Δείτε τις δημοσιεύσεις του ιατρού Ανδρέα Καβαλλάρη

1. Operative treatment of ovarian tumors by laparoscopy. Operative Therapie von Ovarialtumoren durch Laparoskopie. A. Schneider, C. Köhler, A. Kavallaris, U. Endisch, M. Possover. Gynäkol.prax. 26,103-114 (2002).

2. Histopathological extent of rectal invasion by rectovaginal endometriosis. Kavallaris A, Kohler C, Kuhne-Heid R, et al. Hum Reprod. Volume: 18 Issue: 6 Pages: 1323-1327Published: JUN 2003.

Abstract
BACKGROUND: We aimed to evaluate the microscopic extent of
endometriosis in surgical en-bloc specimens of vaginal skin,
rectovaginal septum, cul-de-sac, and part of the rectosigmoid
bowel.
METHODS: From December, 1997 to October, 2001, 50 patients with the
trias of intestinal pain, palpable disease in the rectovaginal
septum, and laparoscopic diagnosis of endometriosis of the
cul-de-sac and/or rectosigmoid colon underwent combined
laparoscopic-vaginal en-bloc resection of the cul-de-sac with
partial resection of the posterior vaginal wall and rectum with
reanastomosis by minilaparotomy. All surgical specimens were
histopathologically evaluated in a standardized fashion.
RESULTS: The mean length of the bowel specimen was 7.48 cm.
Endometriosis involved the serosa and muscularis propria in all
patients, the submucosa in 17 patients (34%), and the mucosa in
five patients (10%). After a mean follow-up of 32 months, 90% of
patients reported a considerable improvement or were completely
free of symptoms and the rate of recurrence was 4% (two
patients).
CONCLUSIONS: Partial bowel resection indicates the depth and
multifocality of endometriosis affecting the recto-sigmoid colon.
Such extensive surgery appears justified by the extent of the
lesions and the long-term relief of symptoms achieved.
PMID: 12773467 [PubMed – indexed for MEDLINE] Free full text

3. Quantification of the response of circulating epithelial cells to neodadjuvant treatment for breast cancer: a new tool for therapy monitoring Pachmann K, Camara O, Kavallaris A, et al. BREAST CANCER RESEARCH Volume: 7 Issue: 6 Pages: R975-R979 Published: 2005.

Abstract
INTRODUCTION: In adjuvant treatment for breast cancer there is no
tool available with which to measure the efficacy of the therapy.
In contrast, in neoadjuvant therapy reduction in tumour size is
used as an indicator of the sensitivity of tumour cells to the
agents applied. If circulating epithelial (tumour) cells can be
shown to react to therapy in the same way as the primary tumour,
then this response may be exploited to monitor the effect of
therapy in the adjuvant setting.
METHOD: We used MAINTRAC analysis to monitor the reduction in
circulating epithelial cells during the first three to four cycles
of neoadjuvant therapy in 30 breast cancer patients.
RESULTS: MAINTRAC analysis revealed a patient-specific response.
Comparison of this response with the decline in size of the primary
tumour showed that the reduction in number of circulating
epithelial cells accurately predicted final tumour reduction at
surgery if the entire neoadjuvant regimen consisted of
chemotherapy. However, the response of the circulating tumour cells
was unable to predict the response to additional antibody
therapy.
CONCLUSION: The response of circulating epithelial cells faithfully
reflects the response of the whole tumour to adjuvant therapy,
indicating that these cells may be considered part of the tumour
and can be used for therapy monitoring.
PMID: 16280045 [PubMed – indexed for MEDLINE] PMCID: PMC1410761

4. Repair of prolapse with vaginal sacrocolporectopexy: technique and results. Kavallaris A, Köhler C, Diebolder H, Vercellino F, Krause N, Schneider A. Eur J Obstet. 2005 Oct 1;122(2):237-42.

Abstract
OBJECTIVE: Axis and support of the vagina can be restored by
sacrocolporectopexy with preservation of coital function. We
developed a new technique of transvaginal sacrocolporectopexy for
patients with prolapse of uterus and vagina or prolapse of the
vaginal vault.
STUDY DESIGN: During a 4-year period, 20 patients with vaginal
vault prolapse and 83 patients with uterine and vaginal prolapse
underwent transvaginal sacrocolporectopexy. Intra- and
postoperative complications were recorded. After a mean follow-up
period of 24 months (6-48), the result of surgery with respect to
prolapse, incontinence, and sexuality was evaluated by patient
interviews.
RESULTS: No serious perioperative complications occurred with the
exception of one patient with bleeding from a presacral vein.
Subjectively, 84 patients (82%) were cured of prolapse symptoms.
One patient had recurrent grade II vault prolapse and four patients
developed a grade II rectocele. Five patients developed urge
incontinence grade I. One patient developed fecal incontinence. No
patient had coital problems as a sequelae of
sacrocolporectopexy.
CONCLUSION: Transvaginal sacrocolporectopexy is a safe procedure
with a success rate comparable to sacrospinous fixation.
PMID: 15950362 [PubMed – indexed for MEDLINE]

5. It is the dynamics of circulating tumour cells in peripheral blood of breast cancer patients in response to adjuvant therapy that is predictive for outcome. (An at least tenfold increase in cell number at the end of therapy predicts relapse). Camara O, Kroll TC, Kavallaris A, et al. BREAST CANCER RESEARCH AND TREATMENT Volume: 100 Pages: S214-S215 Supplement: Suppl. 1 Published: 2006.

6. Seeding of epithelial cells into circulation during surgery for breast cancer: the fate of malignant and benign mobilized cells Camara O, Kavallaris A, Nöschel H, Rengsberger M, Jörke C, Pachmann K. World J Surg Oncol. 2006 Sep 26;4:67.

