Die Frauenklinik an der Elbe in Hamburg gilt als eines der größten Zentren für ambulante gynäkologische Operationen in Deutschland. Seit ihrer Gründung 1984 entwickelte sie ein konsequentes „ambulantes Mindset“, das minimal-invasive Eingriffe bevorzugt und sich kontinuierlich durch medizinische Innovationen erweitert hat. Heute werden jährlich etwa 11.000 ambulante Operationen und etwa 10.000 Spezialsprechstunden durchgeführt. Die Klinik ist besonders auf Endometriose, Onkologie, Dysplasie, Beckenbodenchirurgie und Asherman-Operationen spezialisiert. Ihr Erfolg basiert auf Subspezialisierung, interdisziplinärer Teamarbeit, internationalem wissenschaftlichen Austausch und enger Kooperation mit Krankenhäusern für stationäre Eingriffe. Trotz finanzieller Herausforderungen im deutschen Vergütungssystem zeigt das Modell, dass ambulantes Operieren medizinisch sinnvoll, patientenfreundlich und gesundheitspolitisch zukunftsweisend ist.

OBJECTIVE:To develop a predictive risk score for superficial peritoneal endometriosis (SPE) in patients with negative examination and imaging, based on symptoms and quality of life measures. DESIGN:Multicenter nested case-control study conducted from September 2022 to January 2024 at 18 certified endometriosis centers in Austria, Germany, and Switzerland. Women undergoing first-time surgery for suspected endometriosis had surgical findings documented using the #ENZIAN classification. Only women with isolated peritoneal endometriosis or no endometriosis were included in this analysis. Subjects completed standardized preoperative questionnaires, which assessed pain characteristics, symptom duration, analgesic intake, sexual function (FSFI), and health-related quality of life (EHP-30). Multiple imputation, logistic regression, and receiver operating characteristic curve analyses were performed. SUBJECTS:Of 845 women in the full study cohort, 229 met inclusion criteria, completed all questionnaires, and had complete surgical data available: 121 (53%) had SPE only, and 108 (47%) had no endometriosis. A validation cohort of 268 subjects (206 [77%] SPE and 62 [23%] no endometriosis) was analyzed. EXPOSURE:Pain-related variables, internally validated by bootstrapping, and externally validated in an independent cohort. MAIN OUTCOME MEASURES:Surgically diagnosed peritoneal endometriosis RESULTS: Severe dysmenorrhea (odds ratio [OR] 2.01; 95% CI, 1.14-3.53) and pain duration >3 years (OR 2.40; 95% CI, 1.40-4.11) were significantly associated with SPE. Dyspareunia, dysuria, dyschezia, pain only during menses, analgesic intake, family history, health-related quality of life, and sexual function were not. A 5-item predictive score (maximum six points) showed moderate discrimination in the development cohort (area under the curve [AUC] 0.64; 95% CI, 0.57-0.72), with similar performance on internal validation (AUC 0.64; 95% CI, 0.57-0.71). External validation demonstrated no predictive value (AUC 0.49; 95% CI, 0.41-0.58). CONCLUSION:Although severe dysmenorrhea and long duration of symptoms were associated with SPE, symptom profiles and functional questionnaires were insufficient for accurate prediction. The calculated score performed modestly internally but failed external validation. Given that symptoms common to endometriosis are also reported in women with other etiologies of pelvic pain, symptom-based models appear inadequate for reliable identification of SPE. Integrating clinical factors with biomarkers or emerging diagnostic technologies may be necessary to improve noninvasive diagnostic accuracy. Clinicians and patients should be aware of the high rate of negative surgical findings when making the decision to proceed with laparoscopy versus considering conservative medical therapies instead.

The Frauenklinik an der Elbe in Hamburg is considered one of the largest centers for outpatient gynecological surgery in Germany. Since its founding in 1984, it has developed a consistent "ambulatory mindset," prioritizing minimally invasive procedures and continuously expanding them through medical innovation. Today, approximately 11,000 outpatient surgeries and approximately 10,000 specialized consultations are performed each year. The clinic is particularly specialized in endometriosis, oncology, dysplasia, urogynecology, and Asherman syndrome procedures. Its success is based on interdisciplinary teamwork, international scientific exchange, and close cooperation with hospitals for inpatient procedures. Despite financial challenges in the German reimbursement system, the model demonstrates that outpatient surgery is a medically sound, patient-friendly, and forward-looking approach for healthcare policy.

