Robot-assisted tubo-tubal reanastomosis after sterilization in 10 steps

Five to 20% of women regret having a tubal ligation. These women are generally otherwise fertile and have a better chance of pregnancy than other patients experiencing infertility, whether by in vitro fertilization or after tubal surgery. Historically, tubal anastomosis surgery has long been performed by microsurgery through laparotomy, which provided very high precision but was associated with some degree of morbidity. The parallel development of in vitro fertilization and laparoscopy have contributed to reducing the indications for tubal surgery. The laparoscopic approach is challenging because of the number and precision of the sutures needed. The robot-assisted laparoscopic approach may reduce the surgical difficulty and improve the accessibility of this technique. We have described the technique of tubo-tubal reanastomosis after sterilization with robot-assisted laparoscopy in 10 steps. Robot-assisted laparoscopy provides favourable conditions for performing tubo-tubal reanastomosis after sterilization due to the camera stability, precision of movement, and amplitude of articulations

Effect of laparoscopy by single-port endoscopic access in benign adnexal surgery: study protocol for a randomized controlled trial

Abstract Background Laparoscopic surgery has become the preferred surgical approach due to a reduction in postoperative pain, better recovery, shorter hospitalization, and improved esthetic outcomes. Laparoscopic surgery with single-port laparoscopy (SPL) is a laparoscopic surgery technique that is based on making a single parietal incision using a single trocar specifically designed to allow introduction of several instruments. The level of evidence regarding the advantages of SPL in terms of postoperative pain has remained low despite several randomized studies. Adult patients exhibiting a surgical indication for an a priori benign ovarian pathology or for prophylactic purposes that can be performed by laparoscopy will be randomized to receive conventional laparoscopy (CL) or SPL. The aim of our study is to evaluate whether SPL offers advantages over CL in benign adnexal surgery. Methods The patients will be evaluated preoperatively to confirm their eligibility. The perioperative data up to 24 h after the intervention, as well as the postoperative data at day 7 and at one month from the intervention will be collected. The primary outcome for the study will be the postoperative pain at 24 h ± 2 h after the intervention. The pain will be assessed by a numeric rating scale of 0–10. Other outcomes will also be assessed, such as pain at other times, the consumption of analgesics, the operative time, perioperative bleeding, the number of additional trocars in the two groups, the incidence of laparoconversion, the esthetic criteria of the scar at one month, the incidence of complications, and the quality of life at one month. Discussion If our hypothesis is confirmed, this study will provide evidence that the use of SPL can decrease postoperative pain in adnexal surgery. The standard surgical treatment of this condition would thus be modified. Trial registration ClinicalTrials.gov, NCT02739724 . Registered on 12 April 2016

Low Energy Characterization of Caliste HD, a Fine Pitch CdTe-Based Imaging Spectrometer

International audienceCaliste HD is a recently developed micro-camera designed for X and gamma-ray astronomy, based on a 1×1 cm$^2$ CdTe Schottky pixelated detector. Its entire surface is composed of 256 pixels, disposed on a 16 × 16 pixel array. This spectrometer is buttable on its 4 sides and can be used to create a large focal plane. It is also designed for space environment. Its IDeF-X front-end electronics has low power consumption, excellent noise performance and a wide dynamic range, from 2 keV to 1 MeV. Moreover, electronic noise performances of this device were optimized to set the low level energy threshold lower than 2 keV.This paper focuses on the Caliste HD performance near the low energy limit. For this purpose, we have exposed the CalisteHD module to a mono-energetic X-ray beam, and set energies between 2 and 12 keV. We measured accurately the detectionefficiency in this energy range and found it to be ranging from 39% to 75% for energies from 2.2 keV to 11.6 keV, consideringonly particles detected in the single-event photopeak and ignoring events impinging between two adjacent pixels. Thisefficiency detection profile thereby highlights crucial effects of the Pt electrode opacity on Caliste HD low energy response, andsuggests the presence of absorption zones at the interface between CdTe crystal and platinum. Respective thickness of eachlayer were estimated by simulation and confirmed by RBS ($Rutherford\ Backscattering\ Spectroscopy$).Besides, using a mono-energetic beam allows fine energy resolution measurement, which was found to be ranging from560 to 760 eV FWHM between 2 and 12 keV. In addition, the linearity of this spectrometer and the issue of charge sharingbetween adjacent pixels were studied. This study revealed that spectroscopic performances remain excellent for such boundaryoperating conditions

Overview and guidelines of off-label use of methotrexate in ectopic ă pregnancy: report by CNGOF

