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The caesarean section is one of the most frequently performed surgeries. Due to growing economic challenges, hospitals are encouraged to improve their cost-efficiency. One factor that influences hospital costs of caesarean sections is a prolonged hospital stay.The aim of the current prospective study was to investigate psychosocial factors, with an emphasis on anxiety, and sociodemographic factors that are associated with longer hospital stay after caesarean sections with no medical complications. Data of 195 women who gave birth by caesarean section was analyzed. As possible predictors anxiety levels measured pre-, peri- and postoperative as well as age, parity (primiparous/multiparous), repeated caesarean (yes/no), BMI (30/ ≥30), STAI-Trait scores, duration of surgery, PH arterial and Apgar 5 min. were entered into a backward linear regression with duration of hospital stay as the dependent factor.The analysis revealed that higher age, primiparity as well as higher anxiety scores during the postoperative phase are significant factors associated with prolonged hospital stay. The significant model explains 22.1 % of the variance.The results should sensitize the medical team to these risk factors in order to improve patients' recovery and shorten hospital stays.

Around 30% of births are through caesarean section and repetition rates for receiving a caesarean section are high.The aim of the prospective study was to compare the course of anxiety in women undergoing their first caesarean section and women experiencing a repeated caesarean section.304 women with an indication for an elective caesarean section took part. 155 received their first caesarean section and 149 received a repeated caesarean section.In order to measure the course of anxiety on the day of the caesarean section subjective anxiety levels were measured and saliva samples for cortisol determination were taken at admission, during skin closure and two hours after the surgery. Blood pressure and heart rate were documented at skin incision and skin closure.Women experiencing their first caesarean section displayed significantly higher anxiety levels compared to women with a repeated caesarean section. Scores of the STAI-State and visual analogue scale for anxiety differed significantly at admission (p=.006 and p.001) and heart rate and alpha amylase levels were significantly higher at skin closure (p=.027 and p=.029).The results show that previous experience with a caesarean section has a soothing effect. The study aims to sensitize surgeons, anesthetists, nurses and midwives when treating women receiving a caesarean section and encourage them to incorporate soothing interventions, especially for women receiving their first caesarean section to reduce anxiety levels and consequently improve postoperative recovery and patients' satisfaction.

Triple negative breast cancer (TNBC) harbors a heterogeneous group of carcinomas with poor prognosis and high genetic variability. As a potential aim for targeted therapy, genetic mutations leading to an activation of the phosphoinositide 3-kinase pathway in a catalytic subunit (PIK3CA) in breast cancer have been analyzed currently. Little is known about the clinical impact and prognostic or predictive value of this marker in TNBC subtypes. Samples from 119 TNBC cases were submitted to immunohistochemical PIK3CA protein expression analysis and scored semi-quantitatively as negative, weak (1 +), or strongly expressed (2 +). Expression scores were correlated to patient’s characteristics, imaging features, and TNBC subtypes. TNBC subtypes were categorized into four subtypes: basal like, mesenchymal like, luminal androgen receptor (LAR), and immunomodulatory. We did not observe differences in clinical aspects and imaging features between TNBC with and without PIK3CA expression. PIK3CA expression was in general higher in the LAR subtype. The disease-free survival and overall survival were significantly better in TNBC with PIK3CA protein expression, independent of TNBC subtypes. Despite conflicting results in the literature, our study clearly shows a better outcome of PIK3CA-expressing TNBC, independent of TNBC subtypes. PIK3CA expression in TNBC is not associated with specific clinical or diagnostic features. Further molecular studies and meta-analysis are warranted to clarify the prognostic and predictive role of PIK3CA protein expression.

We demonstrate that two-photon polymerisation-based direct laser writing (TPP-DLW) is a very convenient technique for the fabrication of tunable liquid crystal (LC) based optical diffractive structures. The underlying TPP-DLW scaffold is composed of out-of-plane oriented polymeric ribbons with surface relief gratings on their side walls that induce parallel alignment of the adjacent LC medium. With the aid of such scaffolds infiltrated with the standard nematic liquid crystalline mixture E7, we prepared optical transmission gratings whose diffraction efficiency can be tuned with electric or magnetic fields. We report on an experimental and theoretical comparison between both types of tuning mechanisms.

