Removal of a Nonpalpable Etonogestrel Implant With Preprocedure Ultrasonography and Modified Vasectomy Clamp

Abstract

BACKGROUND: 

Deep etonogestrel contraceptive implant placements still occur despite design modifications to the implant inserter. We present a method for outpatient removal of a nonpalpable etonogestrel implant using preprocedure ultrasonography for implant localization followed by removal with a modified vasectomy clamp, a modification of the “U” technique for six-capsule levonorgestrel implant removal.

TECHNIQUE: 

In women with a nonpalpable etonogestrel implant containing barium sulfate, we obtain a radiographic examination to confirm the implant's presence in the upper extremity. Using an 18-MHz linear ultrasound transducer, we identify and mark the implant location on the patient's arm, noting the depth. We remove the implant with local anesthesia in the office using a modified vasectomy clamp through a 5-mm or less skin incision directly over the implant.

EXPERIENCE: 

All three patients referred to our office with nonpalpable etonogestrel implants had successful removal using this technique.

CONCLUSION: 

Nonpalpable contraceptive implants can be removed in the office using a modified vasectomy clamp after localization with high-frequency ultrasonography. Given the relative infrequency of nonpalpable implant removals, regional expert sites with health care providers experienced in difficult removals should be created for patient referrals.

In Brief

A modified vasectomy clamp in combination with accurate preprocedure ultrasound localization facilitates removal of nonpalpable etonogestrel contraceptive implants in the outpatient setting.