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Z Fucíková

Publications and source records attributed to Z Fucíková.

At least 19 recordsLinked to original sources
PubMed2006

[Enucleation of intramural uterine fibroids in women at fertile age: midterm results of prospective clinical trials].

OBJECTIVE: To analyze clinical and reproductive outcomes of patients after laparoscopic (LM) or open (OM) myomectomy. DESIGN: Prospective clinical trial. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague. METHODS: Women under the age of 40 with intramural fibroid larger than 4 cm were indicated for myomectomy. LM was performed when laparoscopy revealed solitary or 2 fibroids smaller than 8 cm; otherwise the OM was carried out. The patients were followed at 6 months intervals. RESULTS: 80 myomectomies with extirpation of 121 myomas was performed from January 2002 to April 2005. The average age was 33.5 years, average size of dominant fibroid 56 mm. 38% of women suffered from infertility; the mean follow-up was 15.6 months. We performed LM in 56 cases (70%). From 24 open procedures 18 were elective and 6 converted from laparoscopy. In 18 patients some of the fibroid--ischemization procedures (uterine arteries embolization or laparoscopic dissection, or laparoscopic myolysis) preceded myomectomy. In the group with LM there was significantly lower peri-procedural blood loss, lower count of leucocytes and CRP concentration the 2nd day after surgery, shorter stay in the hospital, shorter interval between surgery and conception, and lower incidence of early complications than in women with OM. Fibroid related symptoms fully disappeared in 76% of patients. 20 women from 38 that have already tried to conceive have achieved 22 gestations so far: 9 deliveries (2 preterm; 3 vaginal, 6 Cesarean), 6 miscarriages, 1 ectopic and 6 ongoing pregnancies at the moment. CONCLUSION: In the hands of surgeons experienced in operative laparoscopy the enucleation of intramural uterine fibroids is safe, symptomatically effective, mostly low invasive procedure with good reproductive prognosis.

Adult↗
PubMed2006

[Office hysteroscopy--state of the art].

OBJECTIVE: Sum up the knowledge about office hysteroscopy. TYPE OF STUDY: Review of literature and our own 5 years of experience. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague, Prague. METHODS: Compilation of data from scientific literature and 5 years of our own experience with office hysteroscopy. CONCLUSIONS: Hysteroscopy provides optical evaluation of uterine cavity. Most of the benign intrauterine organics pathologies could be managed in an outpatient setting with a vaginoscopic approach without any anaesthesia and analgesia. Using that approach we can recommend to perform endometrial target biopsy, resection of endometrial polyps up to 1.5 cm and pedunculated submucous myomas up to 1 cm as well as resection of filmy intrauterine adhesions. Method is comfortable for well managed patients and practically complication-free.

Ambulatory Surgical Procedures↗
PubMed2006

["See and treat" hysteroscopy: limits of intrauterine pathology bulk].

OBJECTIVE: To evaluate bulk limits of intrauterine pathology for "see and treat" hysteroscopy. TYPE OF STUDY: A retrospective observational study. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague. METHODS: 200 mg of Indomethacin was administered to the patients by rectum 2 hours before procedure. "See and treat" procedures were performed with "Versascope" in awake patients without any peroperatively admistered analgesia or anaesthesia. As a "see and treat" were managed 796 endometrial polyps, 125 submucous myomas, as well as 62 cases of intrauterine synechias. CONCLUSIONS: endometrial polyps up to 1,5 cm, pedunculated submucous myomas up to 1,0 cm as well as fibroid adhesiones obliterated no more than 1/3 of uterine cavity can be managed as "see and treat" procedures with a high compliance of the patients.

Female↗
PubMed2005

[Embolization of uterine arteries during myoma treatment from the patient's point of view].

