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The fourth German pelviscopy/laparoscopy statistical report includes survey data on a total of 219,314 laparoscopies from 354 clinics and 40,892 laparoscopies from 161 private practices. Clinics' response rate was 44.7%; 98.9% of them reported performing laparoscopies; and the number of serious complications requiring laparotomy or control laparoscopy was 492 (2.2/1,000). For private practices, the comparable figures were 66%, 90.8% and 123 (3/1,000), respectively. Compared with data from the third laparoscopy statistical survey, the data show a slight increase in serious complications, most of which were mechanical lesions of blood vessels in the abdominal wall or in the mesosalpinx, followed by mechanical lesions of the intestine. As shown by the previous survey, 16.5% of the complications were burns. For tubal sterilization, bipolar techniques were still predominant; approximately equal numbers of departments used this method, with or without subsequent transsection of the tubes. Endocoagulation by the method of Semm was the second most popular procedure; the use of clips and rings was of little significance. Monopolar high-frequency (HF) current was still used with transsection by 4.1% of clinics (4.7% of private practices) and without transsection by 2.5% (5.3%). Sterilization failure rates remained the same as those previously reported (4.6/1,000 in clinics, 5.3/1,000 in private practices); the highest rates were observed after the use of monopolar HF techniques. Sixty-six percent of the clinics and 41% of the private practices reported their intention to increase the use of endoscopic operational methods.

Sterilization of the woman during puerperium is performed immediately following delivery via a periumbilical incision during a caesaren section isthmica intraperitonealis via laparoscopy or 3--5 days following delivery by pelviscopy. The surgical procedure currently in use for ligating or severing the fallopian tubes is accompanied by extensive loss of blood. This procedure should, therefore, be replaced by the coagulation method which is safer and does not contribute to the formation of adhesions. If the abdomen has been dissected, either high frequency current or the Endo-coagulation procedure may be used to produce the destructive heat necessary to coagulate the fallopian tubes. If the abdomen has not been opened and the coagulation of the fallopian tubes must be performed via pelviscopy, the Endo-coagulation method should be used instead of the high frequency current procedure which cannot be absolutely controlled by the surgeon. The Endo-coagulation procedure works at or about the temperature of boiling water. The failure rate for this procedure is about 2--3 %0.

The ambulant sterilization of the ovarien tubes with the plastic clip represents a notable method among the operative sterilization methods. With this method, failures can be totally avoided. The bloodless proceeding in the intraperitoneal region results in a minimum of operational risks. The postoperative morbidity is 0%. The clip sterilization takes a few minutes and can be done with intubation or Trapanal/fluothane narcosis in the ambulance. The possibility of refertilization is still to be discussed. From April 1974 till April 1975 this method for sterilization was employed in 97 patients. There were no complications or failures seen.

The second set of statistics on pelviscopy in Germany included information on 269,603 pelviscopies done in 322 general hospitals, and 22,859 pelviscopies done in private clinics between 1978 and 1982. In general hospitals the rate of serious complications was 1.9% and in private clinics 2.0%. Injuries to large blood vessels headed the list of complications. The main technique for tubal sterilization was the bipolar high-frequency current method with 75% in general hospitals and 73.1% in private clinics, followed by the endocoagulation technique according to Semm (36.8%). Sterilization failures were reported in 2.6%. Most failures were reported after sterilization with the bipolar electrocoagulation technique, followed by the clip technique. The rate of post-sterilization ectopic pregnancies was 1.06%. The highest rate of ectopic pregnancies was reported after using the bipolar tubal sterilization method (1.4%).