Epidemiology and Early Detection of Cervical Cancer.

The new German S3 guideline 'Prevention of Cervical Cancer' published in 2016 is based on the latest available evidence about cervical cancer screening and treatment of cervical precancer. Large randomized controlled trials indicate that human papillomavirus (HPV)-based screening may provide better protection against cervical cancer than cytology alone through improved detection of premalignant disease in the first screening round prior to progression. Therefore, women aged 30 years and older should preferably be screened with HPV testing every 3-5 years (cytology alone every 2 years is an acceptable alternative). Co-testing is not recommended. Screening should start at 25 years using cytology alone every 2 years. The preferred triage test after a positive HPV screening test is cytology. Women positive for HPV 16 and HPV 18 should receive immediate colposcopy. Another alternative triage method is p16/Ki-67 dual stain cytology. The mean yearly participation rate in Germany is between 45 and 50%. Offering devices for HPV self-sampling has the potential to increase participation rates in those women who are at higher risk of developing cervical cancer. Regarding primary prevention, the 9-valent vaccine may provide protection against up to 85% of cervical intraepithelial neoplasia (CIN) 3 and 90% of cervical cancer, and is available in Europe as a 2-dose schedule from May 2016.

Evaluation of active camera control systems in gynecological surgery: construction, handling, comfort, surgeries and results.

OBJECTIVE: Surgeon-controlled endoscope leading assistance systems are a novelty in endoscopic surgery. These systems were evaluated for their applicability and reliability in operative gynecology. In this regard, we evaluated possible methods of operation, operative time, setup time, and comfort for the surgeon, complications, blood transfusions, length of stay, hemoglobin levels, and demographic data. METHODS: Two systems with technically identical camera control systems were applied, the SOLOASSISTTM system and the Einstein VisionTM 3D system. The arm systems are attached to the operating table and controlled by surgeon via a manual control, a remote control or a foot switch. Comfort for the surgeon was evaluated using a questionnaire (scale 1-5; 1 "very good", 5 "poor"). All data were collected prospectively in a database (IBM SPSS Statistics 20) and evaluated. RESULTS: One hundred and four patients underwent surgery supported by an active control system. In 43 (41 %) cases, oncological interventions were performed. Average setup time was 7 (3-30) min. There was a significant learning curve regarding the mounting of the system after 20 operations (p = 0.045). Overall comfort was rated as "good", divided into control 2.2 (2-4), physical effort 2.1 (1-4), picture quality 1.6 (1-3), and overall satisfaction 2.1 (1-4). About 75 unwanted camera movements were noticed in 104 surgeries. Complications occurred in no case (0 %). CONCLUSION: The application of an active camera control system was evaluated to be safe for all gynecological laparoscopies. Picture blur is avoided even during prolonged complex procedures. Moreover, the assistant is able to support the surgeon with two instruments, with the result that the presence of a second assistant is not required for complex interventions. Causing only minimal setup time, the examined active control systems improve the effectiveness of surgeries. The physical effort required for the assistant decreases and, by reducing tiring operations and tremor, subsequently, higher precision is reached.