OBJECTIVES: To acquire information about the patient's follow-up evaluation of treating fibroids by uterine artery embolization (UAE). DESIGN: A retrospective multicenter clinical trial. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: 45 women who underwent the UAE due to uterine fibroids from 1999 to 2003 were asked to complete a questionnaire. The questionnaire included 26 questions asking how the women had been informed and what they had expected. Further questions were focused on the course of embolization itself, early post-procedural difficulties (post-embolization syndrome) and patient's overall evaluation of treatment in a longer term. Those women who had completed the questionnaire and had been ready to co-operate were thereafter examined and included in the follow-up monitoring and, if necessary, further treatment was recommended. RESULTS: Thirty one out of 45 patients from 26 to 48 years of age, who had been addressed (68.9%) answered the questionnaire. UAE was indicated 12 times (38.7%) on account of symptoms, 10 times (32.3%) because of sterility, 5 times (16.1%) as a preventive measure within the framework of family planning and 4 times (12.9%) for an asymptomatic but growing leiomyoma. Twenty seven (87.1%) women were also offered an alternative treatment, which they refused. As far as problems are concerned, 18 (58%) women described the course of treatment as corresponding with what they had expected, 5 times it was less painful, and 8 times it was worse than expected. The long-term results were considered as positive by 87.1% of responders, only 12.9% considered the treatment as failure. 5 in 11 women planning pregnancy became pregnant, 3 of them gave birth in term and 2 miscarried in the 1st trimester. CONCLUSION: From the point of view of the patients, the evaluated method proves highly successful, it is well tolerated and it involves a low risk of complications. It is not possible, at this point, however, to give an unequivocal answer to the question whether the method should also be routinely offered to women who are planning pregnancy.

Adult↗
PubMed2004

[Combined treatment of uterine myoma (uterine arteries embolization followed by laparoscopic myomectomy)].

OBJECTIVE: The treatment of uterine myoma with pretreatment of uterine arteries embolization followed by laparoscopic myomectomy is presented. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology 1st Medical Faculty of Charles University and General Faculty Hospital in Prague. SUBJECT AND METHOD: Forty two years old woman with uterine myoma was "pretreated" with uterine arteries embolization followed by laparoscopic myomectomy next day. The reason for this procedure was to improve in short period conditions for surgery and definitively solve uterine pathology. CONCLUSION: The "pretreatment" with uterine arteries embolization improves basically conditions and effect of uterine myoma surgery. This "two step procedure" could be recommended mainly for cases of large and vascularizated myomas.

Adult↗
PubMed2003

[Management of uterine myomas in women of fertile age].

OBJECTIVE: Review of current knowledge about uterine fibroids management in young women. Analysis of possible diagnostic and therapeutic algorithms regarding fertility preserving. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: Analysis of the facts in literature (texts in medical journals, monographies, textbooks, internet database Medline and Ovid) and authors' clinical experience. CONCLUSIONS: Alternatives of treatment of infertility in women with uterine fibroids have significantly enlarged in past 10 years. However none of the indicated methods is perfect. Expectation does not exclude the risk of growth of fibroids and abortion. The effect of pharmacological therapy is only temporary. Myomectomy is associated with the risk of surgical complications, fibroids' recurrence and uterine rupture in subsequent gestation. Although uterine artery embolisation (on an average) halves the fibroids volume, the long-term effect of the method on female fertility is still unknown. Nevertheless it seems convenient to advise the active approach to all women planning pregnancy and having significant (submucous or intramural) fibroid even before spontaneous or assisted conception. Most recent studies indicate significant improvement of reproduction outcomes after myomectomy, especially in young women with the absence of other factors of infertility. Only the results of randomized, controlled trials (that are still awaited) will inform us about comparison of the effects and risks of myomectomy and uterine artery embolization in management of infertility.

Adult↗
PubMed2003

[The role apoptosis in the extent of endometriosis and its clinical symptomatology].

OBJECTIVE: To evaluate the presence and intensity of apoptosis in lesions of peritoneal endometriosis. To consider the role of different intensity of apoptosis in the progression of the disease and in the manifestation of clinical symptoms. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology and Department of Histology and Embryology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Lesions of peritoneal endometriosis were excised at laparoscopy in women with 1st to 3rd stage of the disease. Specimens were fixed in the Karnowski solution. The presence of apoptosis was assessed immunohistochemically. RESULTS: Biopsies of peritoneal endometriosis were consecutively taken in 48 women. Altogether, 29 patients were symptomatic, and 19 did not complain of any symptoms. The average duration of symptoms was 16.6 months. The presence of apoptosis was detected in 11 out of 35 evaluated specimens. In comparing the groups with and without apoptosis, no differences were found in the stage of the disease, in the proportion of asymptomatic patients, and in the manifestation of different subjective complaints. CONCLUSIONS: The study confirmed a frequent presence of apoptosis in biopsies of peritoneal endometriosis. However, there were no relationships found between the presence of apoptosis and the stage of the disease or manifestation or character of subjective complaints.

