Removal of Palpable Subdermal Contraceptive Rod Implants.

Removal of Contraceptive Implant Clinical Trial

Official title:

A Prospective, Single-centre, Non-comparative Feasibility Investigation to Evaluate Performance and Safety of RemovAid ™ Retrieval Device When Used for Removal of Palpable Subdermal Contraceptive Rod Implants.

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02986971
• Other study ID #: REVALID
• Status: Terminated
• Phase: N/A
• First received: November 28, 2016
• Last updated: November 20, 2017
• Start date: January 11, 2017
• Est. completion date: September 15, 2017

Study information

• Verified date: December 2016
• Source: RemovAid AS
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

There are no implant removal devices on the market by any manufacturer. New features are described in comparison with the existing removal technique. Overall, the RemovAid™ combines the features of fixation, incision and extraction. This combination of functions has not previously been combined in a single device.

The investigators wish to perform this pilot clinical investigation with the aim to demonstrate that the Investigational Medical Device (IMD), RemovAid ™, may safely and effectively facilitate implant removal. Other aims are to show that the IMD have the potential to reduce procedure length variability, reduce procedural complexity and reduce the need for additional procedural equipment related to CI removal procedures, without causing any harm to the subject.

Description:

Contraceptive Implants (CIs) were introduced to the commercial market in the early 1980s. They are advocated as a safe and effective method of contraception, and are included on the WHO's Essential Medicines list.

CI manufacturers have focused intense efforts on making insertion of CIs easier, but have largely left CI removals untouched and at the mercy of the various service providers. Different introducers and trocars are available for use with the different CI systems available internationally, and a second generation, single-use trocar is supplied with the Nexplanon® implant system available in Sweden. This second generation trocar has reduced the number of misplaced or deeply inserted CIs, and underlines the benefits of standardizing minor surgical procedures through the use of dedicated medical devices.

The CI removal procedure recommendations have remained essentially unchanged for 40 years, relying on scalpels, forceps and general surgical skills from the service provider. Currently, no standardized technique for removal of CIs exists, and no dedicated CI removal device is found on the commercial market.

Removal of palpable subdermal implants is generally a simple, minor surgical office procedure. However, the procedure for implant removal requires more training and skill than the procedure for insertion. There is a risk of slippage of the scalpel blade or a sudden movement by the client causing inadvertent deeper penetration, in which case any underlying structure could be affected.

Mean removal times, from time of incision until removal of the rod, are consistently reported as less than four minutes, however with ranges from 0.2 - 60 minutes.

Available research shows that the procedure length of the current CI removal procedure is highly variable and reliant on individual operator skills.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 22
• Est. completion date: September 15, 2017
• Est. primary completion date: May 19, 2017
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Female age 18 or older

• Willing to remove a palpable subdermal Implanon/ Neplanon CI

• Willing and able to give written informed consent for participation in the investigation

• Willing to provide follow-up information according to the Clinical Investigators Brouchure

Exclusion Criteria:

• Known allergy to local anaesthetic (lidocaine/lignocaine) or disinfectant (chlorhexidine).

• Active skin lesion over the CI.

• The Investigator considers the subject unlikely to comply with investigational procedures, restrictions and requirements.

• Any contraindication for removal of the PI, as judged by the Investigator.

• Any disorders or medications that might affect coagulation, as judged by the Investigator.

• Any conditions suspected to affect healing or increase risk of infection (e.g. keloid tendency, diabetes or any upper arm dermatological condition that may affect upper arm healing).

Related Conditions & MeSH terms

• Removal of Contraceptive Implant

Intervention

Device:
• New IMD
The contraceptive implants of the subjects in this arm are removed by the new IMD.

Locations

Country	Name	City	State
Sweden	Karolinska University Hospital	Stockholm

Sponsors (5)

Lead Sponsor	Collaborator
RemovAid AS	Amano Clinical Consulting, Bill and Melinda Gates Foundation, Karolinska University Hospital, The Research Council of Norway

Country where clinical trial is conducted

Sweden, 

References & Publications (7)

Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2012 Oct;120(4):983-8. — View Citation

Funk S, Miller MM, Mishell DR Jr, Archer DF, Poindexter A, Schmidt J, Zampaglione E; Implanon US Study Group. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception. 2005 May;71(5):319-26. — View Citation

Levine JP, Sinofsky FE, Christ MF; Implanon US Study Group. Assessment of Implanon insertion and removal. Contraception. 2008 Nov;78(5):409-17. doi: 10.1016/j.contraception.2008.06.016. Epub 2008 Sep 18. — View Citation

Mansour D, Mommers E, Teede H, Sollie-Eriksen B, Graesslin O, Ahrendt HJ, Gemzell-Danielsson K. Clinician satisfaction and insertion characteristics of a new applicator to insert radiopaque Implanon: an open-label, noncontrolled, multicenter trial. Contraception. 2010 Sep;82(3):243-9. doi: 10.1016/j.contraception.2010.04.007. Epub 2010 May 18. — View Citation

Mommers E, Blum GF, Gent TG, Peters KP, Sørdal TS, Marintcheva-Petrova M. Nexplanon, a radiopaque etonogestrel implant in combination with a next-generation applicator: 3-year results of a noncomparative multicenter trial. Am J Obstet Gynecol. 2012 Nov;207(5):388.e1-6. doi: 10.1016/j.ajog.2012.08.002. Epub 2012 Aug 10. — View Citation

Webb AM. Why go to Tiger Country? A report of two cases of Implanon removal. J Fam Plann Reprod Health Care. 2006 Jul;32(3):193-4. — View Citation

World Health Organization. 2014 [cited April 23rd.]; Available from: http://www.who.int/medicines/publications/essentialmedicines/en/

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Successful removal of implant	Percentage of fixated implants that were successfully removed without the use of additional tools.	5 minutes
Secondary	Frequency, severity, causality and outcome of adverse events (AEs)	Frequency and severity of sharps injury, nerve damage, blood vessel damage, tissue damage, wound infection and cytotoxicity during and after the use of the device. Performed by investigation of site at the time of operation and one week later.	1 week
Secondary	Pain during procedure	Mean pain score (maximum pain intensity during the procedure) indicated by the subject on a Visual Analogue Scale (VAS) 0-100 mm ruler, assuming that anaesthesia has been properly administered.	5 minutes
Secondary	Success of fixation of implant	Percentage of palpable implants where the implant could be seen and/or felt on both sides of the clamp after maximum three attempts of fixation.	5 minutes
Secondary	Duration of procedure	Mean time from; making incision until implant is removed.; first handling the device until closing the wound.	25 minutes
Secondary	Technical functionality of device determined by an operators questionnaire.	Fulfilment of pre-defined technical requirements, as documented on an operator functionality questionnaire.	5 minutes
Secondary	Operators impression of the device	The operator's global impression of the IMD will be assessed using a 5-point scale.	5 minutes
Secondary	Subject satisfaction	The subject's global assessment of satisfaction with the procedure will be assessed using a 5- point scale.	5 minutes