Acute puerperal inversion of the uterus--treatment by a new abdominal uterus preserving approach.

OBJECTIVE: Inversion of the uterus is still a rare (1, 2) but serious and life-threatening obstetric complication. It is said to be complete when the fundus uteri protrudes through the cervix and into the vagina. Within minutes a state of shock is reached due to pulling forces on the peritoneum as well as blood loss. METHODS: The vagina was entered by a longitudinal incision (3 m) below the contraction ring. Through this opening it was possible to advance two fingers (second and third finger of the left hand) into the vagina above the invaginated corpus uteri. The invaginated cavum uteri was loaded on these two fingers and, exerting counterpressure with the right hand, the inside was turned out. CONCLUSION: The present operative method guarantees easy reposition of the uterus in cases of failed vaginal manual repositioning. Furthermore, the cavum uteri remains intact and hysterectomy can be avoided.

[Decreasing the surgical risk of laparoscopy by using a newly developed, blunt trocar]. / Senkung des operativen Risikos in der Laparoskopie durch den Einsatz eines neuentwickelten, stumpfen Trokars.

Laparoscopy is one of the most frequent interventions used in operative gynaecology. Because of the possible, occasionally grave complications through the use of the trocar forms applied so far, we have developed a new blunt trocar. By using this trocar throughout 1889 interventions, we have had no complications which could be ascribed to the use of this blunt instrument. The advantage of this trocar lies in the avoidance of the possible and feared injuries to the intestines and vessels. Even though overall complication rates in laparoscopy are low and there is no evidence of a statistically significant reduction compared with the use of the sharp trocar, the advantages of the blunt trocar are obvious. There is only one disadvantage, namely the slightly prolonged training time of the younger colleagues, as well as the theoretical possibility of a prolapse of the omentum. Nevertheless, in our opinion, the use of the blunt trocar is advisable to reduce the complication rate in laparoscopy.

[Intrauterine twin pregnancy after laparoscopic salpingotomy and tubal occlusion with PDS clips]. / Intrauterine Geminischwangerschaft nach laparoskopischer Salpingotomie und Tubenverschluss mit PDS-Klips.

Different laparoscopic tube-saving operations after tubal pregnancies are reported in the literature, but they all entail specific problems. In 35 women with tubal pregnancies, the tubotomy incisions were done laparoscopically and then fixed using PDS clips. One of these women with a contralateral closed tube had an intact intrauterine twin pregnancy 7 months after this procedure. Thus, this case demonstrates that this new variant of a laparoscopic tube-saving operation leads to a functional tube.