Expression dynamics of metalloproteinases during mandibular bone formation: association with Myb transcription factor.

As the dentition forms and becomes functional, the alveolar bone is remodelled. Metalloproteinases are known to contribute to this process, but new regulators are emerging and their contextualization is challenging. This applies to Myb, a transcription factor recently reported to be involved in bone development and regeneration. The regulatory effect of Myb on Mmps expression has mostly been investigated in tumorigenesis, where Myb impacted the expression of Mmp1, Mmp2, Mmp7, and Mmp9. The aim of this investigation was to evaluate the regulatory influence of the Myb on Mmps gene expression, impacting osteogenesis and mandibular bone formation. For that purpose, knock-out mouse model was used. Gene expression of bone-related Mmps and the key osteoblastic transcription factors Runx2 and Sp7 was analysed in Myb knock-out mice mandibles at the survival limit. Out of the metalloproteinases under study, Mmp13 was significantly downregulated. The impact of Myb on the expression of Mmp13 was confirmed by the overexpression of Myb in calvarial-derived cells causing upregulation of Mmp13. Expression of Mmp13 in the context of other Mmps during mandibular/alveolar bone development was followed in vivo along with Myb, Sp7 and Runx2. The most significant changes were observed in the expression of Mmp9 and Mmp13. These MMPs and MYB were further localized in situ by immunohistochemistry and were identified in pre/osteoblastic cells as well as in pre/osteocytes. In conclusion, these results provide a comprehensive insight into the expression dynamics of bone related Mmps during mandibular/alveolar bone formation and point to Myb as another potential regulator of Mmp13.

Intra-operative liver ultrasound--a contribution to colorectal carcinoma staging.

BACKGROUND: Laparoscopic resection of colorectal carcinoma is now a well-established surgical technique with oncology treatment outcome similar to open surgery, yet performing better in some short-term variables. The technique, however, does not allow palpation of intra-abdominal organs and the liver in particular. This prospective study aims to assess the performance of laparoscopic intra-operative ulrasonography of the liver (L-IOUS) and compare its findings with pre-operative staging data. METHODS: In total 70 patients, 53 men and 17 women, who were recruited into the study, were indicated for primary laparoscopic resection for colorectal carcinoma, with laparoscopic intra-operative ulrasonographic examination of the liver (L-IOUS) being used during the initial part of the operation. Before surgery, all patients underwent abdominal and pelvic contrast CT examinations. Ultrasonographic examination of the liver was included. RESULTS: In 14 patients L-IOUS detected a synchronous metastatic lesion of the liver as opposed to only six patients with pre-operative CT-positive findings. Furthermore, CT-positive metastases in three patients were not confirmed by L-IOUS. Several patients were diagnosed with benign lesions not disclosed during pre-operative assessment, e.g. haemangioma in 5 vs 2 patients, focal nodular hyperplasia in 3 vs 1 patient and liver cysts in 7 vs 5 patients. CONCLUSION: Results of the presented prospective study substantiate the use of laparoscopic intra-operative ultrasound of the liver (L-IOUS) within the standard staging protocol, as this seems to appropriately supplement the results of the pre-operative staging. In cases of colorectal carcinoma the method allows highly sensitive detection of occult synchronous liver metastases that could finally alter a therapeutic strategy.

[Laparoscopic resection of rectal cancer: evaluation of perioperative results of the primary resection and resection after preoperative chemoradiotherapy]. / Laparoskopická resekcia karcinómu rekta: zhodnotenie perioperacných výsledkov primárnej resekcie a resekcie po neoadjuvantnej chemorádioterapii.

AIMS: To evaluate and compare perioperative results of laparoscopic resection for low and middle third rectal cancer subgroup of patients intended for primary resection (PR) with those operated after chemoradiotherapy (CHRT). METHODS: 291 patients were operated for rectal cancer during the years 2005-2007 in Department of Surgery, J. G. Mendel Oncological Centre Nový Jicín. 155 patients (49 women and 106 men, mean age 65 +/- 9.7, range 27-87) having laparoscopic resection for low and middle rectal cancer were included in the present prospective single centre study. Primary surgical approach was adopted in 74 patients and 81 patients had a preoperative chemoradiotherapy. RESULTS: Both groups were comparable regarding intraoperative (p = 0.632) and postoperative surgical complications (p = 0.179) and nonsurgical complications (p = 0.654) too. Operative time and postoperative stay were similar in both groups. Number of harvested lymphnodes was higher for PR group (p < 0.001). CONCLUSION: In summary, after short term results evaluation, there is no significant difference for PR and CHRT groups in laparoscopic rectal resection. Neoadjuvant chemoradiotherapy did not lead to worsening of the perioperative results of our patients.