International audienceOur objective is to describe off-label use of methotrexate in ectopic ă pregnancy treatment using evidence based medicine. The patient group ă includes all women with a pregnancy outside the usual endometrium, or of ă unknown location. ă Method used was a Medline search on ectopic pregnancy managed using ă methotrexate treatment; evidence synthesis was done based on this ă current literature analysis. ă Level of evidence (LE) were given according to the centre for evidence ă base medicine rules. Grade was proposed for guidelines but no ă recommendation was possible as misoprostol is off label use for all the ă indications studied. ă In the absence of any contraindication, the protocol recommended for ă medical treatment of ectopic pregnancy is a single intramuscular ă injection of methotrexate (MTX) at a dosage of 1 mg/kg or 50 mg/m(2) ă (Grade A). It can be repeated once at the same dose should the hCG ă concentration not fall sufficiently. Pretreatment laboratory results ă must include a complete blood count and kidney and liver function tests ă (in accordance with its marketing authorization). ă MTX is an alternative to conservative treatment such as laparoscopic ă salpingotomy for uncomplicated tubal pregnancy (Grade A) with ă pretreatment hCG levels 20001U/1, routine MTX treatment is an option. ă MTX is not indicated for combination with treatments such as ă mifepristone or potassium. (C) 2016 Published by Elsevier Ireland Ltd

États des lieux et expertise de l'usage hors AMM du méthotrexate en gynécologie - Obstétrique: Travail du CNGOF

International audienceIn the absence of contraindication, methotrexate by intramuscular unique injection of 1mg/kg or 50mg/m2 is the medical treatment recommended for tubal ectopic pregnancy (EP; LE1). It can be renewed once, at the same dose, according to hCG rates decrease. The pretherapeutic biological assessment contains blood cells numeration, renal and hepatic function. Methotrexate therapy constitutes an alternative conservative treatment to laparoscopic salpingotomy for non-complicated tubal EP (LE1) with hCG level <5000 UI/L (LE2). When the rates of hCG are <1000 UI and or presented a spontaneous decreasing kinetics, the simple prospect (LE2) is preferred. It is recommended to use intramuscular methotrexate in case of surgical conservative treatment failure or more prematurely if the follow-up is not possible (LE3). Except in particular cases there is no indication to use methotrexate in local injection under sonographic control in usual tubal EP (LE2). The use of in situ injection methotrexate is an option to handle the cervical, interstitial or on caesareans scar pregnancies (LE2). In front of a persistent undetermined location pregnancy, after more than 10 days of survey, in an asymptomatic woman and/or at rate of hCG >2000 UI/L, the systematic treatment by methotrexate is an option. The methotrexate is not indicated for first trimester termination of pregnancy or miscarriage neither in placentas accreta nor in association with other treatments such myfegine or potassium

Additional file 1: of Effect of laparoscopy by single-port endoscopic access in benign adnexal surgery: study protocol for a randomized controlled trial

SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb

Women and health professionals’ perspectives on a conditional cash transfer programme to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomised controlled study

Objectives Women of low socioeconomic status have been described as having suboptimal prenatal care, which in turn has been associated with poor pregnancy outcomes. Many types of conditional cash transfer (CCT) programmes have been developed, including programmes to improve prenatal care or smoking cessation during pregnancy, and their effects demonstrated. However, ethical critiques have included paternalism and lack of informed choice. Our objective was to determine if women and healthcare professionals (HPs) shared these concerns.Design Prospective qualitative research.Setting We included economically disadvantaged women, as defined by health insurance data, who participated in the French NAITRE randomised trial assessing a CCT programme during prenatal follow-up to improve pregnancy outcomes. The HP worked in some maternities participating in this trial.Participants 26 women, 14 who received CCT and 12 who did not, mostly unemployed (20/26), and - 7 HPs.Interventions We conducted a multicentre cross-sectional qualitative study among women and HPs who participated in the NAITRE Study to assess their views on CCT. The women were interviewed after childbirth.Results Women did not perceive CCT negatively. They did not mention feeling stigmatised. They described CCT as a significant source of aid for women with limited financial resources. HP described the CCT in less positive terms, for example, expressing concern about discussing cash transfer at their first medical consultation with women. Though they emphasised ethical concerns about the basis of the trial, they recognised the importance of evaluating CCT.Conclusions In France, a high-income country where prenatal follow-up is free, HPs were concerned that the CCT programme would change their relationship with patients and wondered if it was the best use of funding. However, women who received a cash incentive said they did not feel stigmatised and indicated that these payments helped them prepare for their baby’s birth.Trial registration number NCT0240285