[Endoscopic sterilization and related problems (author's transl)]. / La sterilisation endoscopique et ses problemes.

PIP: Endoscopic tubal sterilization by electrocoagulation with unipolar current is very effective, 0.03% failure rate, but difficult to use because of the danger of burns. Sterilization by bipolar current is just as effective and much safer, and it is the method most used today. Sterilization by thermocoagulation allows the use of a low-frequency current, but has a failure rate of 4-7%. Mechanical methods of laparoscopic sterilization include the use of several kinds of clips, with failure rate of 2%, and a recanalization rate of 2%, and the use of Fallopian rings, also of several types. Failure rate of Fallopian rings is about the same as with conventional tubal ligation methods; the application of rings, however, can cause very serious abdominal pains. It appears that mechanical methods of sterilization have more chances for reversibility than other methods. However, it is extremely important that the doctor informs the patient that no sterilization method is totally reversible.^ieng

[The effectiveness of different methods of laparoscopic tubal sterilization (author's transl)]. / Wie sicher sind die einzelnen Methoden der laparoskopischen Tubensterilisation?

If sterilization is offered today to a young multipara pointing out the possibility of eventual later recanalization the most essential point lies in thorough patient information. The patient must be informed that less aggressive techniques like thermocoagulation or mechanical tubal occlusion bear a higher risk of failure and consequently eventual pregnancy 2%-4%-7%. Such failures are part of the method and must and cannot be considered malpractice. Extensive patient information about all pros and cons is the only way to avoid future problems. Spontaneous tubal recanalization has occurred and may occur to the most skilled surgeon. After twenty years of personal experience with almost all methods of laparoscopic tubal sterilization my recommendation today is: bipolar sterilization on one site of the isthmical tubal portion with division of the coagulated tissue. Even so sufficient tubal tissue should remain intact to allow eventual later recanalization. We were never disappointed with this way of proceeding and so far, contrary to all other methods, have observed no pregnancy among our patients.

PIP: If sterilization is offered to a young multipara today with the possibility of eventual recanalization, most essential is thorough patient information. The patient must be informed that less aggressive techniques such as thermocoagulation or mechanical tubal occlusion carry a higher risk of failure and subsequent pregnancy, 2%-4%-7%. Such failures are part of the method and should not be considered malpractice. Extensive patient information about pros and cons is the only way to avoid future problems. Spontaneous tubal recanalization has occurred even with the most skilled surgeon. With 20 years of personal experience with almost all methods of laparoscopic tubal sterilization, the author recommends bipolar sterilization on 1 site of the isthmic tubal portion with division of the coagulated tissue. Even so, sufficient tubal tissue should remain intact to allow for eventual later recanalization. This method has never disappointed anyone, and thus far no pregnancy has been observed among our patients. (Author's modified)

[Photolaparoscopy (author's transl)]. / La photolaparoscopie.

PIP: Photocelioscopy, or laparoscopic photography, has improved enormously due to the development of photographic technology. The availability of new laparoscopes, new sources of light, especially intracorporal sources, new and more sensitive films, now enable teachers to use laparoscopic photography as a didactic tool in medical schools. The Polaroid method can be used for immediate documentation; with this method the quality of film development is of primary importance. Video cassette recording of laproscopic procedures can also be made.^ieng

Ketamine--HCl--diazepam anesthesia for laparoscopy.

Laparoscopy was performed on 150 patients under ketamine-HCl-diazepam anesthesia via intravenous drip infusion. No psychomotor disturbances were noted during the emergence phase. No complications occurred during the procedures, neither from the surgical nor from the anesthesiologic point of view. No alarming stimulation of the cardiovascular system was noted. The patients became responsive within a short time, but a state of strong sleepiness remained for several hours. Therefore, ketamine-HCl-diazepam anesthesia does not appear suitable for outpatient laparoscopies but is a valuable alternative to other methods of anesthesia for laparoscopy.

["Surgical" laparoscopy indications and value]. / Die "chirurgische" Laparoskopie. Indikationen und Aussagewert

From 1971-1973, 1046 patients underwent laparoscopy in the gynecological department; 256 of the cases were surgical problems. In contrast to gastroenterological laparoscopy, surgical laparoscopy was performed in the operating room under general anaesthesia and everything prepared for immediate surgery. Major surgical interventions--if necessary--were performed immediately after laparoscopy. Indications for surgical laparoscopy were the following: preoperative evaluation of nature, extent and eventual metastases of tumors. Preoperative differentiation of acute and chronic appendicitis from other affections, particularly in younger female patients. Suspected intraabdominal hemorrhage of traumatic or non-traumatic origin. Evaluation of pathological palpatory findings in the abdominal cavity. Differential diagnosis of chronic relapsing intraabdominal complaints of unknown origin. Differential diagnosis of putrid, tuberculous or carcinomatous peritonitis with eventual biopsy. Preoperative evaluation of questions concerning surgery of liver, gallbladder or pancreas in connection with occlusive jaundice, hepatic cirrhosis or malignancy. The results of this study show, that by laparoscopy in over 50% of the patients, major surgical interventions could be avoided. Contraindications were primarily limited to pulmonal or cardiac insufficiency. The only complication (intestinal perforation), was adequately dealt with under the given operative conditions.

Chronic pelvic disease of unknown origin.

PIP: Obscure, chronically recurring pains in the lower abdomen and back are common symptoms in the office of the gynecologist or practitioner. Often the cause has never been found. Many are functional or psychosomatic disturbances. There is no objective measurement of the quality or amount of pain. Common diagnoses have been chronic adnexitis, chronic appendicitis, retroflexion of the uterus, or adhesions. Too often surgical operations have been of little benefit. When consultations with other specialists have not helped, laparoscopy is indicated. Endometriosis is a common finding. Cauteriziation of this lesion at laparoscopy is better than hormone therapy. Adhesions may be severed with relief of symptoms. Varicose enlargement of ovarian veins is sometimes seen. Laparotomy may be indicated for conditions not readily treated by laparoscopy. However, indications for surgery should be carefully considered to avoid iatrogenic damage in an already apprehensive patient. Tranquilizers and small doses of cortisone may be adequate. In about 80% of patients complaining of chronic lower abdominal pain, organic disorders may be found by laparoscopy. The procedure should be recommended more frequently.^ieng

On the development of gynecologic laparoscopy. A recording of human ovulation.

PIP: A description of a film shot with a laparoscope film setup precedes a discussion of the development and present use of laparoscopy. The film shows the rupturing of a follicle. Problems encountered in the European development of laparoscopy included need to modify the optical instruments of the gastroenterologists, inadequacy of illumination, and selection of a usable gas for the pneumoperitoneum. Operative laparoscopy is used for tubal sterilization, biopsy is suspected carcinoma or tuberculosis, aspiration of ovarian cysts, wedge resection of the ovary, resection of adhesions, cauterization of endometriotic lesions, resection of sacrouterine ligaments, ventrosuspension of the uterus, and liver biopsy. Tubal sterilization is the most common procedure. Complications due to technical failure include emphysema, gas embolism hemorrhage, hemotoma, intestinal perforation, gastric perforation, and respiratory and circulatory embarrassment. Complications occurring during operative procedures, excluding complications of tubal sterilization, include burning of skin, burning of intestines, necroses of intestines, peritonitis, late hemorrhage, and electric shock by high-frequency current.^ieng