[Da vinci robotic surgery in gynaecological oncology: a critical interim appraisal]. / Da Vinci robotická chirurgie v gynekologické onkologii: kritické hodnocení úvodních zkuseností.

OBJECTIVE: Benefit evaluation of robot-assisted surgery in gynecological oncology. The parameters observed were feasibility, safety, overal surgery length and economic aspects. DESIGN: Prospective study analysing our experience in 10 patients operated due to gynaecological malignancy, adnexal tumors or planned for the procedure used as a part of extensive oncological surgery. SETTINGS: Department of Gynecology and Minimally Invasive Surgery Na Homolce Hospital, Prague. METHODS: The surgeries were performed with Da Vinci robotic system (Intuitive Surgical, inc., USA) including surgeon's console with stereoscopic viewer with hand and foot controls. The second component of the system was In Site vision system with 3D 12 mm endoscope. The third part comprised of 3 telerobotic arms with Endowrist instruments. From 2/2006 to 9/2006 10 patients were operated upon. 2 patients with early invasive cervical cancer, 2 patients with cervical cancer in situ (CIS), 3 patients with complex ovarian tumors, 2 patients with symptomatic atypical endometrial glandular hyperplasia and 1 patient underwent necessary gynecological surgery as a part of oncological treatment of breast cancer. The range of surgery included Total robotic hysterectomy, Robot-assisted vaginal hysterectomy with adnexectomy and frozen section, Robot-assisted radical vaginal trachelectomy with pelvic lymphadenectomy and unilateral adnexectomy with frozen section. The average age of patients was 52 years (range 32-58 years). 30% of patients had a previous laparotomy in their history. RESULTS: All procedures were finished with robot-assisted system. In 2 patients a temporary conversion to laparoscopy was made. In 3 patients a technical fault of the robotic system was noticed. This was corrected during the surgery. The overal surgery time was significantly longer (29 hours for robot-assisted versus 12 hours for laparoscopy). This represented operation time increase of 59% in comparison to identical laparoscopic procedures in our department in 2006. This was caused by lengthy assembly and disassembly time of the robotic system. No patients experienced any peroperative or postoperative comlications. The costs in our setting were approximately 10 times higher in comparison to laparoscopy. CONCLUSION: Our preliminary experience shows that Robot-assisted surgery is comparable to the standard laparoscopic procedure in terms of feasibility and outcome, but costs are considerably higher owing to longer operating time and the use of more expensive instruments. A major limitation is the lack of a large operation field. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of robotic surgery. The use of robotic system in gynecologic oncologic surgery and in abdominal surgery in general offers, at this stage, no relevant benefit and thus is not justified. Clinical data demonstrating improved outcomes are so far lacking for robotic surgical application within the abdomen.

Laparoscopic surgery for endometrial cancer: long-term results of a multicentric study.

PURPOSE OF INVESTIGATION: Surgical treatment of endometrial cancer was traditionally done by laparotomy, however the laparoscopic approach has gained wider acceptance by gynecologic surgeons. The primary aim of the study was to report the perioperative and postoperative outcomes of laparoscopic surgery in a major group of patients with endometrial cancer. The second aim was to study the long-term results of laparoscopic surgery in patients with endometrial cancer. MATERIAL AND METHOD: A prospective multicentric study was conducted at three oncolaparoscopic centres; 221 women who had undergone laparoscopic (177 women) or abdominal (44 women) hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy were included in the study. Women with stage IA, grade I did not undergo lymphadenectomy unless they had a high risk histologic tumor type. Lymph node dissection was performed in 145 women with disease greater than IA or grades other than 1. RESULTS: The mean age and weight were similar in the compared laparoscopic and open groups. Perioperative blood loss was comparable in both groups (211.2 ml vs 245.7 ml, respectively) without any significant consecutive changes in serum hemoglobin values. Although the length of operating time for the laparoscopic surgery was significantly longer than the time for the laparotomy procedure (163.3 min vs 114.7 min, p < 0.0001), the laparoscopic patients were discharged from hospital much earlier at 3.9 days (range 2-16) after the laparoscopic procedure compared with 7.3 days (range 5-16) after the abdominal procedure (p < 0.0001). The difference in surgical complications between groups was statistically insignificant (p = 0.58). Similar long-term results were noted in both groups. With a median follow-up of 33.6 months for the laparoscopy group and 45.2 months for the open group, there were no significant differences in tumor recurrence (p = 0.99] or recurrence-free survival (p = 0.86) between the two groups. CONCLUSION: The study illustrates that laparoscopically assisted surgical staging of endometrial cancer is safe as an open procedure. The laparoscopic approach may also be considered for endometrial malignancy which typically occurs in obese and elderly, high-risk women. Our analysis showed no difference with respect to recurrence or survival between the compared laparoscopic and the open group.