Abstract
BACKGROUND: Surgery of malignant tumors has long been suspected to
be the reason for enhancement of growth of metastases with fatal
outcome. This often prevented surgeons from touching the tumor if
not absolutely necessary. We have shown in lung cancer patients
that surgery, itself, leads to mobilization of tumor cells into
peripheral blood. Some of the mobilized cells finding an
appropriate niche might grow to form early metastases. Monitoring
of tumor cell release during and the fate of such cells after
surgery for breast cancer may help to reveal how metastases develop
after surgery.
METHOD: We used the MAINTRAC analysis, a new tool for online
observation of circulating epithelial cells, to monitor the number
of epithelial cells before, 30 min, 60 min, three and seven days
after surgery and during subsequent variable follow up in breast
cancer patients.
RESULTS: Circulating epithelial cells were already present before
surgery in all patients. During the first 30-60 min after surgery
values did not change immediately. They started increasing during
the following 3 to 4 days up to thousand fold in 85% of treated
patients in spite of complete resection of the tumor with tumor
free margins in all patients. There was a subsequent re-decrease,
with cell numbers remaining above pre-surgery values in 58% of
cases until onset of chemotherapy. In a few cases, where no further
therapy or only hormone treatment was given due to low risk stage,
cell numbers were monitored for up to three years. They remained
elevated with no or a slow decrease over time. This was in contrast
to the observation in a patient where surgery was performed for
benign condition. She was monitored before surgery with no cells
detectable. Epithelial cells increased up to more than 50,000 after
surgery but followed by a complete reduction to below the threshold
of detection.
CONCLUSION: Frequently before but regularly during surgery of
breast cancer, epithelial cells are mobilized into circulation.
Part of these cells, most probably normal or apoptotic cells, are
cleared from the circulation as also shown to occur in benign
conditions. After resection even if complete and of small tumors,
cells can remain in the circulation over long times. Such cells may
remain “dormant” but might settle and grow into metastases, if they
find appropriate conditions, even after years.
PMID: 17002789 [PubMed] PMCID: PMC1599731

7. 94-Months-follow-up (94 Months) of patients with endometriosis of septum recto-vaginal and radical operation with intestinal part resection Kavallaris A, Camara O, Diebolder H, et al. GEBURTSHILFE UND FRAUENHEILKUNDE Volume: 67 Issue: 9 Pages: 1044-1044 Published: SEP 2007.

Abstract
Two young nulliparous females with severe symptomatic recto-vaginal
endometriosis that had not responded to medical treatment were
considered for surgery. Pre-operatively they were investigated by
laparoscopy and Magnetic Resonance Imaging (M.R.I.) which
demonstrated that the lesions were confined to the recto-vaginal
septum with no intraperitoneal involvement. Both patients underwent
resection of the middle third of the rectum and part of the
posterior wall of the vagina with preservation of the ovaries,
uterus and fallopian tubes. In one patient a J-colonic pouch with
colo-anal anastomosis was fashioned and in the other patient a
stapled colo-rectal anastomosis. Both patients are now asymptomatic
with normal bowel function six months post-operatively. Radical
surgery is indicated very rarely. We believe it should be
considered in young nulliparous women who wish to conceive, in whom
the diagnosis has been confirmed histologically and who have severe
symptoms. M.R.I. is a useful pre-operative investigation to
delineate the extent of the disease.
PMID: 2624408 [PubMed – indexed for MEDLINE]

8. Subareolar blue dye only injection sentinel lymph node biopsy could reduce the numbers of standard axillary lymph node dissection in environments without access to nuclear medicine. Kavallaris A, Camara O, Runnebaum IB. J Cancer Res Clin Oncol. 2007 Nov 20;

Abstract
PURPOSE: The gold standard of axillary sentinel lymph node biopsy
(SLNB) in breast cancer is the combination of radioactive colloid
and blue dye injection. Worldwide, numerous hospitals without
access to radioactive tracers still perform a routine complete
axillary lymph node dissection (ALND). We retrospectively analyzed
the false negative rate and identification rate of SLNB with
injection of blue dye in the absence of radioactive colloid and
compared the subareolar (SA) and the peritumoral (PT)
injection.
PATIENTS AND METHODS: Two hundred and fourteen patients with
clinically node negative unifocal breast cancer of up to 3 cm in
size who underwent SLNB followed by ALND were included. Patent Blue
V was injected at the SA site in 120 patients or at the PT site in
94 patients.
RESULTS: Thirty-seven (31%) patients in the SA group and 28 (29.8%)
in the PT group were node-positive by ALND. The mean number of SLNs
identified was 3.1 in the SA group and 1.6 in the PT group. The SLN
identification rate was 91.7% for the SA group and 80.9% for the PT
group (P = 0.017). The false negative rate was 3.6% in the SA group
and 11.8% in the PT group (P = 0.032).
CONCLUSIONS: Our study shows an acceptable low false negative rate
for the SA blue dye only injection and confirms the higher
identification rate of SA versus PT localisation. This technique
could have spared 67.5% (81 out of 120) of our patients the ALND
and could replace ALND of early breast cancer patients in
environments without access to nuclear medicine.
PMID: 18026990 [PubMed – indexed for MEDLINE]

9. The initial response of circulating epithelial tumor cells to primary systemic chemotherapy in breast cancer is highly predictive for final tumor reduction and outcome. Camara O, Kavallaris A, Rengsberger M, et al. BREAST CANCER RESEARCH AND TREATMENT Volume: 106 Pages:S172-S172 Supplement: Suppl. 1 Published: DEC 2007.

Abstract
Having demonstrated in a previous report that the response of CETC
during the first cycles of primary (neoadjuvant) chemotherapy
perfectly reflects the response of the tumor, in the present study
the changes in cell numbers during subsequent cycles and their
possible impact on the therapy’s outcome were examined. Patients
and methods: In 58 breast cancer patients CETC were quantified
during therapy with either EC (epirubicin/ cyclophosphamid) or dose
intensified E (epirubicin) followed by taxane, with or without
trastuzumab, and subsequent CMF (cyclophosphamid/ methorexate/
fluorouracil) Results: CETC numbers declined more than tenfold
(good response) in 65% (her2/neu-negative) and 55%
(her2/neu-positive) of patients during EC, and in 60% during dose
intensified E, respectively, followed by an increase of CETC in all
patients. CETC remained increased, decreasing only when adding CMF.
A good initial response correlated with Estrogen-receptor
negativity, a poor response with early distant relapse (p< 0,0001, hazard ratio = 11,91). Conclusion: Response of CETC already during the first cycles of neoadjuvant treatment predicts the final response of the tumour. Hitherto unknown effects of the release of tumor cells during therapy further our understanding of tumour-blood interaction and may improve access of agents like antibodies to cells. The impact on the further course of disease remains to be evaluated.

10. Monitoring the response of circulating epithelial tumor cells to adjuvant chemotherapy in breast cancer allows detection of patients at risk of early relapse. Pachmann K, Camara O, Kavallaris A, et al. JOURNAL OF CLINICAL ONCOLOGY Volume: 26 Issue: 8 Pages: 1208-1215 Published: MAR 10 2008.

