Laparoscopic surgery is becoming more and more widely performed, but the operation must be performed following some principles and with certain conditions, such as the need for trained and experienced physicians, appropriate equipment, surgical team, and correct surgical philosophy. Gynecological laparoscopic surgical operations: Uterine surgery Myomectomy, secondary excision of the uterus, total excision of the uterus, extensive excision of the uterus. Ovarian surgery Ovarian cysts, chocolate cysts, periovarian adhesions Minimizing damage to the ovaries during surgery: clinical experience of the surgeon, preoperative diagnosis and surgical planning, choice of surgical approach, choice of surgical instruments, patient and careful operation during surgery Instruments used for excision or coagulation: KTP laser, YAG laser, CO2 laser, electric knife, ultrasonic knife, PK knife Electric knife: monopolar electrosurgery The basic working principle of the instrument is that one end is in contact with the human body, and the other end forms a circuit when in contact with the tissue in the surgical area, and the thermal effect caused by the increase in local resistance. It mainly includes electric knife commonly used in surgery, monopolar electric knife or electric hook in lumpectomy, and LEEP knife commonly used in cervical lesion treatment. Because they need to form a circuit with the body, they may produce ionizing radiation and affect the fetus, so their use is absolutely prohibited during pregnancy. This reminds me of why the electric knife is not used in most cesarean sections, and if it is used at all, it is after the fetus is delivered. On the one hand, the blood is in a hypercoagulable state during late pregnancy and can usually stop itself; on the other hand, the fetus is in this current circuit when the electric knife is used, which can lead to unknowable risks. The monopolar electric knife is widely used in electrosurgery because of its versatility and good clinical results, allowing electrodes to be cut and coagulated, with the principle of reducing electrical damage with the lowest effective power! Compared to monopolar, bipolar forms a circuit between the two legs, which improves safety, but after all, it is electrically charged and there is still radiation to the surrounding area. Factors affecting the effect of electrocautery: In addition to the choice of frequency and voltage, other parameters are set to affect the tissue. These include: the size of the electrode: the smaller the electrode, the more concentrated the current; the duration: the longer the duration of the operation, the greater the heat generated and the higher the temperature, creating potential damage to the surrounding tissue. Crust: The resistance of crust is relatively high. Keeping the electrode clean and avoiding crust adhesion can reduce the resistance of the current pathway during the operation and maintain a good use of the results. Laser The focused laser beam can cut like a sharp scalpel or close small blood vessels to stop bleeding; because the laser beam has a small tip area, the damage is minimal compared to electrocautery; no current passes through the body; less crusting. PK knife: is a new generation of surgical instruments that have been improved and updated in recent years for high-frequency electric knife, similar to the three-pole electric knife, actually adding a blade between the two clamp leaves of the bipolar, with electrocoagulation and electrocutting function, which can electrocoagulate a larger range of tissues and blood vessels; with an insulator on the outer surface of the clamp to protect the surrounding tissues from damage, improve patient safety and reduce heat diffusion. There is an intelligent bipolar effect, and the tone will change when the protein denaturation reaches the best coagulation effect during electrocoagulation, avoiding excessive cautery that causes tissue charring instead of hemostasis, which is significantly safer than bipolar. Ultrasonic knife Because of its working principle of ultrasonic vibration, thermal damage to the surrounding tissue is small, and radiation is also smaller, so it can be used safely. However, because of its small damage, it is less effective in coagulation of slightly larger blood vessels than PK knife, which is used more often for cutting. The thermal effect on the surrounding tissues is extremely mild, with low crusting, no electric current passing through the body, higher precision, and very little smoke in the surgical field. Minimizing damage to the ovaries during surgery: good surgical technique, appropriate gentle manipulation of the tissue, minimal use of electrocautery and laser, thorough hemostasis, minimal removal of surrounding normal tissue, use of techniques to reduce adhesions, and minimizing damage to the blood supply to the ovaries. When ovarian cysts are removed, it is important to preserve all normal ovarian cortex and not to remove the cortex on the surface of the cyst, as the cortex is filled with small follicles. Large cysts and chocolate cysts can be removed by puncture and aspiration of the cystic fluid before peeling, avoiding electrocoagulation, using suture techniques to repair the ovary and stop bleeding, and preserving the ovary as much as possible for benign tumors and not removing the adnexa. Follicular cysts and corpus luteum cysts should not be removed. When stripping cysts, stop bleeding while stripping, electrocoagulation should be done on the side of the cyst wall, not on the cortical side of the ovary to reduce thermal damage, and also on the side of the cyst when clipping, preferring to leave some cyst wall (already coagulated and inactive) rather than destroying the cortex. If it is not for hemostasis, sutures should be tied not too tightly and the incision should be closed.