[Laparoscopic sterilization using the Filshie clip--a prospective study of 180 patients]. / Laparoskopická sterilizace Filshie klipem--prospektivní studie 180 pacientek.

OBJECTIVE: In this prospective study from 1997-2000, authors have been analyzing preliminary results of 180 tubal sterilizations, which were performed by method of the laparoscopic application of Filshie clips. DESIGN: Prospective study. SETTING: Department of operative gynaecology and minimally invasive surgery, Hospital Na Homolce, Prague. METHODS: The procedures were performed in accordance with the still valid Public Notice of the Czech Republic Ministry of Health n. 1/1972, section 5/1972. The mean age of the patients was 38.6 years, with each patient having 2.1 living children on average. During the intervention 42% of the patients either had IUD or were taking a hormonal contraceptive, while 29% of the patients had in their history a record of previous abdominal surgery. RESULTS: The average duration of the operation (from the incision to the closure) was 14 min. There were no per- or postoperative complications and until the present we have no knowledge of failure. In the view of both the patient and the surgeon, this is the most acceptable procedure. CONCLUSION: In accordance with the British (RCOG) and the Canadian Gynecological Society conclusions and also on the basis of many randomized studies and recommendations from WHO, we conclude that the laparoscopic approach with the mechanical tubal occlusion by means of the clip is the first choice method. Our previous experience and meta-analytic studies of the literature, demonstrate that from all accessible clip methods, the Filshie clip method is the most suitable as it has the lowest failure rate, the least occurrences of extrauterine gravidity (in a case of failure). Most importantly it is a simple, quick and easily taught method. Another potentially significant factor is the highest rate of successful reversibility.

[Laparoscopic therapy of symptomatic splenic implants in the minor pelvis]. / Laparoskopická lécba symptomatických slezinných implantátu v malé pánvi.

OBJECTIVE: The radical laparoscopic treatment of the aforementioned pathology has made it possible to eliminate recurrent pelvic pain of the 24 years old patient. SUBJECT: Case report. METHODS AND RESULTS: 24 year old, nulligravid patient, had primary laparoscopy in 1998 because of chronic pelvic pain. Histology has confirmed both, the infiltrative endometriosis and the pelvic splenosis. While the endometriosis has been radically excised, splenic implants have been, in accordance with the current opinions in the literature, left in situ. Only their biopsy has been done. Due to recurrent pelvic pain after 15 months and the growth of the splenical implants, the second look laparoscopy was performed with the radical excision of these foci. CONCLUSION: The patient, 4 months after the intervention is asymptomatic. At variance with most of the literature, we assume that the pelvic splenosis in contrast to the abdominal is in many cases symptomatic. It causes especially pelvic pain and dyspareunia in connection with the contingent implant growth. In such cases the radical excision is indicated, where the laparoscopy is the chosen method. Authors are discussing the differentiational diagnosis of this syndrome especially concerning endometriosis, peritoneal carcinomatosis, accessory spleen and the manifestation of the lymphoma.

[Role of total laparoscopic hysterectomy in genital reconstruction in transsexuals]. / Uloha totální laparoskopické hysterektomie v rekonstrukci genitálu u transsexuálních osob.

