Peter F. J. Lang

Ureteral complications with operative gynecologic laparoscopy

OBJECTIVE The study assessed the incidence, diagnosis, management, and causes of ureteral injuries during major laparoscopic operations at our department in a 6-year period. STUDY DESIGN The study was a chart review of 790 consecutive major laparoscopic procedures in 711 patients (mean age 37.4 +/- 11.6 years, mean weight 64.3 +/- 29.1 kg). RESULTS There were four ureteral complications in three patients during or after laparoscopic operations: three of 711 patients (0.42%) and four of 790 procedures (0.38%). All three ureteral complications (one transection and a total of three ureterovaginal fistulas in two patients) occurred during laparoscopically assisted vaginal hysterectomies, for an incidence of 4.3%. There were no ureteral injuries in 291 salpingo-oophorectomies, 414 ovarian cystectomies, and 15 colposuspensions. Both delayed ureteral complications occurred in the lower segment of the ureter after laparoscopic bipolar coagulation and division of the cardinal ligament. CONCLUSION We conclude that in laparoscopic surgery the ureter is most at risk when the cardinal ligament is dissected and divided below the uterine vessels.

Treatment of unruptured tubal pregnancy by laparoscopic instillation of hyperosmolar glucose solution

Sixty patients with unruptured tubal pregnancy were treated with local laparoscopic instillation of 50% glucose solution. This treatment was successful in 49 (98%) of 50 patients with an initial serum human chorionic gonadotropin level of less than or equal to 2500 mU/ml and in six (60%) of 10 with an initial level greater than 2500 mU/ml. No side effects were seen. The average hospital stay of patients who did not require a second intervention was 5.2 days (range 3 to 10). The average time between glucose instillation and the decline of serum human chorionic gonadotropin levels below the level of detectability was 21.3 (+/- 14.3) and 30.2 (+/- 10.9) days in patients with serum levels less than or equal to 2500 mIU/ml and greater than 2500 mIU/ml, respectively. Five patients (8%) underwent a second laparoscopy (n = 4) or laparotomy (n = 1) because of stable or increasing human chorionic gonadotropin levels and progressing clinical symptoms. We conclude that laparoscopic instillation of hyperosmolar glucose solution is safe, technically simple, and effective in the treatment of unruptured tubal pregnancies associated with a serum human chronic gonadotropin level less than or equal to 2500 mIU/ml.

Unrecognized perforation of the cecum at needle suspension of the bladder neck: a case report

Perforation of the cecum at needle suspension of the bladder neck was detected at abdominal surgery for recurrent stress urinary incontinence 4 years later.

Intrauterine pregnancy in a patient with a sole remaining tube after local treatment of tubal pregnancy with hyperosmolar glucose

A spontaneous IUP occurred 8 months after laparoscopic instillation of hyperosmolar glucose solution into a tubal pregnancy in a patient with a sole remaining tube. This is the first unequivocal proof of intact tubal function after treatment of a tubal pregnancy with local hyperosmolar glucose.

Histopathology of the fallopian tube after local instillation of hyperosmolar glucose solution for unruptured tubal pregnancy

Because of an incomplete tubal abortion, salpingectomy was performed in a patient 12 days after glucose instillation into an ampullary tubal gestation. Serum hCG levels had progressively declined from 1.122 mIU/mL at first intervention to 37 mIU/mL at the second operation. Histopathology showed marked necrosis of trophoblastic tissue but no discernible damage of the tubal epithelium and tubal wall attributable to the hyperosmolar solution applied 12 days before. This case offers histopathologic evidence that intraluminal glucose instillation for treatment of unruptured tubal pregnancies does not lead to persisting damage of the tubal mucosa.

Retropubic versus transobturator tension‐free vaginal tape (TVT vs TVT‐O): Five‐year results of the Austrian randomized trial

To compare outcomes of the retropubic versus the transobturator tension‐free vaginal tape (TVT vs TVT‐O) at 5 years.

Reproductive outcome after laparoscopic instillation of hyperosmolar glucose into unruptured tubal pregnancies

OBJECTIVE To determine intrauterine and ectopic pregnancy rates after local instillation of 50% glucose into unruptured tubal pregnancies. DESIGN Retrospective cohort of 183 patients, who were observed for 16 to 108 months (median, 64 months). SETTING University hospital. PATIENT(S) One hundred eighty-three women who underwent laparoscopic instillation of hyperosmolar glucose for unruptured tubal pregnancies. INTERVENTION(S) Completion of questionnaires. MAIN OUTCOME MEASURE(S) Pregnancy rate, tubal recurrence rate. RESULT(S) A total of 124 women returned the questionnaire and had a desire for spontaneous conception. The conception rate and the intrauterine pregnancy rate were 79% and 73%, respectively. Seventy percent of all women with desire for spontaneous conception had live births. The rate of subsequent ectopic pregnancies was 12%. Tubal patency of the treated tube was demonstrated in 69% of 39 women at hysterosalpingography. CONCLUSION(S) The long-term prognosis for conception after laparoscopic instillation of hyperosmolar glucose for unruptured tubal pregnancy is favorable and comparable to that of other conservative treatments.