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9375 laparoscopies were performed at our clinic between 1987 and 1993. In this patient group the incidence of early or localised stages of ovarial malignomas FIGO I and II is 0.9 per cent. 81 laparoscopies were performed on patients suffering from localised stages of ovarial malignomas. 32% (n = 26) of these laparoscopised patients suffering from ovarial malignomas were subjected to extended diagnostic-surgical laparoscopy. These 26 localised stages of ovarial malignomas on which tumour-aggressive laparoscopy had been performed, were followed up and the relevant literature studied and processed. In 23 of the patients thus subjected to tumour-aggressive laparoscopic surgery we did not observe any deterioration of the prognosis during the treatment period (1-8 years). Problematic postoperative courses were seen in 3 patients; the reasons for this are discussed in the present paper. Measures resulting in opening of the tumours during diagnostic-surgical laparoscopy are neither accidental nor unforeseen incidents, but are rather part of an overall surgical strategy. If safety techniques are adopted - as described in this paper - diagnostic-surgical laparoscopy can be performed even during localised stages of ovarial malignomas without any presently recognisable adverse effect on patient prognosis.

677 ectopic pregnancies were treated by laparoscopy from 1983-1993. Complications in 26 cases led to a second laparoscopic intervention; these complications are analysed to access the advantages and risks of this new procedure. The postoperative HCG blood levels were observed and salpingectomy vs. organ-preserving techniques compared. 30 cases of postoperative HCG-increases and 19 cases with operative treatment of residual trophoblast are also analysed. Endoscopic salpingectomy of tubal pregnancies is a safe procedure with a very low complication rate. Organ-preserving treatment of tubal pregnancies via laparoscopy has a critical complication range of 7-9%. This should be considered for the choice of the operating procedure and the patient should be informed of the risks and their frequency.

709 ectopic pregnancies were observed from 1983-1992 in the Department of Gynaecology of the Neukolln Hospital, Berlin, Germany, 585 out of which underwent laparoscopic treatment. 169 of 372 patients treated from 1986-1991 still wished to conceive, and we found intrauterine pregnancies in 60% (102 patients) and recurrent ectopic pregnancies in 27% (46 patients). In 9% (11 patients) of these the recurrence occurred following a delivery. A long term follow-up of patients from 1986-1988 was carried out in 1989 and 1993. Compared to 1989, the data of 1993 show a re-markaIrle increase in recurrences and a merely slight increase in intrauterine pregnancies. For representative results the duration of follow-up should be 5 years or longer. 37 cases were operated on while preserving the organ, on a solitary tube or on both tubes. This group with an intrauterine pregnancy rate of 33-47% and a recurrence rate of 49% is discussed later. The risk of recurrence is increased after organ-preserving treatment of a second tubal pregnancy and after severe pelvic inflammatory disease. The process of deciding between maintaining the organ versus salpingectomy, is also discussed

From 1987 to 1990, 99 patients were treated for appendicitis. 67 patients were treated by endoscopic appendectomy, 32 patients underwent laparotomy for appendectomy. Among these 67 patients we found 4 patients with endometriosis, 6 with pelvic inflammatory disease, and 4 pregnant patients. In no case did we have difficulties during the laparoscopic operation; only 4 patients developed severe inflammatory complications during the postoperative period. For this reason, we do not perform a prophylactic appendectomy during gynaecological laparoscopies. We recommend careful postoperative treatment after laparoscopic appendectomy.

The authors report on the changing aspects in diagnostics and surgical treatment of tubal pregnancy during a period of 7 years (1983-89). In that period, 432 cases of tubal pregnancy were diagnosed and treated, 311 of which were treated by endoscopic abdominal surgery. Diagnosis of tubal pregnancy now depends on radioimmunology for identifying the presence of beta-HCG in the serum as well as on sonographic diagnosis. This may supply proof of tubal pregnancy in many cases as early as 3-4 weeks after conception. Surgery should not be initiated too early, but should also not be too late. We found that the 4th to 5th week after conception yields the best results. During 1986-88, 156 patients were surgically treated by laparoscopy because of tubal pregnancy. These operations and the subsequent fate of the patients are analysed. 66 patients continued to actively wish for a child. In 15% of these there was a recurrence of tubal pregnancy. 62% of these patients became again pregnant in utero.

The article reports on the results of the removal of small benign ovarian tumors (teratoma, cystic adenoma) without oophorectomy. 10 patients were treated by laparotomy and 23 patients with operative laparoscopy. The laparoscopy procedure is limited to tumors not larger than 5 cm. In this procedure it is especially difficult to recognize the difference between a luteal cyst and a cystic tumor which is a already malignant. Careful preoperative and intra-operative attention must be paid to the differential diagnosis. So far, follow up of the 14 patients with cystic adenoma and the 19 patients with teratoma, has shown no recurrence of tumor in the remaining ovary.

During 1971 and 1972 1109 rh-negative mothers with an Rh-positive child were treated with an intravenous standard dose of 80-120 microng of IgG anti-D. To achieve complete elimination of fetal erythrocytes within 72 hours after the first immunoglobulin injection this standard dose had to be increased in 14% of the women. In 1973 and 1974 1138 rh-negative mothers of Rh-positive children were treated with an intravenous standard dose of 240 microng of IgG anti-D. This dose was insufficient in only 1.2% of the rh-negative mothers. More than 98.8% of all women are protected by a standard intravenous dose of 240 microng of IgG anti-D and a single erythrocyte elimination control 72 hours after the birth. It appears that the results after intravenous immunoglobulin are as a whole significantly better than after intramuscular IgG anti-D.

The increase of high general operative risks in women presenting for gynaecological operations suggested the investigation of the influence of these risks on the choice of treatment of gynaecologic cancers appropriate for the stage. The primary treatment of 426 gynaecologic and breast cancers of the year 1977 is reviewed. There were 53 endometrial carcinomas, 29 ovarian carcinomas, 185 breast cancers, 142 carcinomas of the cervix and pre-invasive carcinoma of the cervix. There were 17 other carcinomas. 354 patients were selected for operative treatment. 72 patients were selected for primary radiotherapy. A considerable number of patients (40-60%) were selected for treatment appropriate for the stage of the cancer by a system of diagnosis of risks, classifications of risks, evaluation of risks and pre-operative treatment of operative risks. The choice of the cancer treatment appropriate to the stage is not influenced by single risks but by the sum of the general operative risks. Typical mistakes in evaluation of operative risks versus indications for the operations are described in case reports. The reports include avoidable and unavoided risks.