OBJECTIVE: Evaluation of the suitability of total laparoscopic hysterectomy as an adjunctive procedure in the female-to-male transsexual reassignment surgery. Surgical reassignment surgery in the transsexual is not a frequent procedure. The expertise of an gynaecologist in the treatment of the syndrome is necessary as well as the input of other specialists such as psychiatrists, psychologists, plastic and reconstructive surgeons and urologists. The gynaecological surgeon usually performs the hysterectomy and in some cases also colpectomy. SUBJECT: Case report. METHODS: The authors analyse their own surgical experience with the above mentioned syndrom in the patient in whom the surgical reconstruction took place in two phases. In the first phase the Total Laparoscopic Hysterectomy with Bilateral Salpingo Ophorectomy (TLH, BSO) was performed. Of note is that this procedure was chosen due to extremely narrow vaginal canal with no uterine descent. For the second phase of the surgery the patient was referred to the urological surgeon. RESULTS: The duration of the surgery was 54 minutes, the blood loss was not measurable. We have not encountered any per- and postoperative complications and the patient was discharged after 48 hours. CONCLUSION: We conclude that the TLH/BSO approach has enabled to us to preserve the vital structures needed for reconstruction of external genitalia, e.g. inferior epigastric vessels and rectus muscles were not disturbed. This approach is complex and has clear advantages in comparison to vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy or even total abdominal hysterectomy. It does guarantee a smooth removal of both ovaries and it is not dependent on the size of the vagina or uterine descent.

[Surgical treatment of endometriosis]. / Racionální prístup k chirurgické lécbe endometriózy.

Ovarian endometriotic cysts with adhesions and rectovaginal endometriosis are absolute indications for laparoscopic surgery. Peritoneal minimal endometriosis is considered a relative indications for surgery by many experts. The discussion is ongoing and more randomized studies are necessary. Ureteral and intestinal endometriosis are indicated for surgery in cases of deep infiltration of the ureteral or intestinal wall. In some cases the GnRH analogue (gonadotropin releasing hormone) can be given as neoadjuvant chemotherapy; after it interval endometriotic debulking is possible. In the case of endometriosis we must apply the same strict rules as in oncology especially as regards negative or positive histological findings.

[Laparoscopic excision of endometriosis of the rectovaginal septum using the Diomed laser]. / Laparoskopická excize endometriózy rektovaginálního septa Diomed laserem.

OBJECTIVE: Laparoscopic excision of deep endometriosis of rectovaginal septum and evaluation of technical capabilities of Diomed laser. DESIGN: Prospective pilot study. SETTING: Department of Gynaecology and Minimally Invasive Surgery, Na Homolce Hospital, Prague. METHODS: Eight patients with clinically and laparoscopically diagnosed endometriosis of the rectovaginal septum were selected for laparoscopic surgery. The extent of the lesion was assessed by vaginal palpations and laparoscopic visualisation of the Douglas space with a sponge forceps inserted into the posterior vaginal fornix and using rectal probe simultaneously. To exclude rectal wall infiltration baryum radiography was performed. RESULTS: 7 out of 8 patients experienced a complete disappearance of symptoms such as dyspareunia, dysmenorrhea and pelvic pain. Follow-up is in the range of 1-12 months. SUMMARY: Deep infiltrating rectovaginal endometriosis is a specific disease very different from peritoneal or ovarian endometriosis. A more precise term is rectovaginal adenomyosis. Radical laparoscopic excision is needed. Although simple this is demanding pelvic surgery, the results are gratifying. The use of a laser seems superior to dissection technique.

[Congenital vaginal aplasia: laparoscopic reconstruction of a neovagina using the Vecchietti technique in the Mayer-von Rokitansky-Kuester-Hauser syndrome]. / Kongenitální vaginální aplazie: laparoskopická rekonstrukce neovaginy podle Vecchiettiho pri syndromu Mayer-von Rokitansky-Kuester-Hauser.

OBJECTIVE: Creation of a neovagina in patients with congenital vaginal aplasia and evaluation of laparoscopic approach. DESIGN: Pilot prospective. SETTING: Department of Gynaecology and Minimally Invasive Surgery Hospital Na Homolce. METHODS: Four patients with the above mentioned syndrome were included and the laparoscopic modification of the open Vecchietti's technique was used. All patients had a complete clinical examination and ultrasound evaluation. RESULTS: No complications were found. The mean duration of surgery was 96 min. After two weeks a satisfactory vaginal length was achieved in all patients. SUMMARY: The laparoscopic approach has all advantages of minimally invasive surgery. At the same time the advantages of Vecchietti's open technique are maintained.

Laparoscopic surgery in obese women with endometrial cancer.

