Comparison of transvaginal ultrasound, hysteroscopy, and dilatation and curettage in the diagnosis of abnormal vaginal bleeding and intrauterine pathology in perimenopausal and postmenopausal women.

STUDY OBJECTIVE: To compare transvaginal ultrasound, hysteroscopy, and dilation and curettage (D&C) in the evaluation of women with perimenopausal and postmenopausal bleeding. DESIGN: Descriptive study (Canadian Task Force classification II-1). SETTING: Seven outpatient clinics. PATIENTS: One thousand two hundred eighty-six women. INTERVENTION: Transvaginal ultrasound, hysteroscopy, and D&C. MEASUREMENTS AND MAIN RESULTS: Of our patient population, 29 (2.26%) had a histologic diagnosis of endometrial carcinoma; in 2 of them (7.14%) endometrial thickness was 5 mm or less. In 10 women (34.5%), endometrial carcinoma was missed by hysteroscopy (sensitivity 65.52%, specificity 99.92%). Complication rate of D&C was 1.4%. CONCLUSION: In women with perimenopausal and postmenopausal bleeding neither transvaginal ultrasound nor hysteroscopy as a single diagnostic tool is suitable to rule out endometrial cancer.

[Laparoscopic therapy of interstitial tubal pregnancy]. / Laparoskopische Therapie einer interstitiellen Tubargravidität.

Interstitial pregnancy is life threatening and rarely operated laparoscopically. We report on the diagnostic and therapeutic endoscopic management using monopolar scissors, loop, suturing and bag harvesting.

[Genital tuberculosis--increased incidence or coincidence]. / Die Genitaltuberkulose--Zunahme oder Zufall.

Genital tuberculosis is a rare disease in industrialized countries. Symptoms like bleeding disorders, sterility and lower abdominal pain lead to endoscopic examination. Laparoscopic findings are often misinterpreted, so that histology clears the diagnosis. Three cases are reported.

[Aspects of peritoneal fascia closure after surgical laparoscopy]. / Aspekte des Peritoneal-Faszienverschlusses nach operativer Laparoskopie.

Following laparoscopic surgery using trocar ports of 10 mm and more Richter's hernia and incarceration of bowel are reported. To prevent this wound closure of all layers is a must. Newly developed techniques are described. Fascia closure is accompanied by serious pain. Pain management is achieved by local anesthesia.

[Laparoscopy in the day clinic--a prospective multicenter study for evaluating complications]. / Laparoskopien in der Tagesklinik--Eine prospektive Multizenterstudie zur Komplikationserfassung.

In a six centre prospective study complications after outpatient laparoscopies were registered. Within a four month period 1474 patients have been interviewed after one and four weeks. Surgical complications and conversions to laparotomy 0%, wound infections 2.9%, febrile course 2.4%. 3.7% of the patients were hospitalized > 24 hours. No readmissions occurred. Factors influencing the quality of results are discussed.

Review of 47 laparoscopic appendectomies.

STUDY OBJECTIVE: To assess the indications, technique, complications, and outcome of endoscopic appendectomies. DESIGN: Retrospective study with a follow-up of 2 years. SETTING: A gynecologic surgical center in Hamburg, Germany. PATIENTS: Forty-seven women who underwent laparoscopic appendectomy. INTERVENTIONS: Appendectomies were performed under general anesthesia with bipolar coagulation, loop-ligation, and transection. MEASUREMENTS AND MAIN RESULTS: Forty-seven patients have been followed for 2 years. Thirty laparoscopic appendectomies (LA) were incidental and 17 elective. The majority of LA were performed because of pain symptoms. More than 50% of the patients reported complete pain relief after LA. The average duration of surgery was 47 minutes. The average hospital stay was 66 hours. Use of analgesics was low; 19 women required no analgesia. A febrile reaction was registered in 6%. No wound infection occurred. Two serious complications were noted: one acute peritonitis after 4 days, and one stump abscess after 4 weeks. Both patients recovered uneventfully. CONCLUSIONS: Laparoscopic appendectomy is safe surgery if the described technique is followed. The complication rate is low, conversion rate is zero, and late results underline successful treatment of pain.

Gynecologic laparoscopy and hysteroscopy in a day clinic: trends and perspectives.

We have increased the performance of minimally invasive gynecologic surgery from about 15% to 20% of operations a year, especially hysteroscopies and laparoscopies, many of which are performed in a free-standing ambulatory unit. In 1992 our team performed 8057 outpatient operations, significantly more than in 1991. As the techniques are developed, the number of indications for these operations expands. By maintaining high standards, even with major endoscopic procedures, we have a very low complication rate.

