Norplant implants were removed from fifty (50) patients using a modified approach to Norplant implant removal (Emory Method). Eighty-eight percent (88%) of the removals were accomplished in less than 10 minutes using this technique. The average time for removal of Norplant implants from 50 women included in the current study was 8 minutes. The Emory Method for Norplant implant removal includes three steps which are different from the technique developed by the Population Council. More anesthesia, a slightly longer incision and vigorous disruption of the tissue encapsulation surrounding the implants are recommended. The Emory Method is fast, safe and easy to perform. It has been successfully taught to over twenty-five clinicians.
PIP: Physicians removed 50 subdermal implants (Norplant) between October 1992 and February 1993 at Grady Memorial Hospital in Atlanta, Georgia, using the Emory Method of Norplant removal. The duration of Norplant use ranged from 4 weeks to 20 months. Equipment used for this method include sterile surgical drapes, 1 pair of sterile talc-free gloves, antiseptic, local anesthetic, 12-cc syringe and 22-gauge 1-1/2 inch needle, 1 11 scalpel, 2 mo squito Halstead forceps (1 straight and 1 curved, 5 inches long), 1 tissue Adson forceps (1 x 2 teeth), butterfly bandages or other skin closures, and sterile gauze and compresses. Key points of the method are 6 cc of 1% lidocaine rather than the 3 cc of lidocaine called for by the Population Council Method; inject about 1 cc at incision site and 0.75 cc underneath the lower half of each implant; make a 1 cm superficial, horizontal incision rather than the 3-4 mm incision called for by the Population Council Method at the original incision site or close to the lower ends of the implants; introduce curved 5 inch long mosquito forceps into the incision and vigorously, but gently, dissect the subcutaneous tissues deep to the proximal ends of each implant for about 20 seconds; use the index finger to push the distal end of the implant toward the incision and use the curved forceps to grab the implant; and use the straight mosquito forceps to remove the implant. The steps that distinguish the Emory Method from the Population Council Method were more anesthesia, a longer incision, and vigorous disruption of the tissue encapsulation surrounding the implants. Despite the more vigorous tissue disruption, bruising is no more likely than it is with the Population Council Method. Average removal time was 8 minutes (range, 5-20 minutes) compared to 30 minutes in 50% of Population Council Method cases. Since this study, there have been at least 300 more Norplant removals using the Emory Method. 25 clinicians other than the study physicians have undergone instruction in the Emory Method.