Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University, Marseille, France (Drs. Charavil, Agostini, Rambeaud, Schmitt, and Tourette).
Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University, Marseille, France (Drs. Charavil, Agostini, Rambeaud, Schmitt, and Tourette).
J Minim Invasive Gynecol. 2019 May-Jun;26(4):695-701. doi: 10.1016/j.jmig.2018.07.019. Epub 2018 Aug 1.
To evaluate the feasibility of an en-bloc salpingectomy at the time of vaginal hysterectomy for removal of Essure inserts.
Prospective observational study (Canadian Task Force classification II-1).
Monocenter study at the Conception University Hospital Center, Marseille, France.
Women seeking removal of the Essure device and candidate for vaginal hysterectomy from January 1, 2017 to January 31, 2018.
Patient underwent a total hysterectomy and bilateral salpingectomy by the vaginal route (VH-S) with en-bloc removal of each hemiuterus with the ipsilateral fallopian tube, thereby allowing for removal of the Essure inserts without fragmentation.
Twenty-six VH-S were performed. There was no converted case to laparoscopy or laparotomy because of issues regarding feasibility or complications. Removal of each hemiuterus with the ipsilateral tube as a single unit was feasible in all cases. There was 1 Clavien-Dindo grade 1 perioperative complication: a bladder injury that required 10days of urinary catheterization. There were 2 grade 2 postoperative complications: 1 case of metrorrhagia of a granuloma on the vaginal fundus that was treated with silver nitrate and 1 case of acute urinary retention that required urinary catheterization for 24hours.
Performing a VH-S with en-bloc removal of the hemiuterus with the ipsilateral tube without fragmentation orsectioning of the Essure inserts appears to be feasible. The vaginal route can hence be an approach for women who undergo hysterectomy during Essure insert surgery removal.
评估在阴道子宫切除术中整块切除 Essure 植入物时行输卵管切除术的可行性。
前瞻性观察研究（加拿大工作队分类 II-1）。
法国马赛康 concep tion 大学医院中心的单中心研究。
2017 年 1 月 1 日至 2018 年 1 月 31 日期间要求取出 Essure 装置且适合行阴道子宫切除术的女性。
患者行经阴道（VH-S）全子宫切除术和双侧输卵管切除术，整块切除每侧半子宫及其同侧输卵管，从而可在不使 Essure 植入物破裂的情况下取出。
共行 26 例 VH-S。由于可行性或并发症问题，无 1 例转为腹腔镜或剖腹手术。所有情况下均可行整块切除每侧半子宫及其同侧输卵管作为单一单位。有 1 例围手术期并发症为 Clavien-Dindo 1 级：膀胱损伤，需导尿 10 天。有 2 例 2 级术后并发症：1 例阴道穹窿处肉芽肿性子宫出血，用硝酸银治疗；1 例急性尿潴留，需导尿 24 小时。
整块切除半子宫及其同侧输卵管而不使 Essure 植入物破裂或分割似乎是可行的。因此，对于在 Essure 植入物取出手术期间行子宫切除术的女性，阴道途径可能是一种方法。
