In the field of gynecology, minimally invasive surgical routes such as hysteroscopy, laparoscopy and transvaginal surgery have become the current trend in the development of gynecologic surgery and are gradually becoming the preferred route for the treatment of gynecologic diseases because of their advantages such as less trauma and faster postoperative recovery. During surgery, the appropriate choice of anesthesia is an important measure to expose the operative field and make the surgery go smoothly. As anesthesia is administered to the patient, all or part of the patient’s perception has been lost, muscles are relaxed, protective reflexes have mostly disappeared or diminished, and the ability of autonomic regulation is basically lost. Therefore, a suitable surgical position setting is beneficial to the surgeon’s operation, shortening the operation time, as well as protecting the patient and avoiding the occurrence of related complications. In 2007, the Minimally Invasive Gynecology Center of Beijing Obstetrics and Gynecology Hospital of Capital Medical University completed 4,248 hysteroscopic surgeries and 68 laparoscopic surgeries.
248 cases, 684 cases of laparoscopic surgery and 230 cases of negative surgery. Based on the extensive development of various ways of minimally invasive gynecological surgery, we have standardized the selection of common anesthesia methods and the setting of surgical positions through clinical practice and continuous improvement, which are summarized as follows. Hysteroscopic surgery 1. Surgical position
For hysteroscopic surgery, the operating room should be spacious, with a central operating table, anesthesia machine and monitor at the head of the operating table, monitored ultrasound on the right side of the operating table, and a multi-layer dolly for placing monitors, cold light sources, uterine expanders, high-frequency current generators, video recorders, etc. The patient is usually placed in a modified cystotomy position. Surgical position: (1) After anesthesia takes effect, the patient is placed supine on the operating table with the hips 3-5 cm beyond the lower edge of the operating bed for hysteroscopic operation. (2) Install the leg brace: both lower limbs are placed on the leg brace, and the leg brace is adjusted to the horizontal as much as possible so that the lower leg is placed as horizontal as possible and the knee joint is at rest to reduce the pressure on the N fossa. prolonged pressure on the N fossa can cause impaired blood circulation in both lower limbs and cause endovascular injury to form thrombus. (3) Abduct both legs as much as possible, so that the angle between the two thighs becomes 100° to 120° to increase the available space, too small is not conducive to surgical operation. (4) Elevate the thighs so that the thighs are about 45° from the horizontal line, or 30° from the horizontal line if it is a combined hysteroscopic and laparoscopic operation, so as not to affect the laparoscopic operation. 2.Anesthesia selection
Hysteroscopic surgery is relatively short, but the operation requires dilatation of the cervical canal and various operations in the uterine cavity, which requires a good muscle relaxation effect, so intralesional anesthesia or general anesthesia should be chosen to meet the needs of the operation. Intradural anesthesia such as epidural anesthesia, lumbar anesthesia or combined lumbar-rigid anesthesia can meet the needs of most hysteroscopic surgeries. This method is safe, analgesic, precise inotropic effect, easy to control the length of anesthesia, and less physiological interference to patients, especially suitable for patients with respiratory and cardiac diseases, and can be the preferred anesthesia method for most hysteroscopic surgeries. Moreover, during endotracheal anesthesia, the patient’s consciousness is clear, and if complications of hysteroscopic surgery such as TURP and syndrome occur, they can be easily detected early and treated in time, which is better than general anesthesia. For intrauterine operations that are simple and estimated to be completed in a short time (within 30
Intravenous general anesthesia can be used for surgical operations that can be completed in a short time (within 30 min). The anesthesia method should be implemented with drugs that are short-acting, quick to wake up and less vomiting. During the operation, management of the airway is very important, and intraoperative oxygen is administered by mask to improve the patient’s tolerance to hypoxia. If the operation is estimated to be difficult and the operation time is long, laryngeal mask or tracheal intubation can be considered for general anesthesia to ensure the monitoring of the anesthesia and the anesthetic effect at the time. For complex hysteroscopic surgery sometimes combined laparoscopic surgery is required for monitoring. General anesthesia is usually used for hysteroscopic combined with laparoscopic surgery.