Abstract
PURPOSE: To demonstrate that it is possible to monitor the response
to adjuvant therapy by repeated analysis of circulating epithelial
tumor cells (CETCs) and to detect patients early who are at risk of
relapse.
PATIENTS AND METHODS: In 91 nonmetastatic primary breast cancer
patients, CETCs were quantified using laser scanning cytometry of
anti-epithelial cell adhesion molecule-stained epithelial cells
from whole unseparated blood before and during adjuvant
chemotherapy.
RESULTS: Numbers of CETCs were analyzed before therapy, before each
new cycle, and at the end of chemotherapy. The following three
typical patterns of response were observed: (1) decrease in cell
numbers (> 10-fold); (2) marginal changes in cell numbers ( 10-fold) in numbers of
CETCs. Twenty relapses (22%) were observed within the accrual time
of 40 months, including one of 28 patients from response group 1,
five of 30 patients from response group 2, and 14 of 33 patients
from response group 3. The difference in relapse-free survival was
highly significant for CETC (hazard ratio = 4.407; 95% CI, 1.739 to
9.418; P < .001) between patients with decreasing cell numbers and those with marginal changes and between patients with marginal changes and those with an increase of more than 10-fold (linear Cox regression model). CONCLUSION: These results show that peripherally circulating tumor cells are influenced by systemic chemotherapy and that an increase (even after initial response to therapy) of 10-fold or more at the end of therapy is a strong predictor of relapse and a surrogate marker for the aggressiveness of the tumor cells. Comment in PMID: 18323545 [PubMed – indexed for MEDLINE]

11. Treatment of endometriosis of uterosacral ligament and rectum through the vagina: description of a modified technique. Camara O, Herrmann J, Egbe A, Kavallaris A, Diebolder H, Gajda M, Runnebaum IB. Hum Reprod. 2009 Jun; 24(6):1407-13. Epub 2009 Feb 16.

Abstract
BACKGROUND: Endometriosis is common in women of childbearing age,
whereas involvement of the rectosigmoid requiring resection is
rare. Laparoscopy has become a standard procedure in the management
of endometriosis. The optimum way to diagnose endometriosis is by
direct visualization of the implants. Usually for the removal of
the specimen, an additional larger abdominal incision is
needed.
METHODS: Here we report on cases of four patients with a
uterosacral ligament and rectal endometriosis who were successfully
treated with combined laparovaginal resection, using a modification
of an existing technique. They had been complaining of rectal
bleeding and lower abdominal pain in relation to their menstrual
cycle. The aim of this technique is to achieve a careful and
margin-free resection of the area involved. This can be done
without any large incisions of the abdominal wall. The hypogastric
nerves remain preserved on both sides.
RESULTS: The intra- and post-operative courses were uneventful. No
blood transfusions were needed. Haemoglobin decrease was usually
< or =1 mmol/l. The average tumour diameter was 3.5 cm. CONCLUSIONS: Our technique circumvents a larger abdominal incision. This combined laparoscopic-transvaginal approach, avoiding the extension of port-site incisions, represents a viable option for the treatment of bowel endometriosis. PMID: 19223289 [PubMed – indexed for MEDLINE] Free full tex

12. Security aspects of modern endoscopic surgery—the 12 golden rules. Daniel A. Beyer, Amadeus Hornemann, Constanze Banz, Katharina Kelling, Feriel Amari, Klaus Diedrich, Christopher Altgassen and Andreas Kavallaris. Gynecological Surgery, Volume 6, Number 4 / November 2009.

Abstract
Laparoscopy has become a common tool in modern gynaecological
surgery. Almost 30 years have passed since the first laparoscopic
appendectomy was performed by Semm in 1983. Basic standards are
missing though laparoscopic interventions are performed worldwide.
The objective of this paper was to report on our experience in
laparoscopic surgery and education of young trainees. During 16
years of laparoscopic surgery, we have performed about 15,000
interventions. Inspired by the possibility of videotaping operative
sequences, we built up an internal school of laparoscopy. As a
function of the result of steady work and education in laparoscopic
surgery, we have worked out a common security standard which is to
be considered at any intervention performed at our centre. We call
this standard ‘The 12 golden rules’. We now report for the first
time on our security aspects the 12 golden rules publicly.

13. Management of symptomatic pelvic lymphocyst after radical pelvic or pelvic and paraaortic lymphadenectomy for cervical and endometrial cancer. Andreas Kavallaris, Ehab Abu Marar, Daniel Beyer, Constanze Banz, Klaus Diedrich and Christopher Altgassen. Gynecological Surgery, Volume 6, Number 4 / November 2009.

Abstract
Pelvic and paraaortic lymph node dissection, as part of the staging
surgery for cervical and endometrial carcinoma, interrupts the
afferent lymphatics. The high acceptance by the community of
gyn-oncologists was after finding that laparoscopic lymphadenectomy
can be performed in the majority of patients and is associated with
low complication rate. Incidence of lymphocele formation and
incidence of severe complications associated with lymphocele, such
as infection, deep venous thrombosis, or urinary tract occlusion,
were retrospectively evaluated in the past years (01.2001–01.2007)
after surgery. From January 2001 to January 2007, 226 women
underwent surgery including pelvic or pelvic and paraaortic
lymphadenectomy for primary gynecological pelvic malignancies, of
which 68 (30%) patients had cervical cancer and 158 (60%) patients
had endometrial cancer; all of them were retrospectively analyzed.
Patients with symptoms such as pain in the pelvic area, lymphedema,
or suspicious cyst in the pelvis were sent to our clinic for
further evaluation. The identification was made by physical
examination and confirmed by US or CT. Twenty three out of 226
(10.2%) patients were diagnosed to have symptomatic pelvic
lymphocyst. Additionally, two of the 23 patients had lymphedema,
another two patients had lymphocyst infection, one patient had deep
venous thrombosis, and one patient had ureteral stenosis. A partial
(ventral) resection of the lymphocyst was performed. Median
duration of hospital stay was 12.5 days and median duration of
drainage was 10 days. Laparoscopic lymphocyst resection and
drainage was successful in 22 patients. In one patient, a
re-laparoscopy was necessary because of a recurrent lymphocyst
formation 6 months after the operation. The laparoscopic lymphocyst
resection is a safe and effective procedure and was applied in all
23 patients successfully.

14. Ovarian cancer and Mayer–Rokitansky–Kuster–Hauser syndrome. Andreas Kavallaris, Khalid H. Sait, Ehab A. Marar, Rafat A.Shakra, Klaus Diedrich. Gynecological Surgery, Volume 6, Number 4 / November 2009.

15. Nulliparous patients with small stature delivering at term have an increased risk of secondary cesarean section. Bohlmann MK, Luedders DW, Beyer D, Kavallaris A, Baumann K, Diedrich K, Hornemann A. Arch Gynecol Obstet. 2009 Aug 28.