Endometriosis is a chronic inflammatory disease associated with substantial impairment of quality of life. Although the #ENZIAN classification enables detailed anatomical characterization of disease distribution, its relevance for predicting patient-reported outcomes after surgery remains uncertain. Clarifying this relationship is essential for patient counseling and outcome-oriented surgical decision making. This multicenter study, registered on ClinicalTrials.gov (NCT05624567), prospectively recruited consecutive women aged 18 to 50 years undergoing surgery for suspected endometriosis at certified endometriosis centers in Austria, Germany, and Switzerland. Only women with surgically and histopathologically confirmed endometriosis who completed the baseline Endometriosis Health Profile-30 (EHP-30) questionnaire were included in the final analysis. Disease localization was classified intraoperatively using the #ENZIAN and rASRM systems. Quality of life was assessed using the EHP-30 questionnaire preoperatively and at 6 and 12 months after surgery. Longitudinal changes and predictors of quality-of-life outcomes were analyzed using ordinal logistic regression models. A total of 627 women were included at baseline, with 430 and 325 completing 6- and 12-month follow-up, respectively. Surgical treatment was associated with a marked and clinically meaningful improvement in quality of life, with EHP-30 scores improving significantly within the first 6 months after surgery and remaining stable at 12 months. This improvement was observed consistently across all #ENZIAN compartments, including deep infiltrating and multifocal disease. Anatomical disease distribution and rASRM stage were not significantly associated with baseline quality-of-life or postoperative recovery trajectories. In contrast, baseline symptom burden and complete surgical resection emerged as the strongest predictors of early postoperative quality-of-life improvement. Surgical treatment of endometriosis was associated with substantial and sustained improvement in patient-reported quality of life, independent of anatomical disease distribution as classified by #ENZIAN. These findings suggest that meaningful postoperative benefit can be achieved across all disease localizations and underscore the importance of focusing on symptom severity and surgical completeness rather than anatomical staging alone. Incorporating patient-reported outcome measures alongside anatomical classification is essential for comprehensive evaluation of treatment success.

STUDY QUESTION:Is there an association between pre-operative symptoms and intraoperatively described localization and size of endometriosis lesions as assessed by the #ENZIAN classification system? SUMMARY ANSWER:Dyschezia is associated with any deep infiltrating endometriosis (DE) lesions; severe dyspareunia is associated with adenomyosis. WHAT IS KNOWN ALREADY:Previous attempts to correlate the common symptoms of endometriosis to the size and localization of lesions have been of moderate success. STUDY DESIGN, SIZE, DURATION:This prospective, multicentre, non-interventional cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centres in Austria, Germany, and Switzerland, enrolling a total of 838 patients with endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS:The study included 521 patients with complete information on pre-operative symptoms and intraoperatively diagnosed endometriosis classified by the #ENZIAN classification system. Associations between symptoms and localization of endometriosis lesions were analysed. MAIN RESULTS AND THE ROLE OF CHANCE:Nearly all patients (n = 513) (98.5%) suffered from dysmenorrhea whereas 294 (56.4%), 208 (39.9%), and 102 (19.6%) patients reported dyspareunia, dyschezia, and dysuria, respectively. Dyspareunia rated as ≥8 on a visual analogue scale was reported 3.5-fold more often in patients with adenomyosis only (OR 3.56 [1.38-9.17]) than in those without, while dyschezia was almost twice as likely in those with any form of DE (OR 1.86 [1.3-2.65]). LIMITATIONS, REASONS FOR CAUTION:A larger study population is needed to clinically define relevant sub-groups based on localization of lesions. WIDER IMPLICATIONS OF THE FINDINGS:The findings of the present study identify adenomyosis as a strong driver of pain, especially dyspareunia, making awareness of its high prevalence of utmost importance. Few direct associations between symptoms and lesions were identified. Endometriosis-related symptoms, especially when chronic, are multi-factorial and cannot be readily correlated to specific lesion sites. STUDY FUNDING/COMPETING INTEREST(S):This study received no external funding and all the authors declare they have no conflicts of interest pertaining to this study. TRIAL REGISTRATION NUMBER:Clinical Trials NCT05624567.

