Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015).

Official guideline "indications and methods of hysterectomy" to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated.

[Interdisciplinary Diagnosis and Treatment of Deep Infiltrating Endometriosis].

Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the interdisciplinary approach to the treatment of deep infiltrating endometriosis. Endometriosis has been defined as the presence of endometrial glands and stroma outside the internal epithelial lining of the cavum uteri.

The incidence of complications by hysterectomy for benign disease in correlation to an assumed preoperative score.

Background: Hysterectomies are preformed abdominally, vaginally, laparoscopic or with robotic assistance. When choosing the route of hysterectomy, the physician should take into consideration the safest and most cost-effective route to fulfill all needs of the patient.

Methods: Data were collected retrospectively from 953 patients who underwent hysterectomy between 2002 and 2010 for benign indications at UKSH, Germany.

Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates.

Background And Objectives: The study was designed to analyze preoperative clinical and surgical findings at enucleation of ovarian endometrioma with their impact on recurrence and pregnancy rates.

Methods: This is a retrospective study of 550 histologically verified ovarian endometriomas operated on at the Department of Obstetrics and Gynecology, University Hospital Kiel, Germany, between 1995 and 2004. Preoperative data, surgical findings, and postoperative outcomes of 289 cases were analyzed.

Value of clinical and laboratory inflammation factors in the postoperative period after laparoscopic urogynecological surgery.

Background/aims: Leukocytes and C-reactive protein (CRP) levels are often used to detect infections. The aim of this study was to evaluate the diagnostic and screening validity of leukocytes and CRP levels as well as body temperature >38° C to predict infections after laparoscopic sacrocolpopexy.

Methods: The study included 287 patients suffering from genital prolapse higher than POP-Q I.

Hysterectomy trends over a 9-year period in an endoscopic teaching center.

Objective: To investigate trends in the performance of hysterectomy at a single certified endoscopic teaching center.

Methods: Data were collected retrospectively from 953 patients who underwent hysterectomy between 2002 and 2010 for benign indications at UKSH, Germany. Preoperative risk scores were assigned to patients.

Laparoscopic hysterectomy and prolapse: a multiprocedural concept.

Background And Objectives: Today, laparoscopic intrafascial hysterectomy and laparoscopic supracervical hysterectomy are well-accepted techniques. With our multimodal concept of laparoscopic hysterectomy for benign indications, preservation of the pelvic floor as well as reconstruction of pelvic floor structures and pre-existing prolapse situations can be achieved.

Methods: The multimodal concept consists of 3 steps: 1.

Impact of surgical approach on blood loss during intracapsular myomectomy.

Background: Myomectomy is one of the most common surgical procedures in gynecology and has implications on fertility and subsequent pregnancies. We compared the impact of surgical approach on blood loss during laparoscopic and abdominal intracapsular myomectomy.

Material And Methods: The evaluation comprised 124 fertile women with subserous or intramural myomas: 66 patients treated by laparoscopy and 58 patients treated by laparotomy.

The past, present and future of minimally invasive endoscopy in gynecology: a review and speculative outlook.

Over the last twenty-five years, minimally invasive surgery (MIS) has evolved in a relatively short period of time to overtake the centuries-old visionary and pioneering groundwork of our outstanding colleagues in all surgical disciplines. This overview on the development of gynecological endoscopy, at the invitation of SMIT, highlights past achievements and describes present challenges. It emphasizes future opportunities and possibilities to foster interdisciplinary collaboration and integrate emerging endoscopic, imaging and stereotactic surgical technologies to improve patient safety, enhance quality of care and advance surgical education.

Clinical diagnosis and treatment of ectopic pregnancy.

Background: Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. The rate of ectopic pregnancies has increased from 0.

Combined surgical and hormone therapy for endometriosis is the most effective treatment: prospective, randomized, controlled trial.

Study Objective: To evaluate 3 therapy strategies: hormone therapy, surgery, and combined treatment.

Design: Prospective, randomized, controlled study (Canadian Task Force classification I).

Setting: University-based teaching hospital.

Laparoscopic sacropexy: a retrospective analysis of perioperative complications and anatomical outcomes.

Background And Objective: The aim of this study was to evaluate the surgical outcomes and complications of laparoscopic sacropexy with regard to 3 varying mesh attachment points: the vaginal stump, the cervical stump, and the posterior side of the cervix in the case of uterus preservation.

Method: A retrospective study was conducted among 310 women treated for descensus with laparoscopic sacropexy between January 2000 and December 2007. Information was obtained from medical files and follow-up examinations.