Abstract
PURPOSE: To evaluate the obstetric outcome of pregnant patients
with small stature (5th percentile) with regard to the mode of
delivery, maternal injuries, and neonatal parameters.
METHODS: Retrospective cohort analysis of 13 years of deliveries.
Two groups: group A, patients with a height below the 5th
percentile, and group B, patients with a body height between the
25th and 75th percentile.
RESULTS: Patients with a body height between the 25th and 75th
percentiles showed significantly more spontaneous vaginal
deliveries. Secondary cesarean sections (CS) were significantly
seen more often in mothers with a small body height. The fetal
outcome did not differ significantly between both groups (APGAR,
arterial cord pH, base excess).
CONCLUSIONS: Patients with body height below the 5th percentile
were found to have a significantly higher rate of secondary CS. As
less than half of our patients with a body height below the 5th
percentile were found to have delivered spontaneously at term,
pregnancies in small patients should be recognized by obstetricians
to be at a specific risk. Whereas the neonatal outcome appears to
be comparable between nulliparous women with a body height below
the 5th percentile and those with a body height between the 25th
and 75th percentiles, small mothers carry a significantly elevated
risk of surgical delivery, which should be addressed in prospective
studies and in counseling these patients.
PMID: 19714346 [PubMed – indexed for MEDLINE]

16. Immunohistochemical workup of sentinel nodes in endometrial cancer improves diagnostic accuracy. Altgassen C, Müller N, Hornemann A, Kavallaris A, Hornung D, Diedrich K, Jarutat T. Gynecol Oncol. 2009 Aug;114(2):284-7. Epub 2009 May 17.

Abstract
OBJECTIVE: The purpose of this study was to examine the effect of
immunohistochemical (IHC) staining of sentinel (SLN) and non
sentinel lymph nodes (NSLN) on the detection of additional
metastases in patients with endometrial cancer.
PATIENTS AND METHODS: Between April 2004 and March 2006, 25
patients with endometrial cancer were operated on. A new method for
labelling SLNs with Patent Blue(R) was used. One additional slice
was cut out of each lymph node and immunohistochemically stained
(IHC). Sentinel and NSLN nodes were re-evaluated.
RESULTS: 673 lymph nodes from 21 patients were available for
re-evaluation. With IHC staining significantly more metastases were
detected compared to H&E staining. Though more patients with
metastases were discovered this was not significant on the basis of
affected SLNs or NSLNs. In the conventional evaluation 7 metastases
were found in 3 patients. Applying re-evaluation and IHC 6
additional metastases in 5 patients were detected. These additional
metastases were evenly distributed among the pelvic and para-aortic
area, and among the SLNs or NSLNs. This had an impact on the
diagnostic accuracy of the sentinel concept. Sensitivity reduced
from 66.7% to 33.3% and the negative predictive value (NPV) fell
from 94.7% to 79.0% only if the NSLNs were additionally IHC
stained. On the contrary, if the SLNs were also IHC stained, the
sensitivity rose to 83.3%, the NPV rose to 93.8%.
CONCLUSION: Our results indicate that additional
immunohistochemistry staining of one additional block of SLNs
improves the validity of sensitivity and the NPV in the sentinel
concept.
PMID: 19447478 [PubMed – indexed for MEDLINE]

17. Seven years' experience in laparoscopic dissection of intact ovarian dermoid cysts. Kavallaris A, Mytas S, Chalvatzas N, Nikolettos N, Diedrich K, Bohlmann MK, Hornemann A. Acta Obstet Gynecol Scand. 2009 Oct 23.

Abstract
A large case series on laparoscopic removal of dermoid cysts with a
diameter between 3 and 12 cm, via an endobag, is reported (127
cysts in 121 premenopausal women). The incidence of spillage and
recurrence rate of laparoscopic ovarian dermoid cystectomy, the
duration of the surgical procedure, the length of hospitalization,
the incidence of recurrence and pregnancies was evaluated. In 2.5%
of cases, the endobag ruptured during removal, and a total spillage
rate of 12% was seen. No signs or symptoms of peritonitis were
observed regardless of cystic spillage or not. Laparoscopic
cystectomy of dermoid cysts in premenopausal women is safe and
effective and appears to be a valuable alternative to laparotomy.
Controlled intraperitoneal spillage of cyst contents does not
increase postoperative morbidity as long as an endobag is used and
the peritoneal cavity is washed out thoroughly.
PMID: 19852568 [PubMed – indexed for MEDLINE]

18. Nulliparous patients with small stature delivering at term have an increased risk of secondary cesarean section. Bohlmann MK, Luedders DW, Beyer D, Kavallaris A, Baumann K, Diedrich K, Hornemann A. Arch Gynecol Obstet. 2009 Aug 28.

19. Prävention des Zervixkarzinoms,Prevention of cervical carcinoma.

Abstract
Cervical carcinoma is one of the most frequent malignancies in
women worldwide. Secondary prevention of cervical carcinoma is
traditionally achieved by cytological smears (PAP smear) and
colposcopy. Since it became known that infections with human
papillomavirus (HPV) were responsible for nearly all cases of
cervical cancer, primary prevention through protection against HPV
infection of the genital tract has become extremely important. A
vaccine against HPV has been available in Germany since 2006.In
comparison to other malignancies there are several possibilities to
prevent cervical carcinoma. As the cervix is visible by vaginal
inspection using high magnification (colposcopy) alterations can be
directly visualized. Because the infectious origin is now known a
protection against infection can be administered. Finally it is
thought that a tumor needs at least 10 years to develop, therefore
an intervention long before the development of malignant
transformation is possible.

20. Hornemann, M.K. Bohlmann, K. Diedrich and A. Kavallaris, Der Gynäkologe, Volume 42, Number 11 / November 2009.

21. Zervixkarzinom (Cervical carcinoma).

22. Kreienberg, A. Kavallaris, G. Sauer and K. Diedrich, Der Gynäkologe, Volume 42, Number 12 / Dezember 2009.

23. Trachelektomie Trachelectomy ,Indikationen und Operationsmethoden, Indications and surgical techniques. C. Altgassen, T. Cordes, H. Hertel, K. Diedrich and A. Kavallaris. Der Gynäkologe, Volume 42, Number 12 / Dezember 2009.

