THE ANCHORING TECHNIQUE: A NOVEL APPROACH TO IMPLANON REMOVAL

Objective: To introduce and evaluate an alternative Implanon removal technique. The main objective is to facilitate
removal of both the properly positioned and the misplaced Implanon capsule.
Study design: A descriptive non comparative study
Setting: Fertility Care Unit, Mansoura university hospital, Mansoura, Egypt
Subjects and method: Implanon implants were removed from 217 clients, during the period from July , 2004 to June,
2006 using the anchoring technique. 130 cases had properly inserted capsules and 87 had misplaced capsules. Seventy
cases of the misplaced capsules were deeply located. This technique involves injecting a local anesthetic by a syringe
with 25-gauge needle deep and perpendicular to the long axis of the Implanon capsule. The needle was then fashioned
into a ring, around the capsule and the overlying skin, with a mosquito forceps after puncturing the skin on the other
side of the capsule to allow its anchoring and stabilization during the entire removal procedure. A 2 mm transverse
incision was made against the lower end of the capsule which is pulled by the underlying needle as close lo the surface
as possible. The capsule was then pushed from its upper end so that it emerges from the incision where il can be
grasped with two fingers or a mosquito forceps and removed. The mean length of the removal times, procedure
problems, implant site symptoms after removal and poslrcmoval complications were evaluated.
Results: This technique resulted in a short removal lime (average 1.9 minutes for the properly inserted implants and 2.3
minutes for the misplaced capsule). No-damage to the capsule occurred and extension of the skin incision was not
needed in all cases. No postremoval implant site contusion or infection was encountered and mild pain at the implant
site was experienced in only 7 cases.
Conclusion: These results suggest that the anchoring technique is a simple and valuable technique for removing boih
properly inserted and improperly located Implanon capsule. The technique also needs far less effort and skill from the
physician