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Abstract
At first there is an idea which asks for more comfort for the
patient and equal results compared to conventional procedures. This
means less pain and fatigue, quicker convalescence and shorter
hospital stay. The new procedures requests an entirely new
operative skill and a new technique with new instruments. Those
were early developed in Germany. The roads on which this was
performed will be described. In another chapter the history of this
development is shown, especially the German, French and US
inventors with a special view on their personal experiences and
disappointments like in the German surgeon M_he and the
gynecologist Semm from Kiel, Germany. But they all remained
enthusiastic as a common personal quality. The new technique (MIC)
was translated “Mickey-Mouse-Surgery” and medicolegal consequences
like in M_he were usual events. Another example of misunderstanding
of the impact of the new technique: the first publication of Semm
about the laoaroscopically removed appendix has been withheld so
long in Germany until it was published in the USA in the Journal
“Obstetrics and Gynecology”. Besides this it is reported about the
life cycle of this innovation pointing out to the final promising
report, the professional adoption and public acceptance and the
randomized controlled trials. The last stage is characterized by
“jumping on another train”. Pictures are shown of those pioneers
who had the idea, who understood what they were doing and who took
the responsibility. The final chapter will deal with the
consequences for the future generation of surgeons and their
training and the unanswered questions as to further fields.
Doubtlessly, the pioneer period did not come to an end yet. A
glance into the future may be allowed.
PMID: 10773989 [PubMed – indexed for MEDLINE]


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Abstract
Peritoneal implants and/or venous or lymphatic obstruction,
presenting in advanced stages of ovarian cancer, stimulate
production of ascitic fluid [1]. Also, postoperative production of
ascitic fluid after operations for advanced ovarian cancer is not
rare. Especially in end-stage ovarian cancer, symptomatic and
rapidly reaccumulating ascitic fluid usually needs repeated
paracenteses or drainage though peritoneal catheter. In addition,
thoracentesis, pleurodesis, or catheter has already been used to
drain pleural fluid [2]. On the other hand, in early-stage (Ia)
ovarian cancer, considering the absence of implants, postoperative
ascites usually cannot be cancer-related. In this paper, a rare
complication of excessive production of ascitic fluid after
laparoscopic operation for early-stage clear cell ovarian carcinoma
and the used of treatment method are presented.


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Abstract
INTRODUCTION: The radical surgery of the deep infiltrating
endometriosis of the rectovaginal septum and the uterosacral
ligaments with or without bowel resection can cause a serious
damage of the pelvic autonomic nerves with urinary retention and
the need of self-catheterization.
PATIENTS AND METHODS: We introduce a case series report of 16
patients with laparoscopic nerve-sparing surgery of deep
infiltrating endometriosis. We describe the technique step by step
and compare the patients’ outcome with patients who had undergone a
non-nerve-sparing surgical technique. In 12 patients, a
double-sided and in four patients, a single-sided identification of
the inferior hypogastric nerve and plexus were performed.
RESULTS: In all patients at least single-sided resection of the
uterosacral ligaments were performed. Postoperatively
dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all
patients. The average operating time was 82 min (range 45-185).
Postoperatively, the overall time to resume voiding function was 2
days. The residual urine volume was in all patients 50 ml at two
ultrasound measurements.
DISCUSSION: Identification of the inferior hypogastric nerve and
plexus was feasible. In comparison with non-nerve-sparing surgical
technique, no cases of bladder self-catheterization for a long or
even life time was observed, confirming the importance of the
nerve-sparing surgical procedure.
PMID: 20680309 [PubMed – indexed for MEDLINE]