Endometrial cancer (EC) is the most common cancer affecting the female reproductive organs in higher-income states. Apart from reproductive factors and excess weight, genetic predisposition is increasingly recognized as a major factor in endometrial cancer risk. Endometrial cancer is genetically heterogeneous: while a subgroup of patients belongs to cancer predisposition syndromes (most notably the Lynch Syndrome) with high to intermediate lifetime risks, there are also several common genomic polymorphisms contributing to the spectrum of germline predispositions. Germline variants and somatic events may act in concert to modulate the molecular evolution of the tumor, where mismatch-repair deficiency is common in endometrioid endometrial tumors whereas homologous recombinational repair deficiency has been described for non-endometrioid endometrial tumors. In this review, we will survey the currently known genomic predispositions for endometrial cancer and discuss their relevance for clinical management in terms of counseling, screening and novel treatments.

Summary The first German interdisciplinary S3-guideline on the diagnosis, therapy and follow-up of patients with endometrial cancer was published in April 2018. Funded by German Cancer Aid as part of an Oncology Guidelines Program, the lead coordinators of the guideline were the German Society of Gynecology and Obstetrics (DGGG) and the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG). Purpose Using evidence-based, risk-adapted therapy to treat low-risk women with endometrial cancer avoids unnecessarily radical surgery and non-useful adjuvant radiotherapy and/or chemotherapy. This can significantly reduce therapy-induced morbidity and improve the patientʼs quality of life as well as avoiding unnecessary costs. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimal extent of surgical radicality together with the appropriate chemotherapy and/or adjuvant radiotherapy if required. An evidence-based optimal use of different therapeutic modalities should improve the survival rates and quality of life of these patients. This S3-guideline on endometrial cancer is intended as a basis for certified gynecological cancer centers. The aim is that the quality indicators established in this guideline will be incorporated in the certification processes of these centers. Methods The guideline was compiled in accordance with the requirements for S3-level guidelines. This includes, in the first instance, the adaptation of source guidelines selected using the DELBI instrument for appraising guidelines. Other consulted sources included reviews of evidence, which were compiled from literature selected during systematic searches of literature databases using the PICO scheme. In addition, an external biostatistics institute was commissioned to carry out a systematic search and assessment of the literature for one part of the guideline. Identified materials were used by the interdisciplinary working groups to develop suggestions for Recommendations and Statements, which were then subsequently modified during structured consensus conferences and/or additionally amended online using the DELPHI method, with consent between members achieved online. The guideline report is freely available online. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of endometrial cancer including precancers and early endometrial cancer as well as recommendations on palliative medicine, psycho-oncology, rehabilitation, patient information and healthcare facilities to treat endometrial cancer. The management of precancers of early endometrial precancerous conditions including fertility-preserving strategies is presented. The concept used for surgical primary therapy of endometrial cancer is described. Radiotherapy and adjuvant medical therapy to treat endometrial cancer and uterine carcinosarcomas are described. Recommendations are given for the follow-up care of endometrial cancer, recurrence and metastasis. Palliative medicine, psycho-oncology including psychosocial care, and patient information and rehabilitation are presented. Finally, the care algorithm and quality assurance steps for the diagnosis, therapy and follow-up of patients with endometrial cancer are outlined.

Im April 2018 wurde die erstmalig eine S3-Leitlinie zur Diagnostik, Therapie und Nachsorge des Endometriumkarzinoms, gefordert durch das Leitlinienprogramm Onkologie, publiziert. Auf der Grundlage aktueller systematischer Literaturrecherchen wurden von einer interdisziplinaren, multiprofessionellen Gruppe Empfehlungen konsentiert. Neuerungen im Vergleich zur Vorversion betreffen den Verzicht auf die systematische Durchfuhrung einer radikalen Hysterektomie im Stadium 2, die differenzierte Indikationsstellung zur systematischen pelvinen und paraaortalen Lymphonodektomie sowie die Auswahl der Zugangswege. Weitere Themen sind die Anwendung der Sentinel-Lymphonodektomie und das Vorgehen bei fortgeschrittenen Karzinomen und Karzinosarkomen