[Gynecologic endosonography: initial experiences]. / Gynäkologische Endosonographie: erste Erfahrungen.

Basing on our research work in hysteroscopy, we used recently developed small endosonographic sounds for intrauterine and later vaginal approach, for the first time in 1981. We call this method endosonography. The equipment used so far is described, the procedure explained, and the efficacy of this new technique demonstrated via several endosonograms. The advantage to transabdominal sonography is the close contact of the ultrasound transducer with the organ to be examined. This enables the use of high frequencies with correspondingly good resolution. Finally, our own experience is discussed.

[Experiences with 3120 outpatients sterilized by laparoscopic tubal bipolar coagulation (author's transl)]. / Erfahrungen mit 3120 klinisch-ambulanten laparoskopischen Tubensterilisationen.

3120 patients have been sterilized by laparoscopic tubal bipolar coagulation. The operations were performed in an outpatient procedure. 0.096% severe complications during surgery were caused. The pregnancy rate was 0.06%. Our experiences and results confirm the low risk outpatient way of laparoscopic sterilization as reported in Anglo-American literature.

PIP: 3120 patients were sterilized by laparoscopic tubal bipolar coagulation performed on an outpatient basis. A total of 0.96% of the cases developed severe complications and the pregnancy rate was 0.06%. Our experiences and results are in accordance with the low risks of laparoscopic sterilization on an outpatient basis reported in the Anglo-American literature. (author's)

A preliminary report about transcervical embryoscopy.

Transabdominal amniocentesis and occasionally fetoscopy are used as a means of early diagnosis of fetal damage or abnormality after the 14th week of pregnancy. For medical reasons a still earlier method of diagnosis is desirable. We report about the transcervical approach- using CO2-gas-hysteroscopy to visualize the amnion sac and its contents.

[Outpatient termination of pregnancy in the first trimester during paracervical blockade with Carticain (author's transl)]. / Der ambulante Schwangerschaftsabbruch im ersten Trimenon in Parazervikalblockade mit Carticain.

Sparing termination of pregnancy with a low incidence of complications, using the drainage method in local anaesthesia, can be effected on an outpatient basis. Carticain, which is a rapidacting anaesthetic with good analgesic effect, enables practically painless dilatation of the cervical channel with subsequent evacuation, when combined with good psychological guidance of the patient. When questioned postoperatively, practically all patients were in favor of local anaesthesia. Another positive aspect, in their opinion, was the fact that they could be discharged after brief hospitalization. Furthermore, treatment on an outpatient basis is cost-saving.

PIP: Termination of pregnancy using vacuum aspiration was performed on 112 outpatients using Carticain for paracervical blockade. A rapid-acting anesthetic with good analgesic effect, Carticain permitted nearly painless dilatation of the cervix to Hegar 9 or 11. Evacuation of the uterus generally required less than 1 minute. Patients who were without symptoms of complications 2 hours after the operation were released. Most patients favored local anesthesia because of the savings in hospitalization time and costs.

[A comparative study of the suction and customary curettage methods in the termination of pregnancy (author's transl)]. / Hysteroskopische Untersuchungen nach Aspirations-und instrumentelle Curettage für den Schwangerschaftsabbruch.

90 hysteroscopies using CO2 were performed to evaluate differences in effectiveness between the customary curettage and the suction methods in terminating pregnancy during the first trimenon. Following suction, the uterine cavity was nearly always thoroughly evacuated. Very seldom is there any residual tissue seen. On the contrary, the uterine cavity following termination by customary curettage was almost never completely evacuated. Very often rest tissue of decidua, usually chorionic, in some cases with villous structures, were found. Tissue remnants following termination by either method were removed by target biopsy or curettage and examined histologically. Having made the above observations and comparison, it must be concluded that the suction method is clearly the more advantageous. If applied correctly, it becomes unnecessary to perform curettage right after the suction.

PIP: Vacuum aspiration and instrumental curettage were compared with respect to completeness of uterine evacuation in 90 women. 54 patients had vacuum aspiration, 36 had curettage. Hysteroscopy using CO2 showed that the aspiration patients had less intrauterine bleeding, and pregnancy-related tissue was observed in only 6 of these patients. In the curettage patients, residual tissue was seen in 32 cases, and follow-up curettage or removal of remaining tissue was performed in 20 patients. No complications were observed in either group. Techniques and advantages of aspiration are discussed. It is clear that the suction method is to be preferred and if handled properly, curettage is unnecessary following suction.