Abstract
The trachelectomy was first described by Professor Dargent. He
combined the endoscopic lymphadenectomy with the removal of the
cervix uteri and the adherent parametria. Thus the patients were
able to retain their reproductive possibilities. In the course of
time an open abdominal, a laparoscopic and a robot supported
procedure were described besides the vaginal access. At present the
indication is drawn from carcinomas that are smaller than 2 cm and
show no involvement of the lymphatic region. Oncologic safety, in
this stage, is ensured by classic radical hysterectomy. Although
severe pregnancy difficulties must be reckoned with, the rate of
viable children is higher than 50%. But not every woman fulfils her
potential desire for children. The overview describes the operative
procedures in current use, the possible complications and their
effects on fertility.

24. Laparoskopische nervenschonende radikale Hysterektomie Laparoscopic nerve-sparing radical hysterectomy. A. Kavallaris, K. Diedrich and A. Hornemann. Der Gynäkologe Volume 43, Number 2 / Februar 2010.

Abstract
Endoscopic surgical procedures are becoming the standard treatment
in gynecological oncological diseases. In the operative treatment
of cervical and endometrial cancer, radicality and morbidity are
serious problems. The more radical the parametrial structures are
dissected and removed, the more often a dysfunction of the bladder
and rectum occurs. Laparoscopic nerve-sparing radical hysterectomy
combines the advantages of laparoscopy with the advantages of a
nerve-sparing radical hysterectomy:, significantly lower
postoperative morbidity and faster recovery associated with lower
indirect costs.

25. Kinderwunsch nach tubarer Sterilisation Renewed desire for children after tubal sterilization. M.K. Bohlmann, A. Schultze-Mosgau, G. Griesinger, K. Baumann, A. Hornemann, D.W. Luedders, K. Diedrich and A. Kavallaris Der Gynäkologe, Volume 43, Number 2 / Februar 2010.

Abstract
Worldwide, tubal sterilization is one of the most frequently used
methods of contraception. However, a significant number of patients
subsequently regret their decision, especially after a change in
family circumstances. Therapeutic options for women with a renewed
wish for a child after tubal sterilization include methods of
assisted reproduction, bypassing of the destroyed Fallopian tubes,
and operative tubal reconstruction. Such refertilization procedures
include approaches by laparoscopy or minilaparotomy. This review
summarizes the current knowledge concerning the different
therapeutic options, with special emphasis on the specific risks
and chances of success.

26. Adhäsionsprophylaxe bei minimal-invasiven Eingriffen. Preventing adhesion in minimally invasive operations. A. Hornemann, A. Hackethal, A. Kavallaris, K. Diedrich, D. Hornung, T. Ahrens and M.K. Bohlmann. Der Gynäkologe,Volume 43, Number 2 / Februar 2010.

Abstract
After surgical procedures peritoneal adhesions are quite common.
They might cause pain or infertility and can be the reason for
emergency conditions such as bowel obstruction. Triggers for
adhesion formation can be incisions into the peritoneum, high
pressure, heat, desiccation, or foreign material such as sutures.
Fibrin forms in the damaged structures, leading to peritoneal
adhesions. Reduction strategies include minimizing operating time,
atraumatic surgical techniques, using moisturized and heated gas
for laparoscopy, avoiding high pressure peaks during
pneumoperitoneum, reducing infection by using single-shot
antibiotics if necessary, removing blood clots at the end of the
operation, reducing use of sutures, and applying antiadhesive
substances for high-risk patients.

27. Nulliparous patients with small stature delivering at term have an increased risk of secondary cesarean section. Bohlmann MK, Luedders DW, Beyer D,Kavallaris A, Baumann K, Diedrich K, Hornemann A. Arch Gynecol Obstet. 2010 Sep;282(3):241-4. doi: 10.1007/s00404-009-1216-8. Epub 2009 Aug 28.

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28. Tubo-ovarian abscess in woman with an intrauterine device forgotten for 22 years Doerte W. Luedders, Nektarios Chalvatzas, Constanze Banz, Amadeus Horneman, Klaus Diedrich and Andreas Kavallaris. Gynecological Surgery Volume 6, Number 4 / December 2009.

29. Laparoskopische suprazervikale Hysterektomie, Laparoscopic supracervical hysterectomy. M. Thill, A. Kavallaris, K. Kelling, K. Diedrich and C. Altgassen Der Gynäkologe, Volume 43, Number 2 / Februar 2010.

Abstract
Indications for the 346 hysterectomies performed in the Department
of Obstetrics and Gynecology University of Kiel in the years 1991
till 1994 were myomas with pain, hypermenorrhoea, menorrhagia,
recurrent bleedings and endometriosis. The applied hysterectomy
technique consisted of supercervical hysterectomy without colpotomy
including the resection of the transcervical and transuterine
mucosa by laparotomy and via laparoscopy (pelviscopy).
Histologically results were divided between fibromas, leiomyomas,
adenomyosis and adenomatous hyperplasia. 42 patients where
pretreated with hormones and showed a significantly reduced blood
loss compared to the non treated patients during surgery. Intra-
and postoperative complications were very low. The CISH-technique
is an alternate method for vaginal and abdominal total hysterectomy
via laparotomy or via laparoscopy. Gynecological indications for
hysterectomies presents the following advantages. 1. CISH via
pelviscopy: Prophylaxis against the development of cervical cancer,
preservation of the pelvic floor, preservation of the pericervical
vascular and nerve tissue and especially, avoiding the danger zone
of the uterine arteria and ureter, reduced physical stress, short
hospitalisation and recovery time of the patients. 2. CISH via
laparotomy: Prophylaxes against cervical cancer, preservation of
the pelvic floor, reduction of the pelvic trauma, simple technique.
3. CISH via vagina: The advances of the intrafascial vaginal
hysterectomy are the same as those for laparoscopic intrafascial
hysterectomy without colpotomy, no separation of cardinalia and
sacrouterina ligaments, no cervical amputation. No search for the
uterine artery, no change in sexual life. Ideal conditions for the
preservation of pelvic floor to regain stability. 4. During the
resection of the transcervical and transuterine mucosa the
technique of mucosa ablation emerged, indications are dysfunctional
bleeding.
PMID: 8585358 [PubMed – indexed for MEDLINE]

30. Gynäkologische minimal-invasive Chirurgie, Gynecological minimally invasive surgery. Innovation am Beispiel der LESS-Technik , Innovation using the example of the LESS technique. A. Hornemann, M.K. Bohlmann, C. Banz, A. Agic, K. Kelling, D.A. Beyer, K. Diedrich and A. Kavallaris. Der Gynäkologe, Volume 43, Number 2 / Februar 2010.

31. Rupture rates after laparoscopic myomectomy using single stitches in only one layer. A. Kavallaris, C. Panayotidis, N. Chalvatzas, C. Banz and K. Diedrich, et al. Gynecological Surgery, Online First™, 20 April 2010.