Summary The first German interdisciplinary S3-guideline on the diagnosis, therapy and follow-up of patients with endometrial cancer was published in April 2018. Funded by German Cancer Aid as part of an Oncology Guidelines Program, the lead coordinators of the guideline were the German Society of Gynecology and Obstetrics (DGGG) and the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG). Purpose The use of evidence-based, risk-adapted therapy to treat low-risk women with endometrial cancer avoids unnecessarily radical surgery and non-useful adjuvant radiotherapy and/or chemotherapy. This can significantly reduce therapy-induced morbidity and improve the patientʼs quality of life as well as avoiding unnecessary costs. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimal surgical radicality together with the appropriate chemotherapy and/or adjuvant radiotherapy where required. The evidence-based optimal use of different therapeutic modalities should improve survival rates and the quality of life of these patients. The S3-guideline on endometrial cancer is intended as a basis for certified gynecological cancer centers. The aim is that the quality indicators established in this guideline will be incorporated in the certification processes of these centers. Methods The guideline was compiled in accordance with the requirements for S3-level guidelines. This includes, in the first instance, the adaptation of source guidelines selected using the DELBI instrument for appraising guidelines. Other consulted sources include reviews of evidence which were compiled from literature selected during systematic searches of literature databases using the PICO scheme. In addition, an external biostatistics institute was commissioned to carry out a systematic search and assessment of the literature for one area of the guideline. The identified materials were used by the interdisciplinary working groups to develop suggestions for Recommendations and Statements, which were then modified during structured consensus conferences and/or additionally amended online using the DELPHI method with consent being reached online. The guideline report is freely available online. Recommendations Part 1 of this short version of the guideline presents recommendations on epidemiology, screening, diagnosis and hereditary factors, The epidemiology of endometrial cancer and the risk factors for developing endomentrial cancer are presented. The options for screening and the methods used to diagnose endometrial cancer including the pathology of the cancer are outlined. Recommendations are given for the prevention, diagnosis, and therapy of hereditary forms of endometrial cancer.

Uterus myomatosus und Endometriose gehoren zu den haufigsten benignen, gynakologischen Erkrankungen der Frau. Beide sind heutzutage eine Domane der laparoskopischen Therapie. Der aktuelle Stellenwert der fertilitatserhaltenden minimal-invasiven Chirurgie zur Behandlung von Uterus myomatosus und Endometriose wird anhand der verfugbaren Evidenz aufgezeigt. Mithilfe einer Pubmed-Suche wurde die aktuelle Literatur auf Relevanz gepruft, ebenso wurden die einschlagigen Leitlinien der Fachgesellschaften konsultiert. Die Laparoskopie konnte die Therapie dieser Erkrankungen sowohl in Hinsicht auf die Symptomkontrolle als auch auf die Fertilitat weiter verbessern. Durch die flachendeckende Einfuhrung laparoskopischer Behandlungsansatze in der Myom- und Endometriosetherapie kann einer Vielzahl von Patientinnen, die einen oft langen Leidensweg hinter sich haben, nicht nur effizient, sondern auch schonend und nicht zuletzt mit dem optimalen kosmetischen Ergebnis geholfen werden.

Transmission optical diffraction gratings composed of periodic slices of a ferromagnetic liquid crystal and a conventional photoresist polymer are demonstrated. Dependence of diffraction efficiencies of various diffraction orders on an in-plane external magnetic field is investigated. It is shown that diffraction properties can be effectively tuned by magnetic fields as low as a few mT. The tuning mechanism is explained in the framework of a simple empirical model and also by numerical simulations based on the rigorous coupled wave analysis (RCWA). The obtained results provide a proof of principle of operation of magnetically tunable liquid crystalline diffractive optical elements applicable in contactless schemes for control of optical signals.

