I. Concept of Minimally Invasive
Surgery itself is a “double-edged sword”, which cures disease through injury. Therefore, while curing disease, it inevitably brings “trauma” to human body. How to achieve the maximum therapeutic purpose with minimum trauma, minimize surgical trauma, or even achieve non-invasive, that is, “invasive – minimally invasive – non-invasive”, has been the highest realm of the pursuit of surgery, is the dream of all surgeons to strive for the goal!
The standard of minimally invasive surgery compared with traditional surgery
1. Approaches and methods: Minimally invasive surgery approaches and methods can be the same or different, but the standard of surgical treatment of lesions cannot be lowered, or even higher than traditional surgery.
2.Treatment effect: Minimally invasive surgery has the advantages of small trauma, light postoperative pain and early recovery in the near future, and its long-term effect should be equal to or higher than that of traditional surgery.
3.The degree of risk of surgery: Minimally invasive surgery requires relatively lower systemic conditions than traditional surgery.
Therefore, minimally invasive is a concept, a philosophy, rather than a surgical name and surgical method.
III. Minimally invasive gynecological surgery
(I) Concept of minimally invasive gynecological surgery
With the gradual and extensive application of minimally invasive surgery in the field of surgery, gynecologists have also been challenged as never before, even though the surgery is minimally invasive. In the past decade, our gynecologists have been exploring and practicing in the field of minimally invasive surgery, and their surgical skills have become more and more mature.
(B) Classification of minimally invasive gynecological surgery
Gynecological laparoscopic techniques
Gynecologic hysteroscopic techniques
Transvaginal gynecological surgery
Radiofrequency ablation technology
Gynecologic vascular interventions
Gynecologic ultrasound intervention
(C) Gynecological laparoscopic techniques
Since the 21st century, with the continuous improvement of surgical instruments and equipment and the continuous improvement and maturation of surgical operation skills, the more complicated gynecological surgery can be successfully completed under laparoscopy, and “minimally invasive” has been realized. Now laparoscopy has replaced most traditional gynecological open surgery and become the most widely used, most effective and most promising “minimally invasive gynecological” surgery, which is a great milestone of modern gynecological treatment.
(1) Classification of gynecologic laparoscopic surgery
The International Society for Gynecologic Endoscopy classifies gynecologic laparoscopic surgery into four categories.
(2) Indications for gynecologic laparoscopic surgery
It is divided into 3 categories: optimal indications, general indications and relative indications.
(3) Complications of gynecologic laparoscopic surgery
Laparoscopic surgery is a minimally invasive surgery, which is relatively safe, but minimally invasive is still invasive and complications are difficult to be eliminated. With the general promotion of this type of surgery and the increasing difficulty of surgery, the prevention of surgical complications and their management should be taken seriously. Familiarity with the possible complications of laparoscopic surgery and awareness and attention to them are the keys to prevent and reduce their occurrence as much as possible.
(D) Hysteroscopic techniques in gynecology
Hysteroscopic techniques have been accepted by the majority of gynecologists for their advantages of safety, effectiveness, minimally invasive, and preservation of the uterus. In recent years, with the maturation of the technology, the indications for diagnosis and treatment have been widened. Hysteroscopy and its mediated operations, which are less invasive and do not affect the endocrine function of the ovaries, are regarded as the ideal surgical modality for treating benign lesions in the uterine cavity and have become indispensable elements in modern gynecological diagnosis and treatment.
(1) Indications for gynecologic hysteroscopic surgery
They are divided into 3 categories: optimal indications, general indications and relative indications.
(2) Complications of gynecologic hysteroscopic surgery
(E) Transvaginal gynecological surgery
Gynecological transvaginal surgery is performed by using the natural cavity of the vagina, which has the advantages of less tissue trauma, less interference with abdominal organs, less pain after surgery, faster recovery, shorter hospital stay, no scar on the abdominal wall, lower medical costs, etc. It is more in line with the principle of minimally invasive surgery and its superiority has been recognized. In the last two decades, two major revolutions in the development of cathartic surgery.
(1) Expansion of surgical indications
1. Indications for traditional transvaginal surgery
2. new indications for the expansion of the vulvovaginal surgery
(2) Improvement of surgical instruments and application of DDD “ligation speed” vascular closure system
(F) Radiofrequency ablation technology
Radiofrequency treatment is a kind of high frequency AC electromagnetic wave (150kHz~1MHz), through the treatment electrode into the tissue, and then through the diffusion electrode to form a circuit, the charged ions in the tissue around the electrode needle are affected by the current and oscillate, generating bioheat, thus causing the target tissue degeneration necrosis. At present, radiofrequency ablation technology has been widely used in the field of gynecology, which can enable some patients who are not suitable or unwilling to operate to obtain treatment opportunities and can preserve their normal tissues to the maximum extent.
(1)Indications for radiofrequency ablation technology
(2)Complications of radiofrequency ablation technology
(7) Gynecologic vascular interventions
It is a series of minimally invasive techniques for the treatment of obstetrical and gynecological diseases through catheters and other devices under the guidance of medical imaging equipment and the principles of clinical therapeutics.
(1) Indications for gynecologic vascular interventions
Internationally, interventional therapy is ranked as the third major therapeutic discipline alongside medical and surgical therapeutics. It has been applied to the treatment of many gynecological diseases, achieving certain results and gaining wide attention.
(2) Complications of gynecologic vascular interventions
(H) Gynecologic ultrasound interventions
(ix) Development trend of minimally invasive gynecological surgery
Standardization, individualization, minimally invasive, technology
(J) Summary
The principle of minimally invasive surgery is to treat the disease while minimizing the trauma to the patient.
The depth and breadth of application should depend on the surgeon’s lumpectomy skills and experience.
The change of the surgeon’s concept of minimally invasive surgery.
The indications for surgery and the prevention and management of surgical complications should be strictly mastered.