The study confirmed the safety of Adept in laparoscopic surgery. The proportion of patients with de novo adhesion formation was considerably higher than previous literature suggested. Overall there was no evidence of a clinical effect but various surgical covariates including surgery duration, blood loss, number and size of incisions, suturing and number of knots were found to influence de novo adhesion formation. The study provides direction for future research into adhesion reduction strategies in site specific surgery.

The appropriate surgical technique to treat patients with uterine fibroids is still a matter of debate as is the potential risk of incorrect treatment if histological examination detects a uterine sarcoma instead of uterine fibroids. The published epidemiology for uterine sarcoma is set against the incidence of accidental findings during surgery for uterine fibroids. International comments on this topic are discussed and are incorporated into the assessment by the German Society for Gynecology and Obstetrics (DGGG). The ICD-O-3 version of 2003 was used for the anatomical and topographical coding of uterine sarcomas, and the "Operationsund Prozedurenschlüssel" (OPS) 2014, the German standard for process codes and interventions, was used to determine surgical extirpation methods. Categorical qualifiers were defined to analyze the data provided by the Robert Koch Institute (RKI), the German Federal Bureau of Statistics (DESTATIS; Hospital and Causes of Death Statistics), the population-based Cancer Register of Bavaria. A systematic search was done of the MEDLINE database and the Cochrane collaboration, covering the period from 1966 until November 2014. The incidence of uterine sarcoma and uterine fibroids in uterine surgery was compared to the literature and with the different registries. The incidence of uterine sarcoma in 2010, standardized for age, was 1.53 for Bavaria, or 1.30 for every 100 000 women, respectively, averaged for the years 2002-2011, and 1.30 for every 100 000 women in Germany. The mean incidence collated from various surveys was 2.02 for every 100 000 women (0.35-7.02; standard deviation 2.01). The numbers of inpatient surgical procedures such as myoma enucleation, morcellation, hysterectomy or cervical stump removal to treat the indication "uterine myoma" have steadily declined in Germany across all age groups (an absolute decrease of 17 % in 2012 compared to Zusammenfassung ! Authors M. W. Beckmann (Uterus Commission of the Gynecological Oncology Working Group [Arbeitsgemeinschaft Gynäkologische Onkologie, AGO]), Guidelines Commissioner of the German Society for Gynecology and Obstetrics [Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG]) 1 , I. Juhasz-Böss (Uterus Commission of the AGO, Gynecological Endoscopy Working Group [Arbeitsgemeinschaft für Gynäkologische Endoskopie, AGE]) 2 , D. Denschlag (Uterus Commission of the AGO) 3 , P. Gaß (Guidelines Secretary of the DGGG) 1 , T. Dimpfl (former president of the DGGG) 4 , P. Harter (Ovary Commission of the AGO) 5 , P. Mallmann (Uterus Commission of the AGO) 6 , S. P. Renner (Financing Commission of the DGGG,

The experiences from our small pilot series prove technical feasibility in the clinical setting.

Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application.

gynaecology l " obstetrics l " financing l " DRG l " payment l " structures l " additional charge l " certified centres