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OBJECTIVES: Tubal sterilisation using Essure is a minimally invasive technique for permanent contraception, with high rates of patient satisfaction. However, some women subsequently choose removal of the inserts, due to side effects such as pelvic pain, abnormal bleeding, dyspareunia or allergic dermatitis. This case series presents the management of eight women who underwent laparoscopic removal of Essure inserts in conjunction with salpingectomy. We describe our surgical technique, its underlying principles and immediate surgical outcomes. METHODS: Eight patients were identified as having undergone removal of Essure inserts, via an electronic search of the surgical procedures database. A retrospective review of case records was undertaken. The primary outcome was safety and feasibility of the laparoscopic salpingectomy approach. Secondary outcome measures included implant fracture rate, operative time, blood loss and length of patient stay. RESULTS: All eight women were able to undergo laparoscopic salpingectomy and removal of the Essure inserts without the need for laparotomy or hysterectomy. There were no incidences of fracture or incomplete removal of the insert. Immediate postoperative recovery was uncomplicated in all eight women; the mean length of stay was 17 h. One patient had a small bowel serosal tear attributed to laparoscopic entry. CONCLUSION: This case series suggests that laparoscopic salpingectomy for removal of Essure inserts is safe and feasible. We acknowledge that the numbers were small. However, consistent use of a laparoscopic approach in these eight patients indicates that this procedure is a feasible and suitable alternative to hysterectomy.

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We report a study of the electronic properties of the ferromagnetic semiconductor (Ga,Mn)As using magnetic linear dichroism in the angular dependence of Mn 2p photoemission under hard x-ray excitation. Bulk plasmon loss satellites demonstrate that the probed Mn ions are incorporated deep within the GaAs lattice, while the observed large dichroism indicates that the spectra originate from ferromagnetic substitutional Mn. Simulations of the spectra using an Anderson impurity model show that the ferromagnetic Mn 3d electrons of substitutional Mn in (Ga,Mn)As are intermediate between localized and delocalized.

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Remarkably anisotropic Mn L2,3 x-ray magnetic circular dichroism spectra from the ferromagnetic semiconductor (Ga,Mn)As are reported. States with cubic and uniaxial symmetry are distinguished by careful analysis of the angle dependence of the spectra. The multiplet structures with cubic symmetry are qualitatively reproduced by calculations for an atomiclike d5 configuration in tetrahedral environment, and show zero anisotropy in the orbital and spin moments within the experimental uncertainty. However, hybridization with the host valence bands is reflected by the presence of a preedge feature with a uniaxial anisotropy and a marked dependence on the hole density.

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The use of softer-energy X-rays produced by synchrotron radiation for diffraction is an area of current interest. In this paper, experiments exploiting resonant scattering at the L absorption edges of 3d transition metal elements are reported. Such energies, typically 500-1000 eV, are at the extreme limit of soft X-ray diffraction where absorption effects are so severe that the sample and diffractometer must be placed in a windowless high-vacuum vessel. In addition, the Ewald sphere is so small as to likely contain, at most, only a single Bragg reflection. Advantages of using such radiation for the study of weak diffraction effects such as anomalous scattering, charge ordering, magnetic diffraction and orbital ordering are reported.

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