Fallopian tube stripping forceps: a novel instrumental design for distal tubal pregnancy laparoscopy.

OBJECTIVE: To compare a new method using fallopian tube stripping forceps (FTSF) for salpingostomy in laparoscopic tubal pregnancy management. STUDY DESIGN: Comparative observational study. A total of 102 patients with ampullary tubal pregnancy were treated as follows: 56 patients (Group 1) underwent stripping by FTSF, and 46 patients (Group 2) underwent salpingostomy. The bleeding, operation time, persistent ectopic pregnancy (EP) rate, and the first reproductive performance were investigated. RESULTS: We found less intraoperative bleeding, shorter operation times, and lower rates of EP recurrence in Group 1 compared with Group 2. In contrast, we observed no significant differences in the persistent EP rate, the occurrences of spontaneous intrauterine pregnancy and miscarriage, and the rates of successful IVF between the two groups. CONCLUSION: For distal tubal pregnancy with an ectopic mass ≤30mm, laparoscopic fallopian tube stripping assisted by FTSF may be an easy, less-damaging, conservative operational modality with lower recurrent EP compared with salpingostomy for patients who desire future pregnancy.

[Feasibility of laparoendoscopic single-site surgery in gynecology with conventional laparoscopic instruments]. / Faisabilité de la cœliochirurgie gynécologique par mono-trocart avec instruments droits standards.

OBJECTIVES: To describe the safety and efficacy of single-port access for laparoscopic surgery in gynecology with conventional laparoscopic instruments. PATIENTS AND METHODS: In this prospective study, we report our experience with 90 patients who underwent Single Port Access (SPA) laparoscopic surgery for gynecologic pathology with the use of the SILS(®) Port Multiple Instrument Access Port (Covidien(®), Mansfield, MA). RESULTS: We realised 15 ovarian cystectomies, 30 salpingo-oophrectomies with 14 one side, 9 lysis of adhesions, 7 distal tubal repairs, 6 salpingectomy, 8 other procedures. The mean surgical time is 47 min (25-120). One conversion to conventional laparoscopy and one in laparotomy were performed. The mean duration stay is 2 days [1-3]. DISCUSSION AND CONCLUSION: SPA in gynecology is feasible with conventional laparoscopic instruments. SPA surgery represents the newest frontier in minimally invasive surgery.

Isobaric laparoendoscopic single-site surgery with wound retractor for adnexal tumors: a single center experience with the initial 100 cases.

OBJECTIVE: To report our experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery in 100 patients with adnexal tumors at a single center. STUDY DESIGN: In each case, a wound retractor was used as a working port through a 2.5-cm vertical umbilical incision. The surgical view was secured with the subcutaneous abdominal wall-lift method. Surgical procedures were performed using conventional laparoscopic instruments under vision with a rigid 30°, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes were retrospectively analyzed. RESULTS: Between August 2009 and July 2010, one hundred and seventeen tumors from 100 cases were treated with isobaric LESS surgery (unilateral salpingo-oophorectomy, 46; unilateral cystectomy, 33; bilateral cystectomy, 8; bilateral salpingo-oophorectomy, 6; unilateral cystectomy and contralateral cyst wall ablation, 4; unilateral cystectomy and contralateral salpingo-oophorectomy, 2; and unilateral salpingectomy, 1). Three normal adnexa were prophylactically resected at the same time as contralateral salpingo-oophorectomy of a diseased ovary. Previous abdominal surgery was noted in 20 cases. Emergency surgery was performed in 7 cases. Six pregnant women were treated in the late first trimester. Median tumor diameter was 6.9 cm. Median surgical duration was 55 min and median blood loss was 10 mL. Conversion to conventional laparoscopic surgery was noted in one case of recurrent endometriotic cyst with severe adhesion. Laparotomic conversion was not experienced. Prolonged administration of antibiotics with extended hospitalization was required in 7 cases due to elevated inflammatory parameters. There were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within the umbilicus. With exclusion of 4 endometriotic cysts treated with cyst wall ablation, pathological diagnosis was obtained for 113 tumors (dermoid cyst, 54; endometriotic cyst, 21; serous cystadenoma, 19; mucinous cystadenoma, 9; paraovarian cyst, 8; serous borderline tumor, 1; and paraovarian serous papillary borderline tumor, 1). CONCLUSIONS: With efficient wound retraction to create a wide and flexible orifice during instrumentation, the transumbilical wound retraction system combined with the subcutaneous abdominal wall-lift method contributes favorably to LESS surgery as a safe, feasible and reproducible alternative for a variety of ablative and reconstructive applications in the management of adnexal tumors.

[An alternative approach to the surgical correction of tubal infertility]. / Al'ternativnyi pokhod k khirurgicheskoi korrektsii trubnogo besplodiia.

