Partnerships between Medical Centres and General Hospitals Providing Normal Care Standards in Gynaecology and Obstetrics in Germany.

Hospital managers and the heads of medical departments are nowadays being faced with ever increasing demands. It is becoming difficult for some small hospitals to find highly experienced or even experienced medical staff, to provide specific health-care services at break-even prices and to maintain their position in competition with other hospitals. On the other hand, large hospitals are facing enormous pressure in the investment and costs fields.

Change of aesthetic and functional outcome over time and their relationship to quality of life after breast conserving therapy.

Purpose: We analyzed changes in aesthetic and functional outcome over time after breast conserving therapy. Our special interest resides in the question of whether these aspects gain or loose their influence on quality of life (QoL) with temporal progress.

Patients And Methods: This prospective single centre cohort study included 138 patients, treated with breast conserving surgery and consecutive radiotherapy.

[Abdominal colposuspension: a synopsis of various approaches and techniques including endoscopic modifications].

Though abdominal colposuspension is an established operative procedure in the therapeutic spectrum of female urinary stress incontinence, there is controversy concerning new access routes and fixation techniques. On the basis of a comparison between results of a "feasibility" study at our department concerning the trans- and extra-peritoneal endoscopic access as well as suspension techniques with alloplastic material and suturing vs. stapler application, and al literature survey, a synoptic concept is being evaluated.

[The value of laparoscopic and laser-assisted techniques in reconstruction of distal fallopian tube pathology].

In an overall study population (3 different study designs) of n = 285 patients the role of laparoscopic resp. laser-assisted techniques was evaluated on the basis of the results of distal tubal reconstruction. An interventional comparison of a laparoscopic (n = 150) with a retrospective microsurgical (n = 135) group of patients with distal tubal pathology showed a significantly higher baby-take-home rate in the laparoscopically treated patients (38% vs.

[Endoscopic colposuspension ("retziusscopy" versus laparoscopy). An effective extension of the surgical spectrum of stress incontinence?].

Within the framework of "minimal access surgery" a prospective randomised study was initiated at the Dept. of Obstetrics and Gynaecology of Heidelberg University to examine the feasibility of endoscopical abdominal Burch colposuspension for stress incontinence (II-III), at laparoscopy and "retziusscopy". Further, also prospectively randomised, two suspension techniques: needle suspension and suspension by means of alloplastic material with stapler fixation, were compared, irrespective of the endoscopic approach chosen, especially because long-term results of our study population on colposuspension with fibrin glue which are now available, are below expectations, worse than those obtained with conventional techniques.

Endoscopic retropubic colposuspension: "Retziusscopy" versus laparoscopy--a reasonable enlargement of the operative spectrum in the management of recurrent stress incontinence?

The technical feasibility of the laparoscopic and extraperitoneal approach to the Burch colposuspension for treatment of grade II and III (moderate to severe) stress incontinence was examined in a randomised prospective study. Irrespective of the endoscopic access, two suspension techniques, namely conventional suture and stapler fixation of alloplastic materials, were compared. A total of 20 patients entered this preliminary evaluation.