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 the minimum trauma, minimize the surgical trauma, or even achieve non-invasive, that is, “invasive – minimally invasive – non-invasive”, has been the highest level 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.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. Over the past decade, our gynecological colleagues have been exploring and practicing minimally invasive surgery, and the surgical skills are becoming more and more mature.
Classification of minimally invasive gynecological surgery
Gynecological laparoscopic techniques
Gynecological hysteroscopic techniques
Transvaginal gynecological surgery
Radiofrequency ablation technology
Gynecological vascular interventions
Gynecologic ultrasound intervention
Gynecological laparoscopic techniques
Since the 21st century, with the continuous improvement of surgical instruments and equipment and the continuous improvement and maturity 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 gynecological laparoscopic surgery
The International Society for Gynecologic Endoscopy classifies gynecologic laparoscopic surgery into four categories.
2.Indications for gynecological laparoscopic surgery
It is divided into 3 categories: optimal indications, general indications and relative indications.
3.Gynecological laparoscopic surgery complications
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.
Gynecological hysteroscopic techniques
Hysteroscopic technology has been accepted by the majority of gynecologists for its advantages of safety, effectiveness, minimally invasive, and preservation of the uterus. In recent years, with the maturation of technology, the indications for diagnosis and treatment have been widened. Hysteroscopy and its mediated operations are less invasive and do not affect the endocrine function of the ovaries, so it is regarded as the ideal surgical method for treating benign lesions in the uterine cavity and has become an indispensable element in the field of modern gynecological diagnosis and treatment.
1. Indications for gynecologic hysteroscopic surgery
It is divided into 3 categories: best indication, general indication and relative indication.
2. Complications of gynecological hysteroscopic surgery
V. Transvaginal gynecological surgery
Transvaginal gynecological 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
2. Indications for traditional transvaginal surgery
3.The new indications for the expansion of the vulvovaginal surgery
4.Improvement of surgical instruments and application of DDD “ligation speed” vascular closure system
VI. Radiofrequency ablation technology
Radiofrequency treatment is a kind of high-frequency AC electromagnetic wave 150kHz~1MHz, which is introduced into the tissue through the treatment electrode, and then formed a circuit by the diffusion electrode, and the charged ions in the tissue around the electrode needle are affected by the current and oscillate to produce bioheat, thus causing the target tissue degeneration and 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
VII. Gynecological vascular interventions
Vascular interventional treatment in obstetrics and gynecology is a specific application of interventional radiology in obstetrics and gynecology. It is a series of minimally invasive techniques for the treatment of obstetrics 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 interventional treatment
Internationally, interventional therapy is ranked as the third major therapeutic discipline alongside with medical and surgical therapeutics. It has been applied to the treatment of a variety of gynecological diseases, achieving certain results and gaining widespread attention.
2. Complications of gynecological vascular interventions
VIII. Gynecological ultrasound interventional treatment
Development trend of minimally invasive gynecological surgery
Standardization, individualization, minimally invasive, technology
X. 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 lumpectomy skills and experience of the surgeon.
The change of surgeon’s concept of minimally invasive surgery.
The indications for surgery and the prevention and treatment of surgical complications should be strictly mastered.