Target Group:Physicians interested in endometriosis and infertility as well as medical teams in reproductive medicine and endometriosis centers. Objective:A practical guide for clinical decision-making. This guide was compiled by the working group at the 2025 Weissensee Workshop of the Scientific Endometriosis Foundation. The contents are based on the available evidence regarding fertility and endometriosis and, where this was lacking, on the authors' clinical experience. It is intended as a guide for persons responsible for caring and treating patients with this condition in everyday clinical practice. This work is explicitly not intended to be a guideline as the authors were not commissioned to draft a guideline. Rather, its aim is to provide quality care in clinical practice, avoid unnecessary or potentially harmful measures, and establish the optimal therapy for individual patients.

Expectations determine treatment outcomes in several medical conditions. The significance of expectations for treatment outcomes in patients with endometriosis remains unknown. Endometriosis is a painful and debilitating disease that negatively affects quality of life. Up to 30

Background and Objectives:The LevaLap 1.0 (Core Access Surgical Technologies, Atlanta, GA) was designed to promote safer, more stable, and more predictable abdominal access when using the Veress needle for insufflation. We report on the first postmarket clinical study (PMCF) assessing experience with the use of the LevaLap 1.0 during gynecologic laparoscopic surgery. Methods:Prospective multicenter study, including women ≥18 years old, excluding pregnancy, access site surgery in prior 10 days, abdominal hernia, contraindication to Veress needle or laparoscopy use, body mass index (BMI) >30 kg/m2, and inability/unwillingness to provide consent. Results:A total of 158 subjects were included, involving nine surgeons. Mean age was 43.6 ± 14.6 years and mean BMI: 24.7 ± 3.8 kg/m2. Access site was 83.5% transumbilical, 15.2% periumbilical, and 1.2% other. Using the device 96.8% (95% confidence interval [CI]: 92.8-99.0%, n = 152/157) of patients' access was successfully achieved at first attempt and 99.4% (95% CI: 96.5-100.0, n = 156/157) within the first 2 attempts. One minor device-related adverse event was reported: a circular redness on the skin at the site of device application, resolving spontaneously. Surgeons noted easier access in 59.5%, increased confidence in 68.3%, increased access control in 67.1%, and increased access efficiency in 66.4% of cases. Conclusion:This PMCF study indicates that the use of the LevaLap 1.0 resulted in easier, greater control and greater efficiency during abdominal access using the Veress needle. In 96.8% access was achieved at first attempt and in 99.4% within the first 2 attempts. The use of the LevaLap 1.0 may facilitate abdominal access when using the Veress needle for insufflation.

Physicians interested in endometriosis and infertility as well as medical teams in reproductive medicine and endometriosis centers. A practical guide for clinical decision-making. This guide was compiled by the working group at the 2025 Weissensee Workshop of the Scientific Endometriosis Foundation. The contents are based on the available evidence regarding fertility and endometriosis and, where this was lacking, on the authors’ clinical experience. It is intended as a guide for persons responsible for caring and treating patients with this condition in everyday clinical practice. This work is explicitly not intended to be a guideline as the authors were not commissioned to draft a guideline. Rather, its aim is to provide quality care in clinical practice, avoid unnecessary or potentially harmful measures, and establish the optimal therapy for individual patients.