Adult↗
PubMed2003

[Long-term follow-up after complete treatment of peritoneal endometriosis with the CO2 laser].

OBJECTIVE: To evaluate the effect of laparoscopic CO2 laser ablation of peritoneal endometriosis in the treatment of pelvic pain with a long-term follow-up. To differentiate the effect of surgery on different types of pelvic pain. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Patients with 1st to 3rd stage endometriosis, with manifestation of pelvic pain, and with complete excision of peritoneal endometriosis lesions, were included in the study. All visible lesions were vaporized by CO2 laser following adhesiolysis and complete visualization of the pelvis. After the procedure, patients were followed up at 6-month intervals. The severity of pelipathia, dyspareunia, dysmenorrhea, pain during micturition, and pain during defecation were monitored using a visual analog score of 10 points. RESULTS: A total of 31 patients were included in the study. After 6, 12, and 18 months after surgery, the recurrence of pelvic pain was found in 12 (39%), 15 (48%), and 19 (61%) patients, respectively. Improvement or disappearance of complaints was documented 18 months after the surgery in 11 cases of dysmenorrhea (50%), 9 cases of dyspareunia (50%), 14 cases of pelipathia (58%), 12 cases of pain during micturition (71%), and in 14 cases of pain during defecation (87.5%). The proportion of recurrences increases with the length of the interval after the procedure, mainly in dysmenorrhea and dyspareunia. CONCLUSIONS: The effect (improvement or disappearance of pelvic pain) of a complete CO2 laser ablation of peritoneal endometriosis continues 18 months after the surgery in about 40% of patients. A graduated increase in the number of recurrences is apparent during follow-up, most significantly in dysmenorrhea and dyspareunia. The effect of surgery on different types of pelvic pain varies. A small number of recurrences was found in pain during micturition and pain during defecation, on the other hand, less success was apparent in the treatment of dysmenorrhea.

Adult↗
PubMed2002

[Laparoscopy in chronic pelvic pain--a retrospective clinical study].

OBJECTIVES: To analyze the laparoscopic findings in women with chronic pelvic pain (CPP). To verify the possible predictive value of the anamnestic factors for the laparoscopically established diagnosis. DESIGN: A retrospective clinical trial. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: We realized a detailed analysis of laparoscopies for CPP performed in our clinic in the last 5 years. With the help of statistical analysis (chi 2) the possible influence of age, previous surgical intervention, history of PID, dysmenorrhea, infertility, and some other factors on endoscopic finding was verified. RESULTS: 480 laparoscopies for CPP were performed from the year 1995 to 1999. The most frequent findings were adhesions (22.3%), endometriosis (20.4%), PID (17.7%), and normal finding (17.7%). In 53% of all cases the operative laparoscopic procedure was done, most frequently the adhesiolysis (62.2%). Only one serious complication during laparoscopy was recorded (0.21%). In women younger than 30 years endometriosis was the most frequent finding (22.8%), in women older than 30 pelvic adhesions were the most often (31.9%). Diversity of findings between the groups was statistically significant (P < 0.0001). In patients with previous operation in pelvis the adhesions were found most frequently (46.2%). Diversity of findings in women with and without previous operation was also significant (P < 0.0001). In women treated for PID, pelvic inflammation was found in 25.8%, but in 22.5% the finding was negative and in 20.2% the endometriosis was diagnosed. In these subgroups (women after and without treatment of PID) the diversity of findings was not significant (P < 0.1). In infertile women, suffering from CPP, PID was found most frequently (41.2%). A suspicion of chronic appendicitis was verified in 64.3%. In patients with dysmenorrhea, as well as in women suffering from dyspareunia, endometriosis was dominant finding (30.4%, resp. 29.1%). CONCLUSION: Laparoscopy for CPP is a safe and effective method for verifying and adequate therapy of as yet hidden pathological findings. With the help of anamnestic factors some laparoscopic findings are predictable; although the sensitivity and specificity is very poor.

