Removal of non-palpable etonogestrel implants.

©FSRH J Fam Plann Reprod Health Care 2008: 34(2) Introduction This review has been written by a group of specialists who, between them, have accumulated considerable experience with slightly differing approaches to difficult Implanon® (the single-rod, subdermal implant system releasing etonogestrel; NV Organon, Oss, The Netherlands) removals, largely based on precise implant location using specific ultrasound scanning techniques.1–6 The surgical techniques used for removal depend on a number of factors including depth and anatomical location of the implant, proximity of other structures, experience of the operator and availability of simultaneous ultrasound scanning. Most clinicians working in the field of contraception and sexual health will have reasonable conventional surgical skills, but increasing expertise with the correct type of realtime ultrasound scanning transducer will allow a precise interventional radiology-type approach to removal, even of very deep implants through a small incision.7,8 This review attempts to place different surgical approaches into a sensible clinical context.