STUDY OBJECTIVE: To analyze perioperative and postoperative outcomes of laparoscopic treatment of endometrial cancer in two groups of women of different weight. DESIGN: Prospective, multicenter clinical study (Canadian Task Force classification II-1). SETTING: Three laparoscopic oncology centers. PATIENTS: Sixty-five consecutive women with endometrial cancer, of whom 32 were not obese (weight <81. 7 kg) and 33 were obese (weight (3)81.7 kg, body mass index 30-40). INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Three patients (1 nonobese, 2 obese) in whom laparoscopy was converted to laparotomy were removed from data analysis. Laparoscopy in the remaining 62 (94.38%) was completed successfully. Hysterectomy and pelvic and paraaortic lymphadenectomies were performed based on tumor grade and depth of myometrial invasion. In both groups, 28 women underwent pelvic lymphadenectomy and 21 paraaortic lymph node dissection or sampling. Eight patients had metastases in pelvic or paraaortic nodes. Deep myometrial invasion over 50% was present in five obese and two nonobese women. Mean operating time was 166 and 172 minutes, respectively. The rate of major complications and conversions was higher in the obese group (8 vs 5). CONCLUSION: Laparoscopic surgery is feasible in obese women and may also be considered for endometrial cancer, which typically occurs in obese women.

[Radical trachelectomy in the treatment of early cervical carcinoma]. / Radikální trachelektomie v lécbe casného cervikálního karcinomu.

In recent years a new less radical methods in the treatment of early cervical carcinoma has been introduced. The radical trachelectomy with laparoscopic pelvic lymphadenectomy represents one of these options. This procedure is special in that it not only treats the cervical cancer in acceptable oncological fashion but at the same time preserves the fertility potential of the patients. Thus, this surgery represents a midway point in between conisation and radical hysterectomy. Based on our initial experience in this study the technique of radical trachelectomy is analysed in detail and at the same time the current literature on the subject is reviewed. We conclude that after careful selection of the patients this more conservative approach leads to the same results comparable to classical radical surgery.

Adrenalin versus terlipressin: blood loss and cardiovascular side-effects in the vaginal part of laparoscopically-assisted vaginal hysterectomy or vaginal hysterectomy.

The purpose of the study was to compare blood loss and cardiovascular side-effects in the course of the vaginal part of laparoscopically-assisted vaginal hysterectomy (LAVH) or single vaginal hysterectomy (VH) [1]. Blood loss was evaluated in relation to local application of two haemostatic agents, e.g. adrenalin as a gold standard versus terlipressin. The investigation was designed as a prospective randomised study. A prospective group of 40 patients selected for LAVH or VH was randomised into two groups, e.g. 20 patients in each group. In both of these groups, the blindly selected haemostatic agent was applied locally immediately before circular colpotomy, the surgeon not being aware which agent was being used. Because of the claimed delayed effect of terlipressin a third group of another 20 patients was randomly selected. For comparison in this group terlipressin was locally already applied before the laparoscopic part of LAVH, e.g. 20-25 minutes before performing circular colpotomy. Thus, this particular group could not be made blind to the surgeon. The study confirmed a significantly superior haemostatic effect of adrenalin. On the other hand after the adrenalin application a higher frequency of hypertensive reactions and mild arrythmias were observed but without any clinical seguelae.

[Total laparoscopic hysterectomy: current role in gynecology surgery]. / Totální laparoskopická hysterektomie: soucasná role v gynekologické chirurgii.

UNLABELLED: Total laparoscopic hysterectomy (TLH) could be performed in the place of either Total abdominal hysterectomy or Vaginal hysterectomy, thus, there are not any special indications for this procedure. In recent times there has been developed a specially designed uterine manipulator which renders this procedure safe. This manipulator eliminates the necessity of ureteral dissection and also the necessity of incising through the uterosacral ligaments. This last aspect also causes an improvement in support of the vaginal vault. Hysterectomy of this type enables the surgeon to continue laparoscopically in the correction of the enterocoele by means of Moschowitz-McCall culdoplasty. OBJECTIVE: To evaluate indications, results and complications of 27 Total laparoscopic hysterectomies performed from 1/97-6/98. DESIGN: Prospective study. METHODS: 27 patients have undergone TLH (type IV of hysterectomy according to Clermont Ferrand classification). For the surgery a KOH manipulator (RUMI) was used. A pneumooccluder was used in order to prevent the loss of pneumoperitoneum. The most often encountered indications were menorrhagia, cervical dysplasia and fibroid uterus. An additional indication in some of the patients was the presence of enterocoele. Mean age was 42.5 years (35-52). RESULTS: Mean operating time was 92 min. +/- SD. Mean uterine weight 154 g +/- 25 SD. Mean blood loss 140 ml. No complications were noted. Mean length of hospitalization was 3.6 days. CONCLUSIONS: According their early experience the authors are convinced that it is safely possible for a gynaecological surgeon to ad TLH to his surgical armamentarium on condition that, he is well familiar with the performance of laparoscopically assisted vaginal hysterectomy. The early results with TLH are encouraging.