The authors compare the efficacy of surgical treatment of tubal sterility using laparoscopy (133 cases) and microsurgical techniques (120 cases). The results were assessed with due consideration for the dissemination of adhesions (first-second and third-fourth degrees), status of the uterine tubes, and presence or absence of chlamydial infection. Surgical correction via an endoscopic access was found to be preferable in adhesions of the first-second degree, whereas in adhesions of the third-fourth degree surgical interventions are inadvisable.

[Pelviscopic salpingostomy with everted suture]. / Pelviskopische Salpingostomie mit evertierender Naht.

From 1987 to 1990 pelvioscopic distal salpingostomy was performed in 47 patients at the University Hospital of Kiel. The tubal mucosa was everted and fixed with 4/0 PDS sutures. 35 patients (74%) responded to a questionnaire 2-4 years after surgery. A bilateral salpingostomy had been performed in 16 of these 35 cases, while the contralateral tube was either absent or intramurally occluded in 19 cases. Eight patients (23%) postoperatively had an intrauterine pregnancy, five patients gave birth to a healthy child, one patient was pregnant at time of follow-up. Three patients had abortions and three experienced a tubal pregnancy of one or both sides. Compared to the endoscopic procedure with the CO2 laser pelvioscopic salpingostomy with an everted suture represents an equally suited alternative.

[Possibilities and limits of endoscopic fallopian tube surgery]. / Möglichkeiten und Grenzen der endoskopischen Tubenchirurgie.

Treatment of distal tubal occlusion by microsurgical means allows a pregnancy rate of about 30-40% per patient. The success rate directly depends on patient's age and the grade of tubal destruction and increases to 50% in younger patients. Therefore microsurgical repair still represents a sufficient alternative to IVF. The introduction of endoscopical techniques further facilitates distal tubal surgery and offers the opportunity to evaluate the grade of tubal destruction. When performed correctly based on longstanding experience pregnancy rates after endoscopical salpingostomy are similar to microsurgery via laparotomy. In contrast microsurgery by laparotomy is still the method of choice in cases of proximal tubal occlusion or reversal of tubal ligation. Furthermore laparotomy is still indicated in patients presenting with distal tubal pathology, if the endoscopical approach does not lead to a sufficient postsurgical result.

[The bipolar needle electrode in surgical laparoscopy. Initial technical experimental and clinical results]. / Die bipolare Nadelelektrode in der operativen Laparoskopie. Erste experimentell-technische und klinische Ergebnisse.

To date the tremendous spread of operative laparoscopic procedures associated with monopolar high-frequency techniques has lead to an increase in complications caused by monopolar leakage currents. Experimental-surgical measurements on minipigs have shown no significant leakage currents in clinical relevant power range during laparoscopic application of a bipolar needle electrode as compared to monopolar electrodes. Practicability and safety of the bipolar electrode was proven in 100 operative laparoscopies for organ preserving or reconstructive surgery. In summary, with the new laparoscopic bipolar needle electrode a secure surgical instrument is available, with which finest tissue handling and minimal thermal damage feasible.

[Pelviscopic treatment of female sterility]. / Pelviskopische Behandlung der weiblichen Sterilität.

In 1988 and 1989 176 patients underwent pelviscopy at the Kiel University Hospital of Gynaecology for primary or secondary sterility of at least 12 months duration. 120 patients (68%) filled in a questionnaire on the therapeutic results after 2 to 3 years. Following peripheral salpingostomy in 18 patient, an intrauterine pregnancy developed in 22% of these cases, while an ectopic pregnancy occurred in 11% of the cases. After fimbrioplasty in 37 cases, the intrauterine pregnancy rate amounted to 43%, whereas the rate was 50% following salpingoovariolysis. 4 patients with a subserous or intramural myoma, measuring 2.5 to 8 cm in diameter, but no other pathological signs of disturbed fertility, became pregnant after enucleation of the myoma. 2 patients delivered at full term, the other two miscarried. 5 out of a total of 10 patients became pregnant after endometriosis foci had been coagulated or endometriomas enucleated. In these cases, the adnexa did not require additional surgical treatment. Pelviscopy revealed an untreatable intratubal block in 9 cases. 10 patients could not be included in the study, either because of a successful in vitro fertilisation or a pregnancy following heterologous insemination or because a hysterectomy or tubectomy had been performed in the meantime. In cases, where inspection under magnification had shown at least one non-pathological adnexa and tubal patency of at least one of the tubes, 35% of the patients conceived after pelviscopy and chromopertubation within the follow-up period. The therapeutic action of the chromopertubation and the psychological effect of finding no pathological signs during the genital examination remains speculative.(ABSTRACT TRUNCATED AT 250 WORDS)

Laparoscopic salpingostomy with electrocautery in the management of tubal pregnancy.