Das erhöhte Bewusstsein für das Krankheitsbild Endometriose spiegelt sich in dem Anstieg der Endometrioseprävalenz zwischen 2012 und 2022 wieder. Trotzdem geht man von einer bis zu 7-jährigen Diagnoseverspätung aus. Betroffene junge Frauen leiden nicht nur an den somatischen Beschwerden, sondern auch auf psychischer Ebene durch eine mögliche Missachtung des Leidendrucks. Neben der kausalen leitliniengerechten Hormontherapie, die von den Patientinnen häufig nicht favorisiert wird, sind zusätzliche komplementäre Therapieoptionen vorhanden. Gerade in zertifizierten Endometriose-Zentren können interdisziplinäre Ansätze erarbeitet werden. Ziel ist es, im Prozess einer partizipativen Entscheidungsfindung, in dem auch weitere somatische Erkrankungen, die Persönlichkeit, Wünsche und die Lebenssituation der Patientin berücksichtigt werden, ein individualisiertes Behandlungskonzept zu erarbeiten. In diesem Beitrag werden Therapieoptionen dargelegt und diskutiert.

Background Treatment expectations influence clinical outcomes in various physical and psychological conditions; however, no studies have explored their role in endometriosis treatment. It is necessary to understand how these expectations can be measured to study treatment expectations and their effects in clinical practice. This study aimed to psychometrically analyze and compare different treatment expectation measurements and describe treatment expectations in women with suspected endometriosis. Method Analysis of cross-sectional baseline data of a mixed-method clinical observational study of N=699 patients undergoing laparoscopy in Germany. Descriptives, bivariate associations, convergent and discriminant validity of four expectation measurements (Treatment Expectation Questionnaire (TEX-Q); Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE); numerical rating scales (NRS) assessing improvement and worsening of endometriosis symptoms, expected Pain Disability Index (PDI); range: 0 to 10) were estimated. A cluster analysis was performed on the three GEEE items. Results Most participants expected high improvement (M=6.68 to 7.20, SD=1.90 to 2.09) and low worsening (M=1.09 to 2.52, SD=1.80 to 2.25) of disability from laparoscopy. Participants who expected greater worsening expected more side effects (r=.31 to .60, p<.001). Associations between the positive and negative expectation dimensions, including side effects, were small to non-significant (r =|.24| to .00, p<.001 to.978). Four distinct clusters, described as’positive’, ‘no pain, no gain’, ‘diminished’, and ‘uniform’ were found, with a total PVE of 62.2%. Conclusions Women with suspected endometriosis reported positive expectations concerning laparoscopy, but wide ranges indicated interindividual differences. Treatment expectations seem to be a multidimensional construct in this patient group. The investigated measurements did not correlate to the extent that they measured exactly the same construct. The selection of measurements should be carefully considered and adapted for the study purposes. Clusters provide initial indications for individualized interventions that target expectation manipulation. Trial Registration Number ID NCT05019612 (ClinicalTrials.gov)

Current national figures show a clear increase in the prevalence of endometriosis from 2012 to 2022. The diagnosis is still frequently made after a delay. Those affected are not only impaired by physical symptoms but also at the mental level due to the disregard of their suffering. In many cases not only one form of treatment is the right one and many treatment options each have advantages and disadvantages. Particularly in certified endometriosis centers, interdisciplinary approaches can be combined with complementary medical measures. The aim is to develop an individualized and differentiated treatment concept in a participative decision-making process in which the personality, aims and life situation of the patient are taken into consideration. In this article the treatment options are presented and discussed.

Background Treatment expectations influence clinical outcomes in various physical and psychological conditions; however, no studies have explored their role in endometriosis treatment. It is necessary to understand how these expectations can be measured to study treatment expectations and their effects in clinical practice. This study aimed to psychometrically analyze and compare different treatment expectation measurements and describe treatment expectations in women with suspected endometriosis. Method Analysis of cross-sectional baseline data of a mixed-method clinical observational study of N=699 patients undergoing laparoscopy in Germany. Descriptives, bivariate associations, convergent and discriminant validity of four expectation measurements (Treatment Expectation Questionnaire (TEX-Q); Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE); numerical rating scales (NRS) assessing improvement and worsening of endometriosis symptoms, expected Pain Disability Index (PDI); range: 0 to 10) were estimated. A cluster analysis was performed on the three GEEE items. Results Most participants expected high improvement (M=6.68 to 7.20, SD=1.90 to 2.09) and low worsening (M=1.09 to 2.52, SD=1.80 to 2.25) of disability from laparoscopy. Participants who expected greater worsening expected more side effects (r=.31 to .60, p<.001). Associations between the positive and negative expectation dimensions, including side effects, were small to non-significant (r =|.24| to .00, p<.001 to.978). Four distinct clusters, described as’positive’, ‘no pain, no gain’, ‘diminished’, and ‘uniform’ were found, with a total PVE of 62.2%. Conclusions Women with suspected endometriosis reported positive expectations concerning laparoscopy, but wide ranges indicated interindividual differences. Treatment expectations seem to be a multidimensional construct in this patient group. The investigated measurements did not correlate to the extent that they measured exactly the same construct. The selection of measurements should be carefully considered and adapted for the study purposes. Clusters provide initial indications for individualized interventions that target expectation manipulation. Trial Registration Number ID NCT05019612 (ClinicalTrials.gov)

