Surgical Pearl: Phlebectomy hook Norplant extraction

Removal of Norplant contraceptive implants may be rendered difficult by the size of the capsules and variations in insertion technique. In the standard removal technique a single transverse incision is made close to and below the distal ends of the capsules and a mosquito forceps is used for extraction. Described in this article is a simple technique for the isolation and removal of Norplant with a Ramelot phlebectomy hook. After anesthesia with 1% lidocaine with 1:100000 of epinephrine a 5 mm horizontal stab incision with a Number 11 blade is made at the base of the implants. Using digital palpation for stabilization each capsule is captured with the Ramelot hook and delivered through the incision. After the implant is grasped with a mosquito forceps gentle traction and an oscillating motion dislodge the implant from the surrounding fibrous tissue. Incision sites are closed with plain gut sutures. Complications associated with this procedure include broken capsules cutaneous infection and contusion.