Objective: The OptiBIRTH intervention was developed to enhance women-centred care for pregnant women who had had one previous caesarean section. Firstly, systematic reviews and focus group interviews with clinicians and women were carried out. Another systematic review focused on computer-based behavioural change interventions informed the design of an online component of the OptiBIRTH intervention, which was then tested in the trial to assess its impact on the VBAC rate in the German sites, as well as on interventions and events during labour. Methods: A cluster randomised trial (ISRCTN10612254) was carried out in 15 sites in three European countries (Ireland, Italy, Germany). The German part of the study was led by the Midwifery Research and Education Unit at Hannover Medical School (MiREdU). The participating sites were Buergerhospital Frankfurt, Diakovere Krankenhaus Henriettenstift Hannover, Klinikum Dritter Orden Muenchen, University hospital Wuppertal, and Hannover Medical School. The sites were randomly allocated into three intervention and two control sites. Recruitment of women took place between May 2014 and October 2015. Main international analysis was performed by Queen's University Belfast. Intranational comparisons in Germany were performed by MiREdU using descriptive statistics. Data of the baseline rate came from 2012 compared with data from 2015, which is an interim analysis pending the final comparison to 2016. Results: Overall, there was no statistically significant difference in the change in the proportion of women having a VBAC between 2012 and 2015 in the intervention sites compared to the controls. Although there were significant changes in Italy and Ireland, there were none in Germany. The 2015 VBAC rates in the German sites showed an increase compared to baseline (2012) in one intervention site (+1.0%) and in one control site (+3.2%) but decreases in the three other sites (-0.1, -6.2 and -10.1%). Regarding German OptiBIRTH participants, there was no significant difference in VBAC rates between intervention and control sites (39.1 vs. 40.3%, p = 0.75). There was no significant difference in the frequencies of labour induction (23.2 vs. 20.5%, p = 0.51), amniotomy (16.1 vs. 22.0%, p = 0.13), or oxytocin (47.5 vs. 47.0%, p = 0.93) between intervention and control sites. Epidural analgesia was significantly higher in control compared to intervention sites (45.8 vs. 28.5%, p < 0.001). Opioid application was significantly more common in intervention than in control sites (31.1 vs. 7.7%, p < 0.001). The median duration between onset of labour and birth was significantly shorter in intervention compared to control sites (7.63 vs. 9.95 hrs, p = 0.04). Conclusions: The OptiBIRTH intervention was safe but not effective at increasing VBAC rates in the whole study population or in the German part of the study. It might be more successful in countries with very low rates. Interinstitutional variations in obstetric practice are obvious in Germany.

Introduction: Endometriosis is a heterogeneous disease characterized by a range of different presentations. It is usually diagnosed when patients present with pain and/or infertility, but it has also been diagnosed in asymptomatic patients. Because of the different diagnostic approaches and diverse therapies, time to diagnosis can vary considerably and the definitive diagnosis may be delayed, with some cases not being diagnosed for several years. Endometriosis patients have many unmet needs. A systematic registration and follow-up of endometriosis patients could be useful to obtain an insight into the course of the disease. The validation of biomarkers could contribute to the development of diagnostic and predictive tests which could help select patients for surgical assessment earlier and offer better predictions about patients who might benefit from medical, surgical or other interventions. The aim is also to obtain a better understanding of the etiology, pathogenesis and progression of the disease. Material and Methods: To do this, an online multicenter documentation system was introduced to facilitate the establishment of a prospective multicenter case-control study, the IEEP (International Endometriosis Evaluation Program) study. We report here on the first 696 patients with endometriosis included in the program between June 2013 and June 2015. Results: A documentation system was created, and the structure and course of the study were mapped out with regard to data collection and the collection of biomaterials. Conclusion: The documentation system permits the history and clinical data of patients with endometriosis to be recorded. The IEEP combines this information with biomaterials and uses it for scientific studies. The recorded data can also be used to evaluate clinical quality control measures such as the certification parameters used by the EEL (European Endometriosis League) to assess certified endometriosis centers.

Etwa 42% der Zervix- und 7,5% der Endometriumkarzinompatientinnen erkranken in einem Alter, in dem unter Umstanden der Kinderwunsch noch nicht realisiert bzw. die Familienplanung noch nicht abgeschlossen ist. In Fruhstadien dieser Erkrankungen ist die Prognose gut, und die meisten Patientinnen konnen durch eine adaquate Therapie geheilt werden. Die ablativen Standardtherapien sind jedoch mit einem Kinderwunsch nicht vereinbar, sodass ein Bedarf an alternativen fertilitatserhaltenden Konzepten und Operationstechniken besteht, die auch fur beide Tumorentitaten publiziert worden sind. Die verfugbaren Studien zeigen, dass ein Fertilitatserhalt und auch erfolgreich ausgetragene Schwangerschaften in dieser Patientinnengruppe moglich sind. Eine vorsichtige Selektion geeigneter Patientinnen ist zwingend erforderlich, da ein klinisches „Understaging“ zu einer onkologisch inadaquaten Therapie und damit zu einer vermeidbaren Erhohung des Rezidivrisikos fuhrt.