The role of laparoscopic hysterectomy and lymph node dissection in treatment of endometrial cancer.

BACKGROUND: The development of new diagnostic and surgical methods has brought a differentiated approach to surgery of endometrial cancer. The aim of this study was to verify the peri-and postoperative differences between laparoscopic and open procedure and prepare protocol for a second phase follow-up multicentric study. METHODS: The study includes 133 women with indications for surgery of endometrial cancer. A prospective multicentric study was undertaken at four centres in the Czech Republic. We evaluated differences in the peri-and postoperative outcomes. Sixty-eight patients treated laparoscopically were compared with 65 patients treated by an open procedure of hysterectomy and lymphadenectomy. RESULTS: Three patients with conversion were withdrawn from the study and another 65 patients (97%) from the laparoscopic group successfully completed the procedures. Laparoscopic and abdominal hysterectomy with lymphadenectomy were performed based on the grade of the tumor and depth of myometrial invasion. Out of both groups, 75 patients underwent pelvic lymphadenectomy and 21 women underwent para-aortic lymph node dissection or sampling. Eleven patients had metastases in the pelvic or para-aortic nodes (11.7% versus 4.7% in the open procedure group). Deep myoinvasion over 50% was more frequently present in the group of abdominally-treated women. The rate of major complications (18 versus 14 cases) was higher in the laparoscopic group, but more wound infections were seen in the open procedure group. CONCLUSION: The study illustrates that the laparoscopic approach to surgery is feasible and it also may be considered for endometrial cancer which typically occurs in at risk and obese women. Recovery time is reduced by avoiding an abdominal incision. Laparoscopic surgery was performed successfully in 65 women and in 8 cases (11.7%) malignant spread outside to the regional lymph nodes was found. However, the selection of patients for laparoscopy should be done considering optimal benefit and safety.

[Preperitoneal laparoscopic retropubic colposuspension in the treatment of stress incontinence: the mesh and tacker technique]. / Preperitoneální laparoskopická retropubická kolposuspenze v lécbe stresové inkontinence: mesh & tacker technika.

UNLABELLED: The Burch procedure has enjoyed in the last decade a favourable status among open surgical repairs for stress urinary incontinence. In the last few years this technique was adapted for endoscopic application. This results in decreased recovery time and diminished postoperative patients discomfort. This endoscopic procedure was further simplified by means of extraperitoneal approach and through the use of Mesh & Tacker technique. This enables a high quality durable colposuspension in significantly shortened operational time. OBJECTIVE: Evaluation of preliminary results and experiences of the above-mentioned new laparoscopic extraperitoneal approach in the treatment of stress incontinence. SETTING: Department of Gynaecology and minimally invasive surgery Na Homolce Hospital. DESIGN: Prospective pilot study. METHODS: The patients with stress incontinence proven clinically and by means of urodynamic investigation (cystometry, stress profilometry and uroflowmetry) were included in the study. The Retzius space was dissected laparoscopically via preperitoneal distention balloon (PDB, Origin Medsystems). Colpofixation to Coopers ligaments was achieved by means of Mesh & Tacker technique, e.g. polypropylen Mesh and aplicator of helicose spirals (Origin Medsystems). RESULTS: In this pilot study of initial 8 patients we may conclude that the above-mentioned method is promising. Of note is shortened operational time (35 min), easy performance without necessity of laparoscopic endosuturing and minimal tissue damage. The small amount of patients and short follow up period would not allow definite conclusions but all the patients are sofar fully continent.

[The definition of laparoscopic hysterectomy]. / Definice laparoskopické hysterektomie.

OBJECTIVE: To define laparoscopic hysterectomy. DESIGN: Short review. SETTING: Departments Gynaecology, Kladno Hospital and Na Homolce Hospital, Prague. METHOD: A retrospective study and analyse of literature and information database (Medline 1994-1998). CONCLUSION: We suggest nomenclature and LH classification for the Czech Endoscopic Society, which will bases on the guidelines published by Nezhat et al. and defined especially two forms of laparoscopic assisted vaginal hysterectomy (superior and inferior type).