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Abstract
PURPOSE: To describe the management of a ruptured uterus caused by
placenta percreta in the 21st week of gestation.
METHODS: We present a case report of a 33-year-old patient with a
ruptured uterus in the 21st week of gestation who presented at the
Department of Gynecology and Obstetrics, University of
Schleswig-Holstein, Campus Luebeck. Therapeutic management was
performed by laparoscopy, and consecutive laparotomy and
hysterectomy.
RESULTS: A 33-year-old patient presented with severe abdominal pain
in the 21st week of gestation at the department of abdominal
surgery. A laparoscopy was performed to exclude appendicitis. There
was about one liter of blood in the peritoneal cavity and a small,
bleeding lesion in the fundus uteri was found which was coagulated.
The blood was evacuated and the patient returned to department of
gynecology. One hour after the first operation, the patient
developed signs of hypovolemic shock and ultrasound showed absent
fetal heart beat. An immediate laparotomy was performed and a
ruptured uterus was detected. The fetus was removed and a
hysterectomy performed. Pathology results showed a placenta
percreta. After a few days in hospital and transfusion of 4 liters
of blood the patient was discharged in a healthy condition.
CONCLUSIONS: In a pregnant woman with severe abdominal pain even in
the 21st week of gestation a placenta percreta has to be considered
as a differential diagnosis. If there is no evidence of other
causes, laparoscopy may help to confirm the diagnosis and
hysterectomy is a life saving intervention.
PMID: 21698452 [PubMed – in process]


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Abstract
Increases in technical expertise in gynecological surgery and
advances in surgical instrumentation have led to the development of
laparoendoscopic single-site surgery (LESS). Between March and
September 2009, 24 patients underwent adnexal surgery at our
institution with laparoendoscopic single-site surgery. The LESS
technique was performed using the TriPort through an umbilical
incision of 10 mm and bent laparoscopic instruments. We furthermore
compared the LESS technique with a control group of 24 patients
operated consecutively in the same period and for the same
procedures with conventional multiport laparoscopy. Comparing the
two techniques we found differences between the operation time and
mean hospital stay. The surgeon must master the use of novel bent
instruments in close proximity to each another. The LESS technique
for benign adnexal surgery is technically feasible and safe,
representing a reproducible alternative to conventional multiport
laparoscopy.
© 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica©
2010 Nordic Federation of Societies of Obstetrics and
Gynecology.
PMID: 21241267 [PubMed – indexed for MEDLINE]


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Abstract
PURPOSE: The radical surgery of the deep infiltrating endometriosis
of the rectovaginal septum and the uterosacral ligaments with or
without bowel resection can cause a serious damage of the pelvic
autonomic nerves with urinary retention and the need of
self-catheterization. Major goal of this review article is to
compare different surgical techniques of deep infiltrating
endometriosis and their follow-up results.
METHODS: The research strategy included the online search of
databases [MEDLINE, EMBASE, SCOPUS] for the diagnosis of deep
infiltrating endometriosis with the indication of an operative
resection. The outcome of the follow-up terms were noticed and
compared.
RESULTS: All in all, 16 trials could be identified with included
follow-up. In all patients at least single-sided resection of the
uterosacral ligaments were performed. Follow-up was heterogeneous
in all trials ranging from 1 to 92 months. Postoperative symptoms,
such as dysmenorrhoea, pelvic pain, and dyspareunia were commonly
described in the majority of trials. Nevertheless, a tendency
towards lower comorbidity after nerve sparing resection of
endometriosis could be observed.
CONCLUSION: Identification of the inferior hypogastric nerve and
plexus was feasible in the minority of trials. In comparison with
non-nerve-sparing surgical technique, no cases of bladder
self-catheterization for a long or even life time was observed,
confirming the importance of the nerve-sparing surgical
procedure.
PMID: 21221979 [PubMed – indexed for MEDLINE]