Abstract
Myomectomy is a common laparoscopic procedure and is often used in
patients with infertility, bleeding disorders and other symptoms
caused by leiomyomas. We present a case series report based on a
retrospective audit conducted from January 2001 up to December 2006
in our department. From 451 patients laparoscopically operated for
leiomyomas, we identified only 59 patients operated due to
infertility reasons. We report the post-operative rates of
pregnancy and mode of delivery after a median follow-up of 40
months post-operatively. Laparoscopic technique and obstetrical
outcome is discussed with recent literature review. The average
number of removed fibroids was 2. The mean weight of the leiomyomas
was 94.3 g. The cavum uteri was opened in eight patients. Overall,
42 out of 59 women delivered 51 live newborn babies, yielding a
post-operative success rate of 71%. The miscarriage rate
post-operatively was 8 out of 60 pregnancies (13%). In patients
with leiomyomas identified as infertility cofactor, laparoscopic
management is a convincing therapeutic approach. In our experience,
conception rate was 71%, and complications during pregnancy were
limited to 4% of the patients. Risk of uterine rupture during
labour was present in 4% of the cases, implying that mode of
delivery should always be discussed with the patient.

32. Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome. Kavallaris A, Chalvatzas N, Kelling K, Bohlmann MK, Diedrich K, Hornemann A. Arch Gynecol Obstet. 2010 May 7.

Abstract
INTRODUCTION: Hysterectomy remains the most common major
gynecological operation. This is the first study that describes a
new technique of TLH without using any kind of uterine manipulator
or vaginal tube (TLHwM) and analyzes the intra- and postoperative
surgical outcome of the first 67 cases.
PATIENTS AND METHODS: Between October 2008 and December 2009, 67
patients underwent TLH without uterine manipulator or vaginal tube.
We analyzed the differences in the outcome by using three different
kinds of surgical instruments: in 21 cases the TLHwM was performed
using conventional 5 mm bipolar and scissors, in 22 cases using
Sonosurgical, and in 24 cases using PKS cutting forceps.
RESULTS: There was no intra- or postoperative complications. The
overall mean operating time was by TLHwM with salpingo-oophorectomy
98 min and without salpingo-oophorectomy, 80 min. The mean
operating time using cutting forceps was significantly lower. The
mean uterine weight was 263 g.
DISCUSSION: Uterine manipulator seems to be a safe and practical
surgical method, especially for patients with vaginal stenosis and
in cases of enlarged uterus. With its short operation time and no
complication rate, we believe that this method is an enrichment of
the laparoscopic hysterectomy techniques.
PMID: 20449598 [PubMed – indexed for MEDLINE]

33. 94 months follow-up after laparoscopic assisted vaginal resection of septum rectovaginale and rectosigmoid in women with deep infiltrating endometriosis. Kavallaris A, Chalvatzas N, Hornemann A, Banz C, Diedrich K, Agic A. Arch Gynecol Obstet. 2010 May 11.

Abstract
BACKGROUND: Endometriosis with bowel involvement is the most
invasive form and can cause infertility, chronic pelvic pain and
bowel symptoms. Effective surgical treatment of endometriosis
requires complete excision of endometriosis and in same case may
require segmental rectosigmoid resection.
METHODS: Between December 1997 and October 2003, 55 patients with
rectovaginal endometriosis underwent a combined laparoscopic
vaginal technique. 30 patients were found at a follow-up and
underwent a telephone interview. The questionnaire covered
questions about symptoms related to recurrences of intestinal
endometriosis, dyspareunia, dysmenorrhea and pregnancy.
RESULTS: Twenty-seven of 30 (90%) women have no clinical symptoms
of reported recurrence of endometriosis. Two patients (6.6%) had
evidence of recurrence of bowel endometriosis. Dysmenorrhoea
disappeared in 28 (93.3%), dyspareunia in 26 (86.7%) and pelvic
pain in 27 (90%) patients. 17 patients (31%) tried to become
pregnant and 11 of these patients (65%) became pregnant: 9 patients
delivered healthy newborns, 18 pregnancies occurred and 19 healthy
children were born.
CONCLUSIONS: Despite the small number of follow-up patients, our
94-month follow-up data demonstrated that endometriosis with bowel
involvement and radical resection was associated with significant
reductions in painful and dysfunctional symptoms, a low recurrence
rate (6.6%) and high pregnancy rate (36.6%).
PMID: 20458487 [PubMed – indexed for MEDLINE]

34. Laparoscopic management of ectopic pregnancy during a 9-year period. Banz C, Chalvatzas N, Kelling K, Beyer D, Hornemann A, Diedrich K, Kavallaris A. Fertil Steril. 2010 Jun 2.

Abstract
The present study analyzed the epidemiology and outcome of ectopic
pregnancy during a 9-year period on a total of 473 women. Our
follow-up shows that laparoscopic salpingostomy, performed in 84.9%
of the patients, is a safe and effective treatment for ectopic
pregnancy.
Copyright © 2010 American Society for Reproductive Medicine.
Published by Elsevier Inc. All rights reserved.
PMID: 20605142 [PubMed – indexed for MEDLINE]

35. Standardized technique of laparoscopic pelvic and para-aortic lymphadenectomy in gynecologic cancer optimizes the perioperative outcomes. Kavallaris A, Kalogiannidis I, Chalvatzas N, Hornemann A, Bohlmann MK, Diedrich K. Arch Gynecol Obstet. 2010 Jul 6.

Abstract
INTRODUCTION: The main objective of this study is to illustrate the
effectiveness and the safety of standardized technique of
laparoscopic lymphadenectomy (LNE), newly introduced in a
University Hospital, in patients with gynecologic malignancy.
MATERIALS AND METHODS: A cohort of 104 patients with gynaecologic
malignancies (71 with endometrial and 33 with cervical cancer), who
underwent laparoscopic pelvic with or without para-aortic LNE
between September 2008 and March 2010, were analyzed. Total
laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH
& BSO) was the standard approach for patients with endometrial
cancer (n = 71), while laparoscopic (nerve sparing) radical
hysterectomy (n = 29), laparoscopic-assisted radical vaginal
hysterectomy (n = 2) and radical trachelectomy was the treatment
for patients with cervical cancer. All LNE were performed by a
learning team under the supervision of an expert surgeon, familiar
with the technique.
RESULTS: The median number of pelvic lymph nodes yielded was 22
(range 16-34) and of para-aortic 14 (range 12-24). The mean
operative time ± standard deviation for pelvic LNE for each side
was 29 ± 17 and 64 ± 29 min for para-aortic LNE. The overall
complication rate was 7.6% (n = 8). Two patients were reoperated
laparoscopically, one because of postoperative hemorrhage and the
other because of lymphocyst formation; laparoconversion was not
necessary.
DISCUSSION: Laparoscopic lymphadenectomy performed by a learning
team with standardized technique is effective with adequate number
of harvested nodes, in acceptable operative time and with low rate
of perioperative complications.
PMID: 20607263 [PubMed – indexed for MEDLINE]

36. Excessive production of ascitic fluid after laparoscopic operation for early-stage ovarian cancer. Ioannis Kotsopoulos, Dimitrios Evaggelinos, Paraskevi Skafida, Vasilios Kartsiounis, Nektarios Chalvatzas und Andreas Kavallaris. Gynecological Surgery, Online First™, 23 July 2010.

