has been previously ablated as in second case, or if there was a complicated insertion with perforation. Additionally, we describe the Essure implant composition in detail, describing how intact removal is imperative as fracturing of the device may lead to further complications or adverse effects. Conclusion: Laparoscopic salpingectomy with and without cornuectomy are safe and effective procedures for the intact removal of Essure and are feasible alternatives to hysterectomy for women who desire removal of Essure.
12:17 PM Open Communications 2: Laparoscopy (11:30 AM — 12:45 PM)
Tubal Re-Implantation Following Hysteroscopic Tubal Sterilization Ngan TYT,*,1 Smith C,2 Thiel JA,3 Rattray DD1. 1Obstetrics and Gynecology, Regina General Hospital, Regina, SK, Canada; 2Obstetrics and Gynecology, Fraser Health Authority, Vancouver, BC, Canada; 3 Obstetrics and Gynecology, University of Saskatchewan, Regina, SK, Canada *Corresponding author.
Techniques to Master A Difficult Bladder Flap Melnyk A,*,1 Mansuria SM2. 1OBGYN, UPMC, Pittsburgh, PA; 2UPMC, Pittsburgh, PA *Corresponding author.
Video Objective: In this video, we demonstrate a novel laparoscopic technique of tubal re-implantation after hysteroscopic tubal sterilization with micro-inserts.
Video Objective: The purpose of this video is to review techniques utilized to decrease the risk of bleeding or bladder injury when encountering a difficult bladder flap.
11:37 AM