Introduction. Endometriosis is still somewhat unknown to the general public, often overlooked and not treated satisfactorily. 20-30% of affected women report persistent pain disability even after successful surgical removal of endometriotic tissue via laparoscopy. Medical factors can not explain this symptom persistence. Therefore, psychological factors, such as treatment expectations, might play a role for treatment outcomes of endometriosis and women’s quality of life. This study aimed to characterise women with endometriosis, describe their treatment expectations before laparoscopy, and identify predictors of treatment expectations. Method. This study characterizes a clinical cohort of N = 393 women with endometriosis treated in a specialized endometriosis centre in Germany. Treatment expectations were assessed using the Treatment Expectation Questionnaire and the Generic Rating Scale for Treatment Expectations. Medical characteristics were evaluated with a self-conducted case report form. Analysis. Descriptive and multiple linear regression analyses with ten different treatment expectations as the dependent variable were conducted. Results. The mean endometriosis-related pain disability score was 30.77 ± 13.28, and the mean somatic symptom severity score was 15.61 ± 5.07. 40.2% (n = 158) of the participants had a high likelihood of having major depression, and 39.9% (n = 157) were highly likely to have a general anxiety disorder. Treatment expectations concerning the laparoscopy of participants were rather positive. Multiple linear regressions show that endometriosis-related pain disability and state anxiety predict treatment expectations of women with endometriosis. Medical characteristics were not significantly associated with treatment expectations. Conclusion. Affected women are highly physically and psychologically burdened, mostly over several years. Patients with higher pain disability and anxiety are especially prone to negative treatment expectations. Trial Registration Number: ID NCT05019612 (ClinicalTrials.gov), registration date August 25th.

Introduction Overall, 20%–30% of women with endometriosis report endometriosis-related disability after successful laparoscopy. This indicates a potential impact of psychological factors, such as expectations, on treatment outcomes. It is already known that expectations determine treatment outcomes in various health conditions, such as cardiologic or gynaecology. Therefore, we investigate the impact of expectations and other psychological factors on patients’ course of treatment outcomes after laparoscopy. Methods and analysis A longitudinal mixed-methods study with N=300 women treated at a specialised centre of surgical endoscopy and endometriosis will be conducted with one preoperative and eight postoperative assessments of endometriosis-related disability and a priori specified predictors such as expectations. Additionally, two subsamples (each ~n=30) will be either interviewed about their endometriosis-related disability, expectations, and experiences of laparoscopy before and after surgery or asked once per day for 30 consecutive days using ambulatory assessments. Quantitative data will be analysed using multilevel modelling for longitudinal data. Structural content analysis will be used for qualitative data. Discussion To optimise treatment for women with endometriosis, it is essential to understand how treatment expectations and other psychological and medical factors influence treatment outcomes after laparoscopy. Ethics and dissemination The Ethics Committee of the Psychotherapeutenkammer Hamburg, Germany, gave ethical approval (ROXWELL-2021-HH, 25 June 2021). Trial registration number ClinicalTrials.gov Registry (NCT05019612).