Adult↗
PubMed2001

[Conservative treatment of dysfunctional uterine bleeding].

OBJECTIVE OF STUDY: Analysis of contemporary knowledge of conservative treatment of dysfunctional bleeding. DESIGN: Review of literature. SETTING: Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital, Prague. METHOD: Evaluation and review of problem of DUB based on data from the literature. CONCLUSION: The development of new therapeutic surgical methods of uterine bleeding calls for a critical evaluation of a possible conservative approach. A few years ago failure of medicamentous treatment was an indication for hysterectomy. Thus conservative treatment was used very frequently. The development of many endoscopic techniques changed fundamentally the algorithm of treatment in women who do not plan another pregnancy. The article gives a critical account of contemporary knowledge of conservative treatment of dysfunctional uterine bleeding.

Female↗
PubMed2000

[Paracervical anesthesia in hysteroscopy and transcervical surgery].

OBJECTIVE: To evaluate the efficacity of local-paracervical anaesthesia in hysteroscopy and transcervical surgery. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, 1st medical Faculty, Charles University, Prague. METHODS: In 1998 we performed 144 hysteroscopic procedures under local anaesthesia--paracervical block. In 47 (32.6%) cases we performed transcervical surgery. As anaesthetic agent we used bupivacain (0.25%, Marcain, Astra) combined with an intravenous sedative--midazolam (Dormicum, Hoffman-LaRoche). RESULTS: In 130 (90.2%) cases patients evaluated the procedure as comfortable, in 7 (4.86%) cases the procedure caused discomfort and in 7 (4.86%) cases we used general anaesthesia. CONCLUSION: Paracervical anaesthesia is a safe method for hysteroscopy and transcervical surgery due to its minimal invasivity.

Anesthesia, Local↗
PubMed2000

[Personal experience with thermoablation of the endometrium with the Thermachoice balloon catheter].

OBJECTIVE: To evaluate our first experience with thermal balloon therapy of abnormal uterine bleeding. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University, Prague. METHODS: Ten procedures of balloon thermal endometrial ablations were performed between November 1998 and February 1999. From ten patients with abnormal uterine bleeding, 4 patients with concomitant polymorbidity (sclerosis multiplex, hypertension, hepatopathia, pyelonephritis) where more invasive intervention was not recommended or was contraindicated. Treatment entailed controlled heating of intrauterine balloon. Local anaesthesia-paracervical block with analgosedation was employed in 50% of procedures and general anaesthesia was employed in 50% of cases. Follow up after 3, 6, 12, 24 months is required. Success was defined as the reduction of menses to eumenorrhoea or less. RESULTS: Preliminary results after 6 months follow up are successful in 100%; in 5 (50%) cases we recorded amenorrhoea, in 2 (20%) cases hypomenorrhoea and in 3 (30%) cases eumenorrhoea. CONCLUSION: Thermal balloon endometrial ablation appears to be safe due to its minimal invasivity especially in patients with abnormal uterine bleeding with concomitant polymorbidity.

Adult↗
PubMed2000

[Initial experience with the Versapoint bipolar electrode in hysteroscopic tissue vaporization].

OBJECTIVE: To evaluate our first experience with bipolar electrode (Verspoint, Johnson&Johnson) for transcervical surgery. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, 1st medical Faculty, Charles University, Prague. METHODS: Twenty procedures with bipolar electrode in normal saline as distension fluid were performed between September and November 1999. All 20 patients underwent office diagnostic hysteroscopy with biopsy sampling which demonstrated benign histological finding. We used Olympus operative 7 mm hysteroscope, Versapoint system with bipolar electrodes (twizle, spring, ball). In 13 cases we vaporized intrauterine polyps, in 4 cases we vaporized intrauterine submucous myoma (grade I-ESH), in 1 case we dissected intrauterine septum and in 2 cases we performed intrauterine adhesiolysis. Local anesthesia-paracervical block was employed in 50% of procedures and general anesthesia was employed in 50% of cases. RESULTS: The surgeon evaluated the degree of difficulty during the procedure as comfortable and easy to use in case of intrauterine polyp, intrauterine septum and intrauterine adhesions vaporisation, as mild difficulty in submucous myoma to 2 cm and moderate/severe difficulty in case of myoma vaporisation of more than 2 cm size. No complications were registered during or post procedure, we did not registered no sign of hyponatremia, no complains regarding pain or discomfort from patients. CONCLUSION: The advantage of Versapoint bipolar system for intrauterine operative hysteroscopy is the use of normal saline as distention fluid, which decreases pre and postoperative complications. We evaluated the vaporisation of pedunculate intrauterine pathologies up to 2 cm as comfortable and easy to use. Combined to local anesthesia it appears to be a useful system for office hysteroscopy and transcervical surgery.

