Between 1992 and 1993 surgery conserving the organ was undertaken in 215 patients with uterine myomas. Only myomas of more than 2 cm in diameter were included. It was possible to conserve the organ in 207 cases (90%). Myomectomy by pelviscopy was performed in 131 cases. The procedure was successful in 117 cases (89%), secondary laparotomy had to be done in 14 of these patients. On average the myomas removed by pelviscopy measured 5.2 cm in diameter. The S.E.M.M. (Serrated Edged Macro Morcellator) was used in the procedure. It did not take long to morecellate even larger myomas (the largest one removed by pelviscopy weighed 418 g) and to remove them by means of a 15 mm-trocar. An average of 2 myomas were removed per patient (r: 1-5). The mean Hb drop amounted to 1.5 g%. Repeat pelviscopy had to be done in one patient because of a secondary haemorrhage, a laparotomy and hysterectomy for subilius had to be performed in one case on the 3rd postoperative day. An intestinal loop has adhered to the uterine wound dehiscence. No other complications were observed after pelviscopic myomectomy. A 41-year-old patient wanting children suffered a late complication, namely a ruptured uterus in the 28 w of pregnancy. It is therefore imperative to inform patients who are still in the reproductive phase about the possibility of an uterus rupture after pelviscopic myomectomy.
We analyzed the case histories and operation protocols of 2,465 female patients who had undergone pelviscopy for various reasons at the University Clinic of Obstetrics and Gynecology, Kiel, in the years 1978–1982. 1,743 patients (71%) had reported a previous appendectomy, of whom 965 had had no other intra-abdominal operation. 657 of the latter (68.1 %) presented adhesions; these were located in the right middle abdomen in 36.4% of the cases. In comparison to a collective of 308 patients without adhesions after appendectomy, the existence of chronic lower abdominal pain was independent of the presence of adhesions (30–31 % in both groups). In 55% of the patients with adhesions who were infertile after appendectomy, periovarian and peritubal adhesions were registered. In order to avoid unnecessary appendectomy or other laparotomies with later formation of adhesions, the use of laparoscopy is recommended in all questionable cases.
Between 1984 and 1989,773 patients ≤ 45 years of age, presenting with a total of 809 ovarian cysts, underwent pelviscopy at the Department of Obstetrics and Gynecology of Kiel University. In 36 cases, cysts were bilateral. 678 cysts (84%) were treated by pelviscopy alone. Organ-preserving treatment was performed in 83%, oophorectomy or adnexectomy in only 17% of cases. Two stage la ovarian carcinomas (0.26% of all cysts) were operated on by pelviscopy before laparotomy. Sonography is particularly important in determining whether a pelviscopic approach is appropriate. Pelviscopic procedures are unacceptable in multilocular cysts measuring ≥ 7 cm in diameter with echodense components. Special caution is required for any cyst measuring > 9 cm in diameter. The risk of opening a malignant cyst must be weighed against the advantages of pelviscopic surgery: minimal physical strain, better postoperative quality of life, and organ conservation. In doubtful cases, laparotomy is recommended.
From 1977-1989, 298 ectopic pregnancies were treated pelviscopically at the Dept. of Gynaecology Hospital of the University of Kiel. 26 tubes were already ruptured. In 251 patients (84%), organ preserving treatment was possible, 205 treatment by longitudinal salpingotomy. 46 tubal abortions were extracted. In 47 patients (16%), who did not wish to augment their family any further, or in whom recurrence of tubal pregnancy occurred on the same side, salpingectomy was performed. Complications required re-pelviscopy in 5% and laparotomy in another 1%. The intrauterine pregnancy rate in 143 patients desiring pregnancy was 58%. Abortions occurred in 8%. A recurrence of ectopic pregnancy in the ipsilateral tube occurred in 10%, in the contralateral tube in 6%. 9 patients desiring pregnancy had already undergone salpingectomy on the contralateral side or were treated pelviscopically by longitudinal salpingotomy because of ectopic pregnancy on both sides. Three of them gave birth to healthy infants.
In 969 patients, we observed 1016 ovarian cysts at pelviscopy between the years 1984-89. 36 of these were non-benign. On the basis of the pre- and intraoperative findings (palpation, sonography, inspection of the cyst surface under eye-glass magnification) we treated 827 cysts exclusively by pelviscopy, 189 cysts by laparotomy. Laparotomy was preceded by pelviscopic surgery on the cyst in 94 cases. None of the pre- and intraoperative findings completely eliminated the risk of performing pelviscopic surgery on a stage Ia carcinoma; indeed, this occurred in 2% (2/1016).
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