From August, 1990 to May, 1991, all cases of tubal pregnancy presenting to King George V Hospital for Mothers and Infants were considered for laparoscopic salpingostomy. This procedure involved opening the affected Fallopian tube with diathermy, removal of ectopic tissue via the laparoscope, achieving haemostasis and leaving the tubal incision to heal by secondary intention. The procedure was undertaken in 35 patients and was successfully performed in 31 patients with an average operating time of 66.4 minutes (+/- 20.1 minutes). Average hospital stay was 2.1 days (+/- 1.3). This paper examines the technique and results of the initial learning curve for laparoscopic salpingostomy and finds that with knowledge of potential hazards and care in surgery, this operation can be safely carried out in a selected group of patients.

[Pelviscopic salpingectomy in ruptured extrauterine pregnancy using an automatic stapler-incision instrument]. / Pelviskopische Salpingektomie bei rupturierter Extrauteringravidität mit Hilfe eines automatischen Klammer-Schneideinstrumentes.

The case report presented describes pelviscopic salpingectomy with ruptured tubal pregnancy carried out by an automatic stapling and cutting instrument. This instrument (EndoGIA 30) was developed for endoscopic intestinal surgery by the Autosuture company. It can be inserted via a 12 mm trocar and allows threefold clip suture of 3.3 cm length on each side of the automatically cut tissue. The clip suture is absolutely blood dry and does not pull anatomic structures out of shape. Unfortunately, the instrument is available for single use only and thus more expensive than the traditional "Semm's three-ligature method" (1979). Nevertheless, it will add an improvement to minimal invasive surgery. One of the indication for its use is to avoid laparotomy in individual cases.

[The use of Fogarty's catheter for salpingoplasties in laparoscopic surgery]. / Intérêt de la sonde de Fogarty pour les salpingoplasties en coeliochirurgie.

Nowadays new techniques of laparoscopic surgery make it possible to carry out fimbrioplasties and salpingostomies with results as good as those obtained by microsurgery. We describe a new use for the Fogarty catheter as a means of traction and for demonstrating the ampulla and the fimbrial end of the tube. The pneumatic balloon of the end of the catheter is blown up in the tubal ampulla. This makes it possible to bring the tube close to the laparoscope which makes it possible to carry out precise precise maneuvers with such degrees of enlargement as make it like a form of microsurgery. This kind of procedure helps in these delicate and difficult operations.

[Treatment of tubal pregnancy by pelviscopy--complications, pregnancy and recurrence rates]. / Die Behandlung der Tubargravidität per pelviskopiam--Komplikationen, Schwangerschafts- und Rezidivraten.

From 1977-1989, 298 ectopic pregnancies were treated pelviscopically at the Dept. of Gynaecology Hospital of the University of Kiel. 26 tubes were already ruptured. In 251 patients (84%), organ preserving treatment was possible, 205 treatment by longitudinal salpingotomy. 46 tubal abortions were extracted. In 47 patients (16%), who did not wish to augment their family any further, or in whom recurrence of tubal pregnancy occurred on the same side, salpingectomy was performed. Complications required re-pelviscopy in 5% and laparotomy in another 1%. The intrauterine pregnancy rate in 143 patients desiring pregnancy was 58%. Abortions occurred in 8%. A recurrence of ectopic pregnancy in the ipsilateral tube occurred in 10%, in the contralateral tube in 6%. 9 patients desiring pregnancy had already undergone salpingectomy on the contralateral side or were treated pelviscopically by longitudinal salpingotomy because of ectopic pregnancy on both sides. Three of them gave birth to healthy infants.

[Fibrin gluing in surgical, laser-assisted laparoscopy]. / Fibrinklebung in der operativen, laser-assistierten Laparoskopie.

Fibrin sealing has proved a successful procedure for a variety of indications in operative gynecologic laparoscopy. Ovaries can be reshaped after cystectomy, serosa and peritoneal defects as well as perforations of the uterus can be sealed with fibrin adhesive. At present, application for salpingotomy, fimbrial eversion and tubal anastomosis is being investigated in clinical studies. Yet larger collectives and a longer follow-up are necessary for a final evaluation of the method. No complications were observed in 75 laparoscopic fibrin sealing performed at our department for established indications. Fibrin adhesive can replace time-consuming, complicated endoscopic sutures. It is an atraumatic tissue-sealing and hemostatic technique, easy in handling, thus leading to a considerable reduction in operation times. The excellent hemostyptic and wound healing characteristics of fibrin adhesive are also an advantage.

PIP: Fibrin sealing has proven successful in a variety of situations in operative gynecologic laparoscopy. Ovaries can be reshaped after cystectomy, serosa and peritoneal defects as well as uterine perforations can be sealed with fibrin adhesive. At the present time, application for salpingostomy, fimbrial eversion, and tubal anastomosis are being investigated in clinical studies. Larger samples and longer follow-up periods are necessary for a final evaluation of the method. No complications were observed in 75 laparoscopic fibrin sealings performed at the authors' department. Fibrin adhesive can replace time-consuming, complicated endoscopic sutures. It is an atraumatic tissue sealing and hemostatic technique, easy in handling, and thus leading to a considerable reduction in operation times. The excellent hemostyptic and wound healing characteristics of fibrin adhesive are also an advantage. (author's modified)

[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.