Surgical excision of Essure®
July 25, 2016 8:37 pm
Surgical excision of Essure® devices with ESHRE Class llb uterine malformation: Sequential hysteroscopic-laparoscopic approach to the septate uterus
E.S. Sills¹˒², G.D. Palermo³
¹ Reproductive Research Division, Center for Advanced Genetics; Carlsbad, California, USA.
²Molecular and Applied Biosciences Department, Faculty of Science & Technology, University of Westminster, London, U.K.
³Ronald O. Perelman & Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, U.S.A.
Correspondence at: Reproductive Research Division, Center for Advanced Genetics, 3144 EL Camino Real, Suite 106, Carlsbad, California 92008 USA. E-mail: drsills@CAGivf.com
Most research on uterine anomalies has derived from populations of women with a history of reproductive loss, so there is little data on how prevalent this condition may be in the general population. One investigation, which screened asymptomatic women with no adverse reproductive history, reported that approximately 3% had a septate uterus (Woelfer et al., 2001). Among infertility patients however, this condition is thought to be present in up to 10% of women (Propst and Hill, 2000). One prospective analysis from the United Kingdom showed that women with a septate or bicornuate uterus experienced significantly increased second-trimester miscarriages compared to patients with no uterine malformation (Saravelos et al., 2010).
Each year, more than 300,000 women request permanent surgical sterilization in the United States (Jones et al., 2012), and it is possible that some of these patients will have an undiagnosed Mϋllerian anomaly. The current classification system of uterine malformations uses a taxonomy developed from an international consensus conference (Grimbizis et al., 2016). While laparoscopic bilateral tubal ligation is the most common technique to provide permanent female contraception, a new sterilization option became available in 2002: bilateral tubal occlusion via hysteroscopic insertion of nickel-titanium inserts at the proximal fallopian tubes. Importantly, the presence of a uterine malformation may impair visualization of tubal ostia and thus is listed as a relative contraindication for the Essure® procedure. Nevertheless, the Essure® procedure can be performed in the setting of an ESHRE Class IIb uterine malformation although no data exist to describe how often this occurs. The current report is the first to describe the Essure® technique applied to a woman with a uterine septum and the successful removal of these devices using a minimally-invasive, uterus-sparing surgical approach.
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