Innovative technique for Norplant implants removal.

This study evaluates a unique and completely different approach from the original removal technique. The main objective of this technique is to facilitate removal of widely-spaced, deeply-positioned, and misplaced Norplant capsules. A local anesthetic is injected deep and perpendicular to the long axis of the Norplant rods. The hypodermic needle is left in place underneath the six silicone rods for the entire removal procedure. One or two 3-4mm vertical incisions were made between the capsules over the needle. The Norplant rods were dissected free from the fibrous tissue and the skin with a #11 blade. A curved mosquito forceps was inserted between the skin and the Norplant rod, to hook and deliver the capsule through the incision, from where it can be easily removed. This method resulted in far less time, effort, and skill from the health care provider, no damage to the capsules, and much less trauma to the clients.

PIP: Between September 1993 and June 1994, 4 physicians in California removed 22 Norplant implants using an innovative and simple removal technique designed to remove misplaced capsules. They all had had experience with the original removal technique. They inserted a 2 inch, 21 gauge hypodermic needle perpendicular to the long axis of the Norplant capsules and left it under the capsules during the entire procedure. This served to lift, stabilize, and make the rods easier to palpate and to dissect a tract underneath the rods. They injected 2-3 ml of 2% xylocaine with epinephrine as they slowly advanced the needle. The physicians made one or two 3-4 mm vertical incisions between capsules 2 and 3 and between capsules 4 and 5 over the needle. The 2nd incision reduced trauma and scarring as well as the time, effort, and skill needed from the provider. In about 46% of cases, they were able to remove the rods through a single incision. They used a 11 blade to dissect the rods free. They inserted a small curved mosquito forceps to deliver the rod through the incision. The tip was either facing downwards, then rotated 180 degrees to deliver the rod, or facing upwards to deliver it. Another forceps was used to dissect the rod free from fibrous tissue and to remove it. After removal of the 6th rod, they removed the needle and applied Steri-strips. About 70% of all rods were visible and palpable. About 14% were higher than the other rods. Two women had rods that crossed. It took, on average, 12 minutes to remove all 6 capsules. 77% of the women returned for the follow-up visit (3-4 days postremoval). The physicians followed up with the remaining women by telephone. 64% experienced a minor hemorrhagic spot over the procedure site. The Steri-strips caused a blister in 1 client. At the postremoval visit, no one had removal-site hematomas or infections. This removal technique may increase acceptability and use of Norplant and reduce its cost.