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Peroral transgastric surgery is technically feasible and safe in a porcine model. Although all the procedures were performed successfully, the study highlights some technical difficulties and illustrates the need for major technical innovations and extensive animal studies in order to evaluate the merits of incisionless surgery.

Study objective To assess the safety and patient satisfaction of laparoscopic subtotal hysterectomy (LSH) using a standardised surgical technique.Design Prospective observational study.Setting Princess Royal University Hospital, Chelsfield Park Hospital and Sloane Hospital, Kent, UK.Patients and materials Four hundred consecutive women with menorrhagia underwent LSH. The procedure was performed using the Plasma Kinetic Bipolar Diathermy (Gyrus International Ltd, Berkshire, UK) for pedicle ligation and the Lap Loop system (Roberts Surgical Healthcare Ltd, Kidderminster, UK) to detach the cervix. An electromechanical morcellator (Morcellex; Ethicon Women's Health and Urology, Cincinnati, OH, USA) was used to remove the uterus from the abdominal cavity.Main outcome measures Patient satisfaction, morbidity rates and readmission rates.Results A total of 400 LSH were performed between February 2003 and November 2006. The principal clinical indication for hysterectomy was menorrhagia. The mean duration of surgery was 46.4 minutes. The mean operative blood loss was 126 ml. Concurrent surgery was performed in 141 women. Minor and major perioperative complications were encountered in 5% (n = 20) of women. The major complication rate was 1.2% (n = 5): three women (0.75%) with bladder perforation, two women (0.5%) with bowel injury and one woman (0.25%) with a vesicocervical fistula. Eight women (2%) suffered from cyclical vaginal bleeding postoperatively.Conclusions LSH is a safe and effective treatment for menorrhagia and other menstrual disorders when hysterectomy is indicated. Women appreciate the quick recovery period, reduced time off work and faster return to normal activity. Our data suggest that LSH can replace abdominal hysterectomy in selected cases.

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The objective of this prospective study was to assess the safety and short-term outcome of the Helica Thermal Coagulator in the laparoscopic treatment of early stage endometriosis. Two hundred and fifty consecutive women with chronic pelvic pain and stage I and II endometriosis (r-AFS classification) were treated laparoscopically with the Helica Thermal Coagulator. No bladder, ureteric or bowel injuries occurred. None of the procedures was converted to laparotomy and there were no major peri-operative complications. The only complication was a vaginal perforation during dissection of the cul-de-sac in a patient with a vaginal vault endometriotic nodule. We conclude that the Helica Thermal Coagulator is a safe alternative for the treatment of mild to moderate endometriosis. Long-term efficacy studies are required to better assess the role of the device in laparoscopic management of endometriosis.

The objective of this prospective study was to evaluate the effectiveness of day-case Cavaterm plus thermal balloon endometrial ablation in the treatment of therapy-resistant menorrhagia. The study included 220 patients with a mean age of 41 years, mean parity of 2.1 and mean duration of menorrhagia of 3.2 years. A 6-mm diameter Cavaterm plus catheter with a silicone balloon at its tip was used. The ablation time was 10 minutes at a temperature of 78 degrees C. No procedure-related operative or immediate postoperative complications were encountered. The mean follow-up period was 19 months (range 6-24 months). The amenorrhoea-hypomenorrhoea rates at the various follow-up periods ranged between 74% and 83%. At the end of follow-up, 83% of patients were satisfied with the procedure. We conclude that Cavaterm plus is a safe and effective treatment for menorrhagia and has good patient acceptability.

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