Laparoscopic surgery, as an important part of endoscopic surgery, has become the pioneer of the surgical revolution. Gynecological laparoscopic surgery has developed rapidly in recent years, with the advantages of less injury, less postoperative pain, shorter hospital stay, faster recovery of the organism, better cosmetic results and lighter medical burden. With the update of surgical instruments and equipment, the accumulation of experience and maturity of doctors’ skills, and the development of intraoperative protection measures, the complications of laparoscopic surgery have been significantly reduced, safety has been greatly improved, and the clinical application has become more and more extensive. Since the Department of Gynecology obtained the admission certificate for gynecological laparoscopic surgery at the end of 2007, laparoscopic surgery has become an important part of gynecological surgery in our hospital, and has progressed from simple type I-II surgery to type III-IV advanced surgery. I. Emergency gynecological abdominal diseases can be diagnosed and treated promptly, such as ectopic pregnancy, ruptured corpus luteum, acute pelvic inflammation and pelvic abscess, and ovarian cyst torsion. Early ectopic pregnancy can usually preserve the fallopian tubes; ruptured, shocked ectopic pregnancy can be accomplished with prompt operation. The implementation rate of laparoscopic surgery for gynecologic emergencies is currently considered one of the indicators of the degree of laparoscopic surgery performed in a unit, as it marks the basic concept of laparoscopic surgery and is an indication of its popularity scale. At present, acute laparoscopic surgery has been popularized in our hospital. Benign ovarian tumors Ovarian tumors are common genital tumors in women. Benign tumors are mainly simple cysts of the ovary, benign mature teratomas, ovarian coronary cysts, etc. Laparoscopic surgery is the preferred modality for benign ovarian tumors, which can accomplish laparoscopic cyst debridement or adnexal resection. When surgically debriding cysts or tumors, try to ensure the integrity of cysts and avoid spillage of cystic fluid, and if cyst wall rupture occurs, immediately perform thorough irrigation of the surgical area to avoid complications, such as chemical peritonitis. It can usually be avoided by paying attention to gentle operation during surgery. III. Endometriosis Laparoscopy is the gold standard for the diagnosis of endometriosis and is the basis for rAFS (American reproductive society) staging, which is the best treatment route. Both peritoneal and ovarian types can be treated laparoscopically to achieve lesion reduction, pain relief, fertility improvement and recurrence reduction. Observation and experimental treatment of suspected endometriosis or adnexal masses is not currently advocated because it may delay the disease (e.g. ovarian cancer). Surgery is chosen differently depending on the patient’s condition, generally in three ways, conservative surgery (preservation of reproductive function), semi-conservative surgery (hysterectomy with preservation of ovaries) and radical surgery (removal of the uterus and both adnexa). IV. Chronic pelvic pain This is a common symptom due to multiple causes. Laparoscopy is the best way to make a definitive diagnosis and the pain can be relieved in 80% of patients by microscopic management (e.g., separation of adhesions, removal of lesions). For endometriosis, uterosacral ligamentotomy or presacral neurectomy can be performed microscopically, which can achieve a 70% relief rate. V. Infertility To rule out the causes of ovulation disorders, laparoscopy focuses on infertility caused by tubal and uterine factors. The laparoscopy can understand the pelvic cavity, directly observe the uterus, fallopian tubes and ovaries for lesions or adhesions, and perform tubal lavage test to determine whether the fallopian tubes are patent under direct vision. During surgery, depending on the microscopic findings, adhesions can be separated, tubal ostomy, tubal cystoplasty, salpingo-oophorectomy and ovarian electrocoagulation perforation can be performed. Hysterectomy is the most common operation in gynecology, which used to be done openly or vaginally, but now can be performed laparoscopically. It is divided into laparoscopically assisted vaginal hysterectomy (laparoscopically assisted hysterectomy)
assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH).
hysterectomy (TLH), the former is a laparoscopic treatment of the adnexa, the upper part of the uterus or most of it, mainly the uterine vessels and below through the vagina, so it is called laparoscopically assisted vaginal hysterectomy; while the latter is a laparoscopic completion of all operations. Although laparoscopic hysterectomy is still a difficult procedure for many physicians, for skilled practitioners, total laparoscopic hysterectomy can be accomplished successfully with essentially the same surgical results as open surgery. Therefore, it is an important development direction of gynecological laparoscopic surgery and a new procedure of hysterectomy. Laparoscopic myomectomy Laparoscopic myomectomy is a difficult operation in laparoscopic surgery, which requires skilled laparoscopic surgical skills and microscopic suture tying techniques to stop bleeding and eliminate dead space, and requires strict training and longer experience in laparoscopic surgery. The indications include ① the operator’s mastery of laparoscopic suturing skills; ② single or multiple myomas with a maximum diameter of ≤10 cm; ③ multiple myomas with a number of myomas ≤10; ④ preoperative exclusion of myoma malignancy. With the accumulation of surgical experience, the surgical indications can be broadened. I have performed laparoscopic resection of a solitary interstitial myoma up to 12 cm in diameter with an intraoperative bleeding of about 100 ml. Although it is difficult to examine the hidden intermural or submucosal fibroids under the microscope, which increases the chance of retention and recurrence, the literature reports that there is no significant difference in the recurrence rate between laparoscopic myomectomy and open myomectomy, and that laparoscopic myomectomy can improve the reproductive function without adverse obstetric outcomes. Laparoscopic evaluation and treatment of cervical cancer, endometrial cancer and ovarian cancer have unparalleled advantages over open surgery. With the advancement and update of technology and equipment, and the accumulation of experience in laparoscopic surgery, laparoscopic surgery for endometrial cancer and cervical cancer can be completed at home and abroad, while laparoscopic surgery for comprehensive staging of ovarian cancer is one of the more difficult and most controversial surgeries.
Nevertheless, it is conceivable that with the advent of related technologies, the procedure will be more effective. Nevertheless, it is conceivable that with the maturity and development of related technologies, gynecologic oncologic surgery may get rid of the traditional huge incision. Laparoscopic surgery has changed the traditional surgical approach to pelvic organ prolapse (POP) and stress urinary incontinence (SUI), allowing for the microscopic performance of Burch surgery, uterosacral ligament folding, and presacral vaginal fixation. suturing techniques. As minimally invasive surgery, laparoscopic surgery is definitely favored by both physicians and patients. With the continuous improvement and perfection of minimally invasive instruments, the maturity of more and more techniques, and the improvement of doctors’ level, laparoscopic surgery will be safer and its application will become more and more popular, and laparoscopic surgery is gradually replacing traditional surgery, and the 21st
In the 21st century, gynecological surgery treatment is not only minimally invasive, but also humanized and artistic, and its prospect is very broad.