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Objective To evaluate the use of laparoscopically assisted vaginal hysterectomy (LAVH) by a cross-section of gynaecologists in Scotland. Design A prospective registration of cases of LAVH carried out by gynaecologists. Case-note review was also performed in selected hospitals. Setting 13 hospitals in seven Scottish Health Boards. Subjects Women undergoing an LAVH. Results 505 LAVHs were reported between April 1994 and March 1996. Of these, 463 (91.7%) were successfully carried out laparoscopically. The uptake of laparoscopic surgery in Scotland overall is low, with a handful of surgeons performing the majority of procedures. Patient satisfaction with the procedure was high. Complication rates were high at 18.2% but this was mostly on account of postoperative infection. Only 34% of surgeons had any formal training in laparoscopic techniques, but this had increased to 55% by the end of the audit. Conclusions Complication rates in the present study were higher than those reported by expert laparoscopic surgeons, but perhaps reflect more accurately those expected from a cross-section of gynaecologists in current practice.

Objective To evaluate the use of laparoscopic procedures in the treatment of ectopic pregnancies by a cross-section of gynaecologists in Scotland Design A prospective registration of cases of laparoscopically treated ectopic pregnancy by gynaecologists. Case-note review was also performed in selected hospitals. Setting 13 hospitals in seven Scottish Health Board areas. Subjects Women having laparoscopic treatment of ectopic pregnancy. Results Between April 1994 and March 1996, 85 ectopic pregnancies were treated laparoscopically. Contraindications for laparoscopic surgery were most commonly size of the ectopic gestation (53%), presence of intraperitoneal bleeding (42%) and tubal rupture (44%). Salpingotomy was performed in 16% overall with only 86% of consultants monitoring serial human chorionic gonadotrophin levels. Conclusions Laparoscopic treatment of ectopic pregnancies in Scotland is infrequent. Lack of availability of adequate equipment and trained staff was often quoted as the reason preventing surgeons from developing their skills in these techniques. Complication rates were low and patient satisfaction high.

To investigate bladder neck and urethral function after radical hysterectomy, 21 patients were investigated before and 3 months after the operation. Each patient had an excretory urogram, CO2 cystoscopy, uroflowmetry, water cystometry and a urethral pressure profile, using a dual sensor microtransducer catheter, at rest and during stress. Postoperatively there was a significant reduction in urethral length and urethral closure pressure; however, pressure transmission ratios were maintained, indicating no loss of bladder neck support with stress. Of the six patients with pre-operative bladder neck weakness, two (33%) had stress urinary incontinence at the 3 months assessment. No patient with a normal pre-operative assessment developed this complication. Fifteen (71%) voided by abdominal straining and this manoeuvre emptied the bladder effectively. These data suggest that patients with pre-operative evidence of an incompetent bladder neck may be predisposed to develop stress urinary incontinence after radical hysterectomy because of a reduction in the urethral closure pressure.