Removal of deeply inserted, nonpalpable levonorgestrel (Norplant) implants

Abstract

Deeply inserted, nonpalpable contraceptive implants can often be removed easily using 6-8 cm3 of 1% lidocaine and a single 1 cm incision. There is no need for suturing of the incision. The location of nonpalpable implants not retrieved by this procedure can be determined by a plain, soft tissue x-ray (standard AP and lateral and internal oblique; 45-55 kVP) of the area where the implants are inserted. Removal can then be accomplished several weeks later.

PIP: Between October 1992 and January 1995 clinicians removed 48 deeply inserted, nonpalpable contraceptive implants at Grady Health System in Atlanta, Georgia. They used 6-8 cu. cm of 1% lidocaine and a single 1-cm incision. No suturing of the incision was needed. The incision scars were small and the women found the scars cosmetically acceptable. 90% of the removals were conducted in no more than 30 minutes. No complications occurred. One clinician used soft tissue X-ray, plain X-ray, fluoroscopy, and ultrasound to locate the nonpalpable implants in one volunteer to determine the most cost-effective method of locating them. Neither fluoroscopy nor plain X-ray located the implants. The soft tissue X-ray, low KVP X-ray, and ultrasound detected the implants. These findings indicate that the technique used to identify and remove nonpalpable contraceptive implants at Grady Health System in Atlanta is simple and cost-effective and also benefits patients and clinicians.