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Abstract
PURPOSE: To verify a seasonal variation in the incidence of spina
bifida and thus to identify possible environmental triggers leading
to its developement.
METHODS: An interdisciplinary approach has been taken to develop a
better understanding of spina bifida through collaborative efforts
from investigators specializing in genetics, fetal pathology,
paediatrics, neuro-surgery and prenatal ultrasonographic diagnosis.
All pregnancies with fetal spina bifida were retrospectively
analyzed from May 1 1993 through May 1 2010 at Luebeck University
Fetal Health Center. Results were used to construct a model to
predict the occurrence of fetal spina bifida based on seasonal
variation and environmental influence reflected by climatic changes
and environmental pollution. Furthermore, data were categorized in
respect to the date of conception and subdivided into date of
conception during summer (April-September) and winter months
(October-March).
RESULTS: Neither a seasonal distribution of conception for fetuses
with spina bifida in the defined time frame could be verified nor a
relevant influence of the analyzed environmental factors on the
prevalence of spina bifida could be proved. The incidence of spina
bifida has remained relatively stable within the last 17 years at
2.5 per 1,000 screened pregnancies.
CONCLUSION: Since we were unable to demonstrate a relationship
between seasonal variation and certain environmental factors on the
incidence of fetal spina bifida, other factors should be
investigated for a possible association with the onset of fetal
spina bifida.
PMID: 21079979 [PubMed – in process]


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Abstract
INTRODUCTION: To evaluate the operative outcomes of patients
managed by laparoscopic-assisted vaginal hysterectomy (LAVH) with
and without laparoscopic transsection of the uterine artery for
benign gynaecologic diseases.
PATIENTS AND METHODS: A retrospective analysis of 1,255 women from
two different centers undergoing hysterectomy between 1998 and 2009
with benign indications is presented. 856 patients were treated by
LAVH type I (vaginal transsection of the uterine artery) and 399
patients by LAVH type II (laparoscopic transsection of the uterine
artery). Operative outcomes, intraoperative and postoperative
complications, as well as laparoconversion rates were the main
objectives of the study.
RESULTS: Median operative time was similar between LAVH type I and
II (136 vs. 126 min, respectively, P = NS). Intraoperative
complication rate was not significantly different between the two
groups of the study (LAVH type I: 1.5% vs. LAVH type II: 1.26%,
respectively, P = NS). The injury of the urinary tract, especially
of the bladder, was the most common intraoperative complication for
both the groups of the study. Laparoconversion rate was similar in
LAVH type I and II (0.5 vs. 0.35%, respectively, P = NS), while
postoperative complications were significantly higher in LAVH type
I (2.25%) compared to LAVH type II (1.16%), mainly because of
postoperative vaginal and intrabdominal haemorrhage in the group of
the LAVH type I.
CONCLUSION: LAVH with laparoscopic transsection of the uterine
artery is an effective and safe technique with less postoperative
complication compared to LAVH with vaginal transsection of the
uterine vessels.
PMID: 20830481 [PubMed – in process]


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Abstract
PURPOSE: To evaluate the obstetric outcome of pregnant patients
with small stature (5th percentile) with regard to the mode of
delivery, maternal injuries, and neonatal parameters.
METHODS: Retrospective cohort analysis of 13 years of deliveries.
Two groups: group A, patients with a height below the 5th
percentile, and group B, patients with a body height between the
25th and 75th percentile.
RESULTS: Patients with a body height between the 25th and 75th
percentiles showed significantly more spontaneous vaginal
deliveries. Secondary cesarean sections (CS) were significantly
seen more often in mothers with a small body height. The fetal
outcome did not differ significantly between both groups (APGAR,
arterial cord pH, base excess).
CONCLUSIONS: Patients with body height below the 5th percentile
were found to have a significantly higher rate of secondary CS. As
less than half of our patients with a body height below the 5th
percentile were found to have delivered spontaneously at term,
pregnancies in small patients should be recognized by obstetricians
to be at a specific risk. Whereas the neonatal outcome appears to
be comparable between nulliparous women with a body height below
the 5th percentile and those with a body height between the 25th
and 75th percentiles, small mothers carry a significantly elevated
risk of surgical delivery, which should be addressed in prospective
studies and in counseling these patients.
PMID: 19714346 [PubMed – indexed for MEDLINE]


Ελληνογερμανική Εταιρεία Μαιευτηριών Γυναικολόγων

Ιατρείο Θεσσαλονίκης

Dr Ανδρέας Καβαλλάρης
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2ος όροφος
55133 Καλαμαριά, Θεσσαλονίκη
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