Department of Obstetrics & Gynecology, Minnesota Women's Care, Maplewood, MN.
Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
JSLS. 2022 Oct-Dec;26(4). doi: 10.4293/JSLS.2022.00072.
To analyze long-term effectiveness of a conservative, uterine-sparing approach to laparoscopic Essure removal. Specific outcomes of interest include patient satisfaction, symptom resolution, and subsequent surgical intervention.
A retrospective case series and follow-up survey. Patients who underwent laparoscopic Essure removal without concomitant hysterectomy between January 1, 2016 and December 31, 2019 were identified. Greater than 18 months after removal participants completed a survey assessing outcomes.
Twenty-nine patients underwent conservative Essure removal and there were 19 survey respondents. Among survey respondents, the mean length of time from Essure placement to removal was 56.7 months (range 5 - 117), and the mean length of time from removal to survey administration was 48.3 months (range 23 - 63). The most frequently reported symptoms were pain (100%), bleeding (52.6%), headache (42.1%), and dyspareunia (42.1%). Methods for removal included laparoscopic salpingectomy (58.6%), a combined hysteroscopic and laparoscopic approach (34.4%), and cornuectomy (6.9%). Regarding symptom improvement after Essure removal, 47.4% of patients reported total improvement, 36.8% reported almost total improvement, 5.3% reported some improvement, and 10.5% reported no improvement. Most patients (89.5%) reported satisfaction with their surgical results, and only two patients required subsequent surgical intervention for symptom management.
Most patients in our cohort reported total or almost total improvement in symptoms almost two years after Essure removal, with low rates of reintervention. A uterine-sparing approach to Essure removal, using laparoscopic and hysteroscopic modalities, may be a feasible and effective approach to addressing Essure-attributed symptoms.
分析经腹腔镜行埃索雷尔绝育装置（Essure）保留子宫的保守性移除术的长期疗效。感兴趣的具体结果包括患者满意度、症状缓解以及随后的手术干预。
回顾性病例系列和随访调查。确定 2016 年 1 月 1 日至 2019 年 12 月 31 日期间行腹腔镜下 Essure 移除而未同时行子宫切除术的患者。移除后超过 18 个月，参与者完成了一项评估结果的调查。
29 例患者行保守性 Essure 移除术，其中 19 例接受调查。在调查对象中，Essure 放置至移除的平均时间为 56.7 个月（范围 5-117），移除至调查实施的平均时间为 48.3 个月（范围 23-63）。报告最常见的症状为疼痛（100%）、出血（52.6%）、头痛（42.1%）和性交困难（42.1%）。移除方法包括腹腔镜输卵管切除术（58.6%）、宫腔镜和腹腔镜联合方法（34.4%）和Cornu 切除术（6.9%）。关于 Essure 移除后症状改善，47.4%的患者报告完全改善，36.8%报告几乎完全改善，5.3%报告有些改善，10.5%报告无改善。大多数患者（89.5%）对手术结果表示满意，仅有 2 例患者因症状管理需要再次手术干预。
我们队列中的大多数患者在 Essure 移除后近两年报告症状完全或几乎完全改善，再次干预率低。使用腹腔镜和宫腔镜方法对 Essure 保留子宫的移除，可能是一种可行且有效的治疗 Essure 相关症状的方法。
