The U-technique for Norplant removal is a simple procedure that was initially developed by an Indonesian physician, Dr. Untung Praptohardjo, to assist in the difficult Norplant removal. Modification has improved its effectiveness. Its advantages include ease of performance, small incision size, and minimal dissection. This technique requires the use of a special clamp that is a modified version of the no-scalpel vasectomy clamp. Although similar in appearance to the no-scalpel vasectomy clamp, the modified clamp has different dimensions thereby minimizing the risk of tearing the implant. Download Norplant Video 2.5meg avi

STEPS:

1. Both ends of each implant are marked with a pen and the implant is drawn on the arm to facilitate its removal.

    

2. The arm is prepped with Betadine solution.

    

3. A site approximately one-third from the base of the fan between the third and fourth implants is injected with Xylocaine 1% with bicarb 1cc/10cc. The injection is then carried laterally underneath the implant with a total of 4-6 cc of local anesthetic injected under the three implants on each side.

    

4. A 4mm incision is made with a #11 blade.

    

5. The Norplant removal clamp is inserted so as to grasp each implant approximately one-third of the way from the bottom end. This is made easier by stabilizing each implant with a finger from the opposite hand.

   

6. Using gentle traction, each implant is brought to the incision where using gauze sponge, #22 needless or knife blade, the capsule is gently incised. If a knife is used the capsule is scraped gentle in a direction parallel to the implant and not in a cutting motion across the implant as this may transect the implant and make removal more difficult.

7. The implants are removed.

   After removing all implants, the implants are displayed for the patient to see and then dressing is placed over the incision site. Postoperative wound care is similar to other Norplant removal techniques.

As levonorgestrel is cleared within 96 hours, alternative contraception should be provided prior to discharging the patient.

For more information, please read Modified U-Technique, Reynolds R: Journal of Family Practice (Feb 1995, Vol 40, pages 173-80)