Cross-linked sodium hyaluronate, an anti-adhesion barrier gel in gynaecological endoscopic surgery.

Objectives: In the context of common adhesion prevention in laparotomic, laparoscopic and hysteroscopic surgery this article details the effects of a cross-linked sodium hyaluronate anti-adhesion barrier gel. The observed adhesion score is expressed in the following three measurements: Severity, extent and incidents of adhesions.

Material And Methods: From a total of 85 patients treated by laparoscopy and hysteroscopy, a second look endoscopic procedure could be performed in 35 cases.

Principles and safety measures of electrosurgery in laparoscopy.

Background: Electrosurgical units are the most common type of electrical equipment in the operating room. A basic understanding of electricity is needed to safely apply electrosurgical technology for patient care.

Methods: We reviewed the literature concerning the essential biophysics, the incidence of electrosurgical injuries, and the possible mechanisms for injury.

Perinatal management of pregnancies with severe fetal heart defects and epigenetic aspects.

Objective: To describe pregnancies with severe fetal heart defects (CHD) with respect to perinatal complications and management. To discuss epigenetic factors with respect to maternal body mass index (BMI) and assisted reproduction treatment (ART).

Methods: We performed a retrospective analysis in a single centre for prenatal diagnostics.

Complications of Uterine Fibroids and Their Management, Surgical Management of Fibroids, Laparoscopy and Hysteroscopy versus Hysterectomy, Haemorrhage, Adhesions, and Complications.

A critical analysis of the surgical treatment of fibroids compares all available techniques of myomectomy. Different statistical analyses reveal the advantages of the laparoscopic and hysteroscopic approach. Complications can arise from the location of the fibroids.

Imaging in gynecologic surgery.

The technical development of instruments for endoscopic surgery started in the field of gynecology. In the early 1970s, with the improvement of optics and instruments for laparoscopic surgery, gyne-endoscopic surgery developed and set milestones for all other surgical fields. However, the general surgeons propagated the advantages of 2D or 3D imaging surgery much better than the conservative gynecologists.

Organ-preserving management of ovarian pregnancies by laparoscopic approach.

This article discusses the possible etiology and the preoperative, operative, and postoperative management of five ovarian pregnancies based on the initial nonspecific signs and symptoms and the high risk of hemoperitoneum and/or hypovolemic shock of a ruptured ovarian pregnancy with the associated diagnostic problems. The advances made in transvaginal ultrasonography and monitoring of serum β-hCG levels in blood samples, as well as the substantial progress made in diagnostic pelviscopy and operative laparoscopy, have led to an early minimal invasive surgical management with the main emphasis on an organ-preserving procedure, i.e.

Precarious preoperative diagnostics and hints for the laparoscopic excision of uterine adenomatoid tumors: two exemplary cases and literature review.

Objective: To present two exemplary cases of adenomatoid tumors.

Design: Case report.

Setting: Two laparoscopic centers in Germany.

Laparoscopic intracapsular myomectomy: comparison of single versus multiple fibroids removal. An institutional experience.

Objective: The aim of this study was to compare single versus multiple laparoscopic myomectomy with an intracapsular method.

Study Design: A total of 335 laparoscopic intracapsular myomectomies were compared. They were subdivided into two groups.

Robotic assistance in gynecological oncology.

Purpose Of Review: The da Vinci robot has proved to be the most advanced surgical system in gynecology. In this review we evaluated the possibilities of applying robotic assistance to improve gynecological endoscopic oncological surgery.

Recent Findings: A literature survey on robotic-assisted gynecological oncology clearly supports the use of the da Vinci surgical system in laparoscopic oncological surgery.

Enhancing laparoscopic performance with the LTS3E: a computerized hybrid physical reality simulator.

Objective: To determine the value of this simulator in acquiring basic laparoscopic skills and to evaluate the correlation between the frequency of trials and performance.

Design: Cross-sectional study.

Setting: Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany.

Early detection of a twin tubal pregnancy by Doppler sonography allows fertility-conserving laparoscopic surgery.

Background: Vital twin tubal gestation is a rare complication in pregnancy.

Case: An asymptomatic gravida 1 female presented with increasing beta-HCG levels without an intrauterine gestation. Doppler sonography revealed cardiac motion of unilateral tubal twins.

Bladder endometriosis: possibility of treatment by laparoscopy.

Background And Objectives: Genital endometriosis is still an unclear enigma of the female. It occurs in approximately 20% to 35% of all women of reproductive age. The urinary tract is seldom affected.