Adult↗
PubMed2000

[[Endometrial ablation--prospective 5-year follow-up study].

OBJECTIVE: Objective of the study is to evaluate the effectiveness of endometrial ablation in patients with persistent uterine bleeding who are unresponsive to conservative therapy. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital in Prague, Czech Republic. METHODS: 100 women with intractable uterine bleeding were subjected to undergo endometrial ablation. 44 patients were treated preoperatively not only with danazol or progestins but also with Norethisteron acetas to stop the acute bleeding preoperatively and 65 gave no preoperative drug administration. Under appropriate anesthesia the cervix was dilated to 100 mm and the uterine cavity was distended with Purisol (Sorbitol and Manitol). Roller-ball coagulation technique combined with loop highfrequency endoresection was used in most of the patients (85 patients). The findings of small uterine myoma(s) were not consider as a contraindication of the endometrial ablation. RESULTS: At 51-2 months 42 (42%) of patients reported amenorrhea, 51 (51%) hypomenorrhea, 5 (5%) eumenorrhea and 2 (2%) nochange. The mean time to complete operation was 30 minutes (range 15-45 minutes). The procedure was completed in all 100 women and we had no serious complications. CONCLUSION: It is concluded, that endometrial ablation is safe and effective hysteroscopic procedure in the cases of abnormal uterine bleeding for women with normal uterine morfological findings or small uterine myoma(s) considering the follow up 51-2 month of the study.

Adult↗
PubMed2000

[Ambulatory hysteroscopy--a new trend in the diagnosis and treatment of intrauterine pathology].

OBJECTIVE: An analysis of ambulatory hysteroscopic procedures. DESIGN: Retrospective study. SETTING: Dept. of Obstetrics and Gynecology of the 1st Faculty of Medicine, Charles University and the General Faculty Hospital, Apolinárská 18, Prague 2, Czech Republic. METHODS: The sample consists of 225 patients who underwent ambulatory hysteroscopy, during the period between September 1999 to February 2000. The sample makes up 46.3% of the total number of hysteroscopies performed during that period. The procedures were performed under a paracervical block, only rarely in combination with analgesic sedation. RESULTS: Indications for the procedure were most often abnormal uterine bleeding peri- or postmenopausally, 51.2%, abnormal ultrasound findings in 9.8%, and endometrial polyps in 1.8%. In only 23.11% of cases, hysteroscopy was performed in the frame of TCS (transcervical surgery), the remaining procedures were diagnostic. The paracervical block was a great benefit to the comfort of the ambulatory procedures. In 93%, the procedure was evaluated as comfortable, in 4.8% there was discomfort, and in only 2.2% general anesthesia was used due to significant pain. We did not observe any early or late complications. CONCLUSION: Hysteroscopy can be performed as an ambulatory procedure, assuming quality equipment, an experienced surgeon, and properly administered local anesthesia. Our results demonstrate that hysteroscopy is not only a diagnostic procedure, but can be used for certain procedures in the area of TCS (with low or intermediate level of difficulty).

Ambulatory Surgical Procedures↗
PubMed1999

[Endometrial ablation: prospective 3-year follow-up study].