„Innovation“ bedeutet wortlich „Neuerung“ oder „Erneuerung“. Die gynakologische Onkologie durfte in den letzten Jahren nicht nur Zeuge, sondern v. a. Motor einer Vielzahl von Innovationen sein, die von der Primarpravention, wie der Humanen-Papillomvirus(HPV)-Vakzinierung, bis hin zu bislang ungeahnten Langzeitremissionen durch die zielgerichtete Therapie des metastasierten Mammakarzinom reicht. Solche Entwicklungen kritisch zu begleiten und aktiv mitzugestalten, ist einer der besten Garanten fur die erfolgreiche Positionierung und Zukunftssicherung des Faches. In diesem Beitrag werden exemplarisch 4 Beispiele genannt, die demonstrieren sollen, dass die Gynakologie in der Lage ist, Neuerungen des medizinischen Fortschritts aktiv zu gestalten und international Akzente zu setzen, aber auch durch die notwendige kritische Auseinandersetzung mit den neuen Methoden bislang erzielte Therapieergebnisse nicht in Gefahr zu bringen. Gerade in der interdisziplinaren Zusammenarbeit liegt eine wesentliche Chance fur die Gynakologie, eine fuhrende Rolle als Innovationsmotor einzunehmen.

Fragestellung: Bei der Endometriose handelt es sich um eine benigne hormonabhangige Erkrankung der Frau im reproduktionsfahigen Alter. Ziel einer operativen Therapie ist die chirurgische Entfernung der Endometrioseherde. Medikamentose Therapieansatze zielen ab auf eine Suppression des Ostrogens auf ein postmenopausales Hormonniveau, was durch den Einsatz von Gonadotropin-Releasing-Hormon-(GnRH-)Analoga erreicht werden kann. Der therapeutische Nutzen einer systemischen Endometriosetherapie ist jedoch limitiert und mit signifikanten Nebenwirkungen vergesellschaftet. Aus diesem Grund besteht ein groser Bedarf an der Entwicklung einer spezifischen und zielgerichteten Therapie der Endometriose. Ziel dieser Untersuchung war die Identifikation geeigneter Zielstrukturen. Material und Methodik: Vergleichende Untersuchungen der Expression von VEGF, Midkine, Angiopoietin-2 und Heparanase erfolgten in Endometriose-Stroma und ‐drusenzellen, eutopem Endometrium und makroskopisch unauffalligen Peritonealgewebeproben mittels immunhistochemischer Untersuchungen und RT‐PCR. Anschliesend wurde die Expressionsstarke von VEGF und Heparanase in oberflachlichen peritonealen Endometrioseherden und tief infiltrierenden Endometrioseknoten immunhistochemisch untersucht. Zur Untersuchung des therapeutischen Einsatzes wurde ein VEGF-gesteuertes rekombinantes Adenovirus (AdVEGFE1) als Vektor eingesetzt. Untersucht wurden die spezifische Induktion von Apoptose in vitro sowie die Biodistribution in einem Mausmodell. Ergebnisse: VEGF und Heparanase werden in Endometriosezellen signifikant starker exprimiert als in eutopem Endometrium oder makroskopisch unauffalligen Peritonealgewebeproben. Weiterhin zeigen die korrespondierenden Promotoren beider Gene eine starke Expression in peritonealen Endometrioseherden. Eine Korrelation der Expressionsstarke mit dem Schweregrad der Erkrankung lies sich jedoch nur fur VEGF nachweisen. In Untersuchungen zur therapeutischen Anwendung eines VEGF-gesteuerten adenoviralen Vektors zeigt AdVEGFE1 in vitro eine Induktion von Apoptose in aufgereinigten kultivierten Endometriosezellen von Patientinnen. Das rekombinante konditional replizierende Adenovirus Ad5VEGFE1 zeigt eine effiziente Apoptoseinduktion in vitro und im Biodistribution-Mausmodell eine nur schwache Infektion des eutopen Endometriums und der Leber. Schlussfolgerung: VEGF ist eine geeignete Zielstruktur zur Entwicklung einer zielgerichteten Therapie der Endometriose.

Objective. The purpose of this prospective study was to investigate the predictive value of single prepartum findings combined with serum biomarkers sFlt-1 (soluble fms-like tyrosine kinase-1) and PlGF (placental growth factor) indicating severity of preeclampsia (PE) for occurrence and extent of impaired postpartum kidney function.Study Design. In this prospective, single center study 44 PE patients were compared to 39 healthy controls (similar in age and gestational age with singleton pregnancy) evaluated at time of delivery and at 6 months and 12 months postpartum.pvalues below 0.05 are considered statistically significant.Results. The majority of the PE patients had persistence of proteinuria (>120 mg/L after delivery) 6 months (p=0.02) and 12 months postpartum (p<0.0001) compared to controls. Also reduced GFR (glomerular filtration rate) persisted up to 6 months postpartum in PE patients compared to controls (p<0.001). Prepartum sFlt-1 levels indeed correlated with impaired renal function parameters.Conclusion. A significant proportion of our PE patients had lower GFR levels and persistent proteinuria up to 12 months postpartum. Prepartum sFlt-1 is a trend-setting marker for impaired renal function postpartum, but it is not sufficient enough to predict renal impairment after PE. An evaluation of 24-month follow-up data is scheduled.

