[Novel laparoscopic techniques in gynecologic surgery]. / Legújabb laparoszkópos technikák a nogyógyászati sebészetben.

The practice of gynecologic surgery has been revolutionized by laparoscopic techniques in the past decades. Nowadays minimal invasive procedures are feasible and safe standard options in the management of most benign and malignant gynecologic diseases. Natural orifices transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed in an attempt to further reduce the morbidity and scarring with minimal invasive procedures. These techniques share a common conception that a reduction in the number of transcutaneous points of access may benefit patients in terms of port-related complications, risk of hernia formation, recovery time, pain and cosmetics by potentially performing scarless surgery. The development of LESS has been facilitated by the concept of scarless surgical procedures. Increasing experience revealed by recent publications have allowed for the expansion of NOTES and LESS techniques in the gynecologic surgery. Almost all laparoscopic procedures can be performed by acquiring these concepts. Although these surgical methods are feasible and safe, certain technical problems (e.g. loss of triangulation, problems of visualization, ergonomic considerations) has yet to be solved and several questions must be answered before LESS and NOTES could gain widespread acceptance as single procedures. Despite successful technical developments these methods remain investigational approaches and refinement of indications as well as further development of instrumentation are expected to define its area of future application.

[Selective chromopertubation via hysteroscopic tubal cannulation]. / Szelektív chromopertubatio hiszteroszkópos kürtkatéterezés útján.

Tubal infertility and particularly, proximal tubal occlusion (15-25%) is gaining increasing attention among experts of reproductive medicine. In case of bilateral tubal occlusion in vitro fertilization is indicated, since the expected pregnancy rate is the same as can be expected from macrosurgical procedures. Despite the fact that better and better results are being obtained by sophisticated assisted reproduction techniques, in vitro fertilization procedures that are performed unnecessarily or not indicated objectively can result in serious consequences for the patients as well as for health insurance. Therefore, there is no question that refining procedures used for evaluating the tubal patency is extremely important in order to reduce physical and psychological burden on the patients, as well as from the viewpoint of cost-effectiveness. We demonstrate an optional protocol which can be performed as a one-step evaluation and recommend a diagnostic method to assure tubal patency. The procedure is easy to perform by diagnostic hysteroscopy, and according to our experience, the examination is highly accurate.

Safety and Effectiveness of UFE in Fibroids Larger than 10 cm.

INTRODUCTION: Early literature suggested that the size of the uterus, the size of the dominant fibroid, and the amount of applied embolization particles would be the risk factors for major postprocedural complications, but recent publications have confuted these early results. The purpose of our study was to evaluate whether the size of the dominant fibroid would influence the complication rate and effectiveness in a large single-center cohort. PATIENTS AND METHODS: From 28 April 2008 until 31 December 2012, 303 patients had uterine artery embolization (UAE). 262 patients had small [largest diameter <10 cm (Group 1)], 41 patients had large [largest diameter >10 cm (Group 2)] fibroid. UAE was performed from unilateral femoral access using 500-710 and 355-500 µm polyvinyl alcohol particles. Periprocedural and postprocedural complications and numerical analog quality-of-life scores (0-unbearable symptoms; 100-perfect quality of life) were listed and statistically analyzed. RESULTS: During the mean follow-up time [7.79 ± 5.16 (SD) month], data on 275 patients (275/303 = 90.8 %) were available. Quality-of-life score was 33.3 ± 23.5 and 33.5 ± 24.1 before, whereas 85.6 ± 16.0 and 81.5 ± 23.5 after UAE in Group 1 and Group 2, respectively, (Mann-Whitney U test one-sided, p = 0.365). There were 4 myoma expulsions, 1 acute myomectomy, and 2 acute hysterectomies reported from Group 1, meanwhile 1 myoma expulsion, 1 acute myomectomy, and 2 acute hysterectomies were documented from Group 2 (NS differences). CONCLUSION: There was no significant difference in the effectiveness and in the number of minor and major complications between fibroids with <10 cm largest diameter compared to those >10 cm.