A. What diseases can be treated by minimally invasive gynecological laparotomy?
1.Diagnosis of various difficult diseases: such as acute abdominal pain, chronic pelvic pain, uterine perforation, infertility, dysmenorrhea, etc.
2.Treatment: various types of ectopic pregnancy, conservative treatment of ectopic pregnancy (preservation of fallopian tubes), pelvic adhesions, endometriosis, ovarian endometriosis cyst, benign ovarian teratoma, ovarian cyst, uterine fibroid, various pelvic masses, tubal sterilization, tubal recanalization. Niu Lina, Department of Obstetrics and Gynecology, Yuncheng Central Hospital
Can one operation treat gynecological diseases and gallbladder stones at the same time?
If a patient has gynecological diseases (such as uterine fibroids, ovarian cysts, ectopic pregnancy, etc.) and gallbladder stones and cholecystitis at the same time, the traditional surgery is first surgical cholecystectomy, hospitalization for 7-10 days, and then gynecological surgery for 2-3 months, hospitalization for 10-15 days, two hospitalizations, two anesthesias, two surgeries, great damage to the patient, great pain, long hospitalization time, high costs, and long delays for family members to go back and forth to take care of the patient. The patient’s family needs to spend more time to travel to and from the hospital to take care of the patient. If laparoscopic minimally invasive gynecological and surgical joint surgery is implemented, only one hospitalization is needed, about 3-5 days, one anesthesia, gallbladder and gynecological pelvic masses can be removed at the same time, 24 hours can be down to the ground, early feeding, and fast recovery after surgery.
Third, can obese patients implement laparoscopic surgery to treat gynecological diseases?
Obese patients are more suitable for laparoscopic surgery treatment. Obese patients to implement open surgery, because the incision is large and deep, subcutaneous fat easy to liquefy, so easy to cause postoperative incision infection, incisional hernia, etc.. In addition, the respiratory function of obese patients is significantly lower than that of those with normal weight, and postoperative complications such as pulmonary infection and pulmonary atelectasis are also significantly higher than those with normal weight. If laparoscopic surgery is performed, there is no difference between obese patients and normal weight patients in terms of wound size, duration of surgery, damage to the muscle and incidence of postoperative complications. The incidence of complications such as incisional infection and pulmonary infection is lower in laparoscopic surgery than in open surgery. Therefore, obese patients are more suitable for laparoscopic surgery.
Fourth, how to minimally invasive treatment such as uterine fibroid cysts to not leave scars?
If ectopic pregnancy is considered and the fallopian tubes are removed, the resected material can be easily and directly removed from the small opening. If depending on the ovarian cystic mass, the fluid inside the cyst can be sucked out first with a thin puncture needle to shrink the mass and remove it from the small opening in the abdominal wall. In the case of larger solid masses, such as uterine fibroids, the masses can be cut into strips with special instruments and then removed through small incisions in the abdominal wall. All of the above specimens should be placed in a specimen bag and removed through a small incision in the abdominal wall. The entire mass can also be removed from the vagina. The large masses are removed without large scars on the abdominal wall, with only 3-4 small incisions (0.5-1 cm), and no trace of surgery is visible at all after healing.
V. Can the fallopian tubes be preserved by laparoscopic treatment of ectopic pregnancy?
For those with unbroken tubal pregnancy, pregnancy mass <3cm in diameter, requiring preservation of reproductive function, blood HCG ≤2000IU/L, no abnormal liver and kidney function, no intra-abdominal bleeding, and excluding intrauterine pregnancy, the fallopian tube can be preserved by performing laparoscopic intra-tubal drug injection to kill the embryo, or performing abdominal removal of tubal pregnancy by cutting open the fallopian tube and removing the embryo, thus preserving the fallopian tube and preserving reproductive function. The fallopian tubes can be removed to preserve the fertility function.
Can I get pregnant again after laparoscopic tubal preservation surgery?
Many data prove that if there are no other factors of infertility, there is no difference between the pregnancy rate of patients after tubalplasty and tubectomy.
Can laparoscopic removal of ovarian cysts preserve the ovulatory function of the affected ovary?
Yes. Depending on the condition of the ovarian cyst, the cyst can be removed and part of the normal ovary can be preserved, and the endocrine function of the ovary can be preserved without affecting ovulation.
Can patients with polycystic ovary syndrome be treated with laparoscopy?
Polycystic ovary syndrome is a complex group of syndromes caused by abnormal hormone secretion and regulation between the hypothalamus-pituitary-ovary. It is characterized by the patient’s ovaries not ovulating. Clinical symptoms include menstrual disorders, obesity, hirsutism, and bilateral ovarian enlargement. The traditional surgical treatment is open surgery with wedge excision of the ovaries. Laparoscopic treatment of polycystic ovary syndrome can restore ovulation in 90% of patients, with a postoperative pregnancy rate of 70%, and is simple to perform with few postoperative pelvic adhesions. At present, laparoscopic treatment of polycystic ovary syndrome has replaced open ovarian wedge resection.
Can laparoscopy treat pelvic inflammatory disease and pelvic abscess?
Yes. Most surgical explorations for pelvic inflammatory disease via open treatment are considered inflammatory tissue edema, increased tissue fragility, surgery is easy to tear, tissue congestion, capillary bleeding is extremely easy, hemostasis is not ideal, therefore, intraoperative blood transfusion is often required. Postoperatively, the presence of infection spread and incisional infection make the dosage of antibiotics larger. The minimally invasive laparoscopy has little damage, no need for blood transfusion, and less postoperative medication, which is a good method with little damage and diagnostic and therapeutic effects, and can be used for the diagnosis and treatment of pelvic inflammatory disease and pelvic masses.
X. What kind of patients can undergo laparoscopic treatment?
No serious cardiovascular disease, no cardiopulmonary insufficiency, no middle or late pregnancy, no coagulation dysfunction and hematologic disease can be applied to laparoscopic treatment.