Abstract
Peritoneal implants and/or venous or lymphatic obstruction,
presenting in advanced stages of ovarian cancer, stimulate
production of ascitic fluid [1]. Also, postoperative production of
ascitic fluid after operations for advanced ovarian cancer is not
rare. Especially in end-stage ovarian cancer, symptomatic and
rapidly reaccumulating ascitic fluid usually needs repeated
paracenteses or drainage though peritoneal catheter. In addition,
thoracentesis, pleurodesis, or catheter has already been used to
drain pleural fluid [2]. On the other hand, in early-stage (Ia)
ovarian cancer, considering the absence of implants, postoperative
ascites usually cannot be cancer-related. In this paper, a rare
complication of excessive production of ascitic fluid after
laparoscopic operation for early-stage clear cell ovarian carcinoma
and the used of treatment method are presented.

37. Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome.Kavallaris A, Banz C, Chalvatzas N, Hornemann A, Luedders D, Diedrich K, Bohlmann M. Arch Gynecol Obstet. 2010 Aug 1.

Abstract
INTRODUCTION: The radical surgery of the deep infiltrating
endometriosis of the rectovaginal septum and the uterosacral
ligaments with or without bowel resection can cause a serious
damage of the pelvic autonomic nerves with urinary retention and
the need of self-catheterization.
PATIENTS AND METHODS: We introduce a case series report of 16
patients with laparoscopic nerve-sparing surgery of deep
infiltrating endometriosis. We describe the technique step by step
and compare the patients’ outcome with patients who had undergone a
non-nerve-sparing surgical technique. In 12 patients, a
double-sided and in four patients, a single-sided identification of
the inferior hypogastric nerve and plexus were performed.
RESULTS: In all patients at least single-sided resection of the
uterosacral ligaments were performed. Postoperatively
dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all
patients. The average operating time was 82 min (range 45-185).
Postoperatively, the overall time to resume voiding function was 2
days. The residual urine volume was in all patients 50 ml at two
ultrasound measurements.
DISCUSSION: Identification of the inferior hypogastric nerve and
plexus was feasible. In comparison with non-nerve-sparing surgical
technique, no cases of bladder self-catheterization for a long or
even life time was observed, confirming the importance of the
nerve-sparing surgical procedure.
PMID: 20680309 [PubMed – indexed for MEDLINE]

38. Laparoscopic nerve-sparing radical hysterectomy: Description of the technique and patients' outcome. Kavallaris A, Hornemann A, Chalvatzas N, Luedders D, Diedrich K, Bohlmann MK. Gynecol Oncol. 2010 Aug 9.

Abstract
OBJECTIVE: The radical hysterectomy type three can be accompanied
by postoperative morbidity, such as dysfunction of the lower
urinary tract with loss of bladder or rectum sensation. We describe
the technique of laparoscopic nerve-sparing radical hysterectomy
and patient’s outcome.
METHODS: Thirty-two patients underwent laparoscopic nerve-sparing
radical hysterectomy with pelvic lymphadenectomy. Both the
hypogastric and the splanchnic nerves were identified bilaterally
during pelvic lymphadenectomy.
RESULTS: The median age of the patients was 52 years, and the
average operating time was 221 min. There were no intraoperative or
postoperative complications considering the nerve-spring radical
hysterectomy. Postoperatively, in all patients spontaneous voiding
was possible on the third postoperative day with a median residual
urine volume of 50 ml.
CONCLUSIONS: Laparoscopic identification (neurolysis) of the
inferior hypogastric nerve and inferior hypogastric plexus is a
feasible procedure for trained laparoscopic surgeons who have a
good knowledge not only of the retroperitoneal anatomy but also of
the pelvic neuro-anatomy as this qualification could prohibit
long-term bladder and voiding dysfunction during nerve-sparing
radical hysterectomy.
Copyright © 2010 Elsevier Inc. All rights reserved.
Comment in

PMID: 20701958 [PubMed – indexed for MEDLINE]

39. Laparoscopic-assisted vaginal hysterectomy with and without laparoscopic transsection of the uterine artery: an analysis of 1,255 cases. Kavallaris A, Kalogiannidis I, Chalvatzas N, Hornemann A, Beyer D, Georgiev I, Herrmann J, Camara O, Altgassen C, Diedrich K. Arch Gynecol Obstet. 2010 Sep 10.

Abstract
INTRODUCTION: To evaluate the operative outcomes of patients
managed by laparoscopic-assisted vaginal hysterectomy (LAVH) with
and without laparoscopic transsection of the uterine artery for
benign gynaecologic diseases.
PATIENTS AND METHODS: A retrospective analysis of 1,255 women from
two different centers undergoing hysterectomy between 1998 and 2009
with benign indications is presented. 856 patients were treated by
LAVH type I (vaginal transsection of the uterine artery) and 399
patients by LAVH type II (laparoscopic transsection of the uterine
artery). Operative outcomes, intraoperative and postoperative
complications, as well as laparoconversion rates were the main
objectives of the study.
RESULTS: Median operative time was similar between LAVH type I and
II (136 vs. 126 min, respectively, P = NS). Intraoperative
complication rate was not significantly different between the two
groups of the study (LAVH type I: 1.5% vs. LAVH type II: 1.26%,
respectively, P = NS). The injury of the urinary tract, especially
of the bladder, was the most common intraoperative complication for
both the groups of the study. Laparoconversion rate was similar in
LAVH type I and II (0.5 vs. 0.35%, respectively, P = NS), while
postoperative complications were significantly higher in LAVH type
I (2.25%) compared to LAVH type II (1.16%), mainly because of
postoperative vaginal and intrabdominal haemorrhage in the group of
the LAVH type I.
CONCLUSION: LAVH with laparoscopic transsection of the uterine
artery is an effective and safe technique with less postoperative
complication compared to LAVH with vaginal transsection of the
uterine vessels.
PMID: 20830481 [PubMed – in process]

40. Response to the letter entitled "Bladder function after laparoscopic nerve-sparing radical hysterectomy", by Dr. F. Plotti et al. Kavallaris A, Dafopoulos A. Gynecol Oncol. 2010 Nov 12.