Modern surgical strategies aim to reduce trauma by using functional imaging to improve surgical outcomes. This reviews considers and evaluates the importance of the fluorescent dye indocyanine green (ICG) to visualize lymph nodes, 54 Hackethal A et al. Die Rolle von... Geburtsh Frauenheilk 2018; 78: 54–62 Su pp le m en ta ry M at er ia l – de ut sc hs pr ac hi ge Zu sa tz in fo rm at io n! Zi ti er ba r is t au ss ch lie ß lic h de r en gl is ch sp ra ch ig e A rt ik el . GebFra Science | Übersicht

To evaluate postoperative sexual functioning and the influence of patients’ expectations on the change in sexuality following laparoscopic total (TLH) versus subtotal hysterectomy (LASH).

Modern surgical strategies aim to reduce trauma by using functional imaging to improve surgical outcomes. This reviews considers and evaluates the importance of the fluorescent dye indocyanine green (ICG) to visualize lymph nodes, lymphatic pathways and vessels and tissue borders in an interdisciplinary setting. The work is based on a selective search of the literature in PubMed, Scopus, and Google Scholar and the authorsʼ own clinical experience. Because of its simple, radiation-free and uncomplicated application, ICG has become an important clinical indicator in recent years. In oncologic surgery ICG is used extensively to identify sentinel lymph nodes with promising results. In some studies, the detection rates with ICG have been better than the rates obtained with established procedures. When ICG is used for visualization and the quantification of tissue perfusion, it can lead to fewer cases of anastomotic insufficiency or transplant necrosis. The use of ICG for the imaging of organ borders, flap plasty borders and postoperative vascularization has also been scientifically evaluated. Combining the easily applied ICG dye with technical options for intraoperative and interventional visualization has the potential to create new functional imaging procedures which, in future, could expand or even replace existing established surgical techniques, particularly the techniques used for sentinel lymph node and anastomosis imaging.

Abstract Background: Triple negative breast cancer (TNBC) is characterized by an unfavorable prognosis. While patients do not benefit from endocrine or Her2 targeted therapies except chemotherapy, there is an increased propability of response to taxane-/anthracycline-containing therapy compared to other breast cancers. However, molecular determinants of chemotherapy sensitivity for patients with TNBC specifically remain largely unknown. The WNT signaling cascade has been shown to play an important role in breast cancer pathogenesis. Material and Methods: Differentially expressed genes in triple negative (TN) vs. non-TN breast cancers of patients treated with neoadjuvant taxane-/anthracycline-containing chemotherapy were identified and validated in an independent AffymetrixU133A gene chip dataset. Genes were tested for correlation with relapse-free survival, response to neoadjuvant chemotherapy and Ki67 expression. The effects of siRNA mediated knockdown in the TNBC and non-TNBC cell lines on proliferation, chemo sensitivity invasion competency and gene expression of target genes via quantitative real-time PCR were analyzed. Results: sFRP-1 (secreted frizzled related protein 1) and TCF7L2 (transcription factor-7 like 2) were identified as significantly over expressed genes in TNBC vs. non-TNBC and validated in an independent dataset. While sFRP-1 expression was not associated with relapse-free survival in TNBC, it was significantly correlated with a pCR. Importantly, no correlation to Ki67 expression could be demonstrated. While mRNA knockdown of sFRP-1 in MDA-MB 468 was associated with an increased resistance to paclitaxel, doxorubicin and cisplatin, target gene expression analysis suggest sFRP-1 as a biphasic modulator in breast tissue. TCF7L2 knockdown analysis in the TN cell line MDA MB 231 as well as the non-TN lines MCF7 and SKBR-3 shows an increased cell invasiveness of up to 200 %. Conclusion: We suggest sFRP-1 as predictive biomarker and potential mediator of sensitivity to taxane-, anthracycline and platinum-containing chemotherapy in TNBC in vitro referring to its biphasic WNT modulation. Furthermore TCF7L2 is suggested as a prognostic biomarker in vitro breast cancer cell lines including TN and non-TN cell lines. Our results provide proof of principle that high-throughput gene expression analysis may be exploited as a means to derive at a biological / translational hypothesis that may be supported by basic science. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3024. doi:1538-7445.AM2012-3024