INTRODUCTION: Patients with persistent uterine bleeding not responsive to conservative therapy may in selected cases opt for endometrial ablation rather than hysterectomy. METHODS: 50 women with intractable uterine bleeding were subjected to endometrial ablation. 26 patients were treated preoperatively with danazole 200 to 400 mg/day for 4 weeks, 4 received progestins, 5 norethisteron acetas to stop the acute preoperative bleeding and 15 were not given preoperative treatment. Under anaesthesia the cervix was dilated to 10 mm and the uterine cavity was distended with Purisol (sorbitol and mannitol). Roller-ball coagulation technique combined with loop resection was used in 32 patients, resection using the electrosurgical loop in 17 and coagulation with roller ball in 1 patient respectively. The endometrium of the internal os of the uterus was resected in 16 cases. The findings of small uterine myoma(s) were not considered a contraindication of endometrial ablation. RESULTS: Patients' satisfaction with the effect of treatment was recorded in 48 cases (96%). After 35--5 months 22 (44%) patients reported amenorrhea, 24 (48%) hypomenorrhea, 3 (6%) eumenorrhea and 1 (2%) no change. The mean time of operation was 25 minutes (range 15-40 minutes). The procedure was completed in all 50 women and we had no serious complications. DISCUSSION: There was some evidence of superior health related quality of life among hysterectomy patients reported in literature. The rate of secondary hysterectomy was 10% because of associated lesions: myoma with adenomyosis in 50% of the cases, so that the procedure in cases of myoma(s) is questionable. This is the reason why it is necessary to make a careful selection of patients who are to be treated by this metod in order to avoid complications and secondary hysterectomy. CONCLUSION: It is concluded, that endometrial ablation is a safe and effective hysteroscopic procedure in cases of abnormal uterine bleeding in women with normal uterine morphological findings or small uterine myoma(s).

Adult↗
PubMed1999

[Rational laparoscopic intervention in laparoscopically-assisted vaginal hysterectomy (LAVH): prospective study].

INTRODUCTION: Despite evidence that the vaginal route of surgery is associated with fewer complications and faster recovery, more than two-thirds of hysterectomies are performed abdominally. Diagnostic and operative laparoscopy leads to an increasing number of hysterectomies performed vaginally, although laparoscopy may lead to serious complications. The object of the study was to evaluate the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. METHOD: 100 consecutive women subjected to hysterectomy were indicated for laparoscopically assisted vaginal hysterectomy. The procedures were performed by the same surgical team experienced in laparoscopy and vaginal route hysterectomy which evaluated the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. The mean age of the patients was 48.1 years (range 34-71 years). 7 were nulliparae. 69 patients were indicated for operation due to myomas, 20 for the previous operation in the pelvic area, 6 for adnexal cystic masses, 5 for the associated indications. At the same time bilateral adenexectomy was performed in 74 patients. Uterine descensus was diagnosed in 9 patients preoperatively and the operations for stress urine incontinence were performed in 7 cases (Kelly-Stoeckel 4 and Pereyra 3 respectively). Ovarian vessels were coagulated by bipolar coagulation during laparoscopy and uterine vessels were ligated by the vaginal route. RESULTS: The uterus was extripated electively by the abdominal route in 2 patients after diagnostic laparoscopy (unfavourabl localised intraligamentous myoma, distended bowels after using Tractrium by the anestesiologist). Hysterectomy by the vaginal route was completed in 98 patients. The mean operation time was 80 minutes (range 55-180 minutes) and the mean operation time of the laparoscopic part of the operation was 35 minutes (range 25-45 minutes). The estimated blood loss was 300 ml (range 100-550 ml). In 2 patients lysis of dense pelvic adhesions during the laparoscopic part caused that the vaginal part of surgery was safe. 10 complications were encountered postoperatively (3 cases of bleeding from the vaginal vault and 1 from ovarian vessels respectively, 3 cases of pelvic inflammatory disease, 2 injuries of the urinary bladder were recognized and treated peroperatively and 1 case of stress urinary incontinence 10 weeks after hysterectomy). DISCUSSION: According to the literature a different extent of surgical laparoscopy in vaginal hysterectomy is possible. Nulliparity or uterine myomas are no contraindications for vaginal hysterectomy. The main contribution of surgical laparoscopy for vaginal hysterectomy consists in lysis of dense adhesions in the pelvic area and in evaluating or operating adnexal cystic masses. Other indications are controversial because of prolonging the operative time and general risks of diagnostic and surgical laparoscopy. CONCLUSION: The main contribution of laparoscopy for the purposes of vaginal hysterectomy remains the assessment and treatment of dense pelvic adhesions or adnexal pathology rather than hysterectomy itself. Bipolar coagulation of ovarian vessels decreases the blood loss in cases of enucleation of morcellation of myoma(s) during the vaginal part of the operation.

Adult↗