41. Seasonality of spina bifida in Northern Germany. Beyer DA, Diedrich K, Weichert J, Kavallaris A, Amari F. Arch Gynecol Obstet. 2010 Nov 16.

Abstract
PURPOSE: To verify a seasonal variation in the incidence of spina
bifida and thus to identify possible environmental triggers leading
to its developement.
METHODS: An interdisciplinary approach has been taken to develop a
better understanding of spina bifida through collaborative efforts
from investigators specializing in genetics, fetal pathology,
paediatrics, neuro-surgery and prenatal ultrasonographic diagnosis.
All pregnancies with fetal spina bifida were retrospectively
analyzed from May 1 1993 through May 1 2010 at Luebeck University
Fetal Health Center. Results were used to construct a model to
predict the occurrence of fetal spina bifida based on seasonal
variation and environmental influence reflected by climatic changes
and environmental pollution. Furthermore, data were categorized in
respect to the date of conception and subdivided into date of
conception during summer (April-September) and winter months
(October-March).
RESULTS: Neither a seasonal distribution of conception for fetuses
with spina bifida in the defined time frame could be verified nor a
relevant influence of the analyzed environmental factors on the
prevalence of spina bifida could be proved. The incidence of spina
bifida has remained relatively stable within the last 17 years at
2.5 per 1,000 screened pregnancies.
CONCLUSION: Since we were unable to demonstrate a relationship
between seasonal variation and certain environmental factors on the
incidence of fetal spina bifida, other factors should be
investigated for a possible association with the onset of fetal
spina bifida.
PMID: 21079979 [PubMed – in process]

42. Follow-up of dysfunctional bladder and rectum after surgery of a deep infiltrating rectovaginal endometriosis. Kavallaris A, Mebes I, Evaggelinos D, Dafopoulos A, Beyer DA. Arch Gynecol Obstet. 2011 Jan 11.

Abstract
PURPOSE: The radical surgery of the deep infiltrating endometriosis
of the rectovaginal septum and the uterosacral ligaments with or
without bowel resection can cause a serious damage of the pelvic
autonomic nerves with urinary retention and the need of
self-catheterization. Major goal of this review article is to
compare different surgical techniques of deep infiltrating
endometriosis and their follow-up results.
METHODS: The research strategy included the online search of
databases [MEDLINE, EMBASE, SCOPUS] for the diagnosis of deep
infiltrating endometriosis with the indication of an operative
resection. The outcome of the follow-up terms were noticed and
compared.
RESULTS: All in all, 16 trials could be identified with included
follow-up. In all patients at least single-sided resection of the
uterosacral ligaments were performed. Follow-up was heterogeneous
in all trials ranging from 1 to 92 months. Postoperative symptoms,
such as dysmenorrhoea, pelvic pain, and dyspareunia were commonly
described in the majority of trials. Nevertheless, a tendency
towards lower comorbidity after nerve sparing resection of
endometriosis could be observed.
CONCLUSION: Identification of the inferior hypogastric nerve and
plexus was feasible in the minority of trials. In comparison with
non-nerve-sparing surgical technique, no cases of bladder
self-catheterization for a long or even life time was observed,
confirming the importance of the nerve-sparing surgical
procedure.
PMID: 21221979 [PubMed – indexed for MEDLINE]

43. Laparoendoscopic single-site surgery (LESS) - is it feasible in gynecological surgery? Kavallaris A, Chalvatzas N, Hornemann A, Luedders D, Diedrich K, Bohlmann MK. Acta Obstet Gynecol Scand. 2011 Feb;90(2):195-7.

Abstract
Increases in technical expertise in gynecological surgery and
advances in surgical instrumentation have led to the development of
laparoendoscopic single-site surgery (LESS). Between March and
September 2009, 24 patients underwent adnexal surgery at our
institution with laparoendoscopic single-site surgery. The LESS
technique was performed using the TriPort through an umbilical
incision of 10 mm and bent laparoscopic instruments. We furthermore
compared the LESS technique with a control group of 24 patients
operated consecutively in the same period and for the same
procedures with conventional multiport laparoscopy. Comparing the
two techniques we found differences between the operation time and
mean hospital stay. The surgeon must master the use of novel bent
instruments in close proximity to each another. The LESS technique
for benign adnexal surgery is technically feasible and safe,
representing a reproducible alternative to conventional multiport
laparoscopy.
© 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica©
2010 Nordic Federation of Societies of Obstetrics and
Gynecology.
PMID: 21241267 [PubMed – indexed for MEDLINE]

44. Spontaneous uterine rupture at the 21st week of gestation caused by placenta percreta.Hornemann A, Bohlmann MK, Diedrich K,Kavallaris A, Kehl S, Kelling K, Hoellen F.Arch Gynecol Obstet. 2011 Oct;284(4):875-8.

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45. Seasonality of spina bifida in Northern Germany. Beyer DA, Diedrich K, Weichert J,Kavallaris A, Amari F.Arch Gynecol Obstet. 2011 Oct;284(4):849-54.

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46. Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome. Kavallaris A, Banz C, Chalvatzas N, Hornemann A, Luedders D, Diedrich K, Bohlmann M.Arch Gynecol Obstet. 2011 Jul;284(1):131-5.

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47. Laparoscopic-assisted vaginal hysterectomy with and without laparoscopic transsection of the uterine artery: an analysis of 1,255 cases. Kavallaris A, Kalogiannidis I, Chalvatzas N, Hornemann A, Beyer D, Georgiev I, Herrmann J, Camara O, Altgassen C, Diedrich K.Arch Gynecol Obstet. 2011 Aug;284(2):379-84.

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48. Retromesenteric para-aortic lymphadenectomy in gynecologic malignancy. Altgassen C, Bends R, Kelling K, Hornung D, Friedrich M, Salehin D, Diedrich K, Kavallaris A. Eur J Gynaecol Oncol. 2012;33(6):574-8.

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49. Laparoscopic myomectomy of a giant myoma. Kavallaris A, Zygouris D, Chalvatzas N, Terzakis E.Clin Exp Obstet Gynecol. 2013;40(1):178-80.

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