Der Knochenstoffwechsel unterliegt unterschiedlichen Regulationsmechanismen vor und nach der Pubertat. Wahrend das Wachstum prapubertar durch genetische Disposition, das Kalzium-Vitamin-D-System und physiologische Belastung reguliert wird, ist die Regulation ab der Pubertat zusatzlich durch Sexualhormone bestimmt. Die physiologische Reduktion des Ostrogenspiegels in der Menopause hat dementsprechend eine altersabhangige Anderung der Knochenqualitat zur Folge, die bei Vorliegen eines entsprechenden Risikoprofils zum Auftreten von osteoporotischen Frakturen fuhren kann. Der niedergelassene Gynakologe hat hier in der Betreuung postmenopausaler Patientinnen eine besondere Verantwortung, individuelle Risikofaktoren zu erkennen und im Bedarfsfall eine Basisdiagnostik zu indizieren. Diese beinhaltet neben der Anamnese, korperlichen Untersuchung und Laboruntersuchungen auch die Durchfuhrung einer Knochendichtemessung mit Bestimmung des individuellen Frakturrisikos, um bei Bedarf prophylaktische bzw. therapeutische Masnahmen einleiten zu konnen.

Despite advances in therapy, metastatic breast carcinoma maintains a disappointing 5-year survival rate of 20.4 %. Hence, there is a need for alternative and complementary therapeutic strategies. In this regard oncolytic virotherapy is a promising approach that uses mainly conditionally replicative viruses (CRAds) to selectively kill tumor cells by exploiting the lytic property of virus replication. Adenovirus-based vectors have emerged as leading candidates for in vivo virotherapy. However intravenously injected CRAds have shown only limited antitumor efficacy due mainly to low viral infectivity and insufficient viral delivery to the sites of tumor. Based on recent findings that systemically administered human mesenchymal stem cells (hMSCs) home to breast cancer metastasis of the lung, our investigation assesses the possibility of using hMSCs as cellular virus carriers to pulmonary metastases of breast cancer. HMSCs were transduced with CRAds. In a SCID mouse xenograft model we established breast cancer pulmonary metastatic disease to examine the effects of intravenously injected CRAd-loaded hMSCs versus CRAds alone. In mice treated with CRAd-loaded hMSCs the transduced stem cells homed to the metastatic lesions and led to reduced tumorgrowth and extended survival compared to mice treated with CRAds alone. We concluded that systemically administered hMSCs transduced with CRAds have the ability to home in on and kill metastatic breast cancer cells; these findings validate the feasibility of using hMSCs as cellular vehicles for the targeted therapy of metastatic breast cancer with CRAds.

Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover

Purpose: Advances in technology have spawned monopolar, bipolar and ultrasonic tools to facilitate dissection, ligate vessels, and resect tumor tissue. The Ligasure vessel sealing system uses bipolar electric energy to seal tissue and blood vessels up to 7 mm in diameter. Methods: We have used the Ligasure system since September 2001 at 56 operations for gynecologic malignancies. Ten randomly selected operations were analyzed. Indications for surgery were carcinoma of the cervix (3 primary, 2 recurrent), ovary (n = 2), endometrium (n = 1), or vagina (1 sarcoma, 1 carcinoma). Patients underwent anterior (n = 1), posterior (n = 1) or total (n=4) pelvic exenteration, vaginal colpectomy (n = 1), or radical hysterectomy (n = 3). Blood loss and transfusion requirements, operating time and hospital stay were compared with those in a control group of 10 women operated on conventionally during the same period. Results: Blood loss and transfusion requirements were significantly less in the patients operated on with the Ligasure system compared with those operated on conventionally (2120 ± 1376 vs. 4637 ± 3746 mL, P < 0.02, and 2.8 ± 2.4 vs. 6.6 ± 5.8 units, P < 0.03, respectively). There were no severe intraoperative or postoperative bleeding complications in either group and no differences in operating time or length of hospital stay. Conclusion: Our intial experience indicates that the Ligasure system reduces intraoperative blood loss and thus seems useful for major gynecologic procedures such as pelvic exenterations. Randomized trials would appear appropriate.

Zusammenfassung Neben dem seit Jahrzehnten bekannten Einsatz von mono- oder bipolaren Instrumenten hat die medizintechnische Industrie in den letzten Jahren eine Reihe von neuen Koagulations- und Schneidesystemen auf den Markt gebracht, die auf unterschiedlicher energetischer Basis arbeiten. Die z. Zt. in der operativen Gynakologie am haufigsten verwendeten Systeme sind das monopolare Messer, die bipolare Schere und das LigaSure™ Gefasversiegelungssystem als Vertreter der Elektrochirurgie, sowie das Harmonic Scalpel® und der CUSA™, die jeweils ultraschallvermittelt arbeiten. Die Fortschritte gerade in der operativen Laparoskopie sind untrennbar mit der Entwicklung dieser Systeme verbunden. Im Folgenden wird die zugrunde liegende Technik der einzelnen Systeme, deren Anwendungsmoglichkeiten in der operativen Gynakologie sowie mogliche Vor- und Nachteile beschrieben. Fazit: Innovative Koagulations- und Schneidesysteme sind nicht zuletzt durch die Verwendung in der minimalinvasiven Chirurgie fest in der modernen operativen Gynakologie etabliert.

Introduction: In 2002, gynecology residents in North Rhine-Westfalia (NRW) were asked how satisfied they were with their working and training conditions. A new extended survey of gynecology residents aimed to evaluate whether changes to specialist training regulations had affected residentsʼ levels of job satisfaction and to identify areas where training conditions still urgently required improvement. Material and Methods: A total of 1223 questionnaires with 52 questions were sent to the 159 gynecology clinics in NRW. Responses could be dichotomous, multi-level or quantitative. The results were analyzed with regard to age, gender, family status and type of clinic and were additionally compared with the results of a previous survey. Results: The percentage of women residents has increased to 84.6 %. A workload of more than 48 hours per week has resulted in decreased motivation and lower levels of satisfaction during training, although overall levels of satisfaction have clearly improved compared to the previous survey. Use of a logbook to create a more structured training program has not achieved the desired effect. Nevertheless, seven of eight gynecology residents would study medicine again, although 28 % of the budding gynecologists are considering working abroad or in private industry. Conclusion: Both training and overall satisfaction with working conditions must be improved to preserve the appeal of gynecology for young academics. This survey aims to identify key factors which are responsible for (dis)satisfaction with working conditions.

enema. Purpose: We describe the implementation of quality improvement measures in a quality management system. Methods: With questionnaires for radiologists and patients, we investigated the relations between patient preparation and diagnostic quality serving the main purpose, to improve diagnostic quality with the help of more detailed patient information (e.g., changing preparation sheets and handling out perimed information sheets to the patients). Furthermore, a comparative data ascertainment at other institutes was integrated. Results: For the group of outpatients, increasing process quality (patient information) and outcome (diagnostic quality) could be achieved. Taking aspects of quality costs into consideration, a decrease in costs due to failures was achieved. Conclusion: More detailed patient information has positive effects on diagnostic quality of the double contrast (barium) enema.

Radical resection of deep infiltrating endometriosis (DIE), including bladder and bowel resection, provides relief from pain in symptomatic patients. The laparoscopic approach to treatment is well established for bowel resection but normally requires additional abdominal incisions for specimen retrieval. Here we describe our technique of laparoscopically assisted rectal resection and transvaginal specimen retrieval (LARRT) and provide follow-up information on pain scores and complications.Retrospective observational monocentric study on all DIE patients with rectal infiltration treated between 2008 and 2010 with LATRR at our department. Follow-up was obtained for at least 3 years, including baseline 1-year and 3-year pain scores.We identified four patients undergoing LARRT available for follow-up. DIE was confirmed by histology in all cases. There were no intraoperative complications. Two patients had transient postoperative urinary retention, one patient developed recto-vaginal fistula and required transient colostomy. One patient suffered from persistent vaginal dryness. All patients, however, reported persistent pain relief, including at the end of follow-up period.LARRT is a feasible variation of laparoscopic bowel resection for DIE with rectal infiltration. In our study it has promising results with respect to pain control. Larger studies will, however, be required to determine the safety of this procedure.