In recent years, with the development of surgical medical technology, people are not only seeking medical treatment for the cure, but more people are considering physical and mental rehabilitation, such as pain during surgery, post-operative scars, etc. In order to minimize the trauma of patients, laparoscopy is one of the minimally invasive representatives in recent medical history. At present, our hospital has become a minimally invasive gynecological center in Quzhou area, and laparoscopic microsurgery has been used in our gynecology department for many years. Although it is recognized by the majority of women, most people are still curious and worried about laparoscopy, and the following are a few problems commonly encountered in the clinic.
1. What diseases can be treated by gynecological laparoscopic minimally invasive surgery?
Diagnosis: various difficult diseases, such as acute abdominal pain, chronic pelvic pain, uterine perforation, infertility, dysmenorrhea, etc.
Treatment: various types of ectopic pregnancy, conservative treatment of ectopic pregnancy (preservation of fallopian tubes), pelvic adhesions, endometriosis, ovarian endometriosis cysts, benign ovarian teratoma, ovarian cysts, uterine fibroids, various pelvic masses, tubal sterilization, tubal recanalization.
2.Can one operation treat gynecological diseases and gallbladder stones at the same time?
If a patient has gynecological diseases (such as uterine fibroids, ovarian cysts, ectopic pregnancy, etc.) and gallbladder stones or cholecystitis at the same time, the traditional surgery is to perform cholecystectomy in surgery for 7-10 days, followed by gynecological surgery for 2-3 months for 10-15 days, two hospitalizations. Two hospitalizations, two anesthesias, two surgeries, great damage to the patient, great pain, long hospitalization, high costs, and long delays for family members to go back and forth to take care of the patient. If laparoscopic minimally invasive gynecological and surgical joint surgery is implemented, only one hospitalization is needed, about 3-5 days, one anesthesia, gallbladder and gynecological pelvic masses can be removed at the same time, 24 hours to get down to the ground, early feeding, and fast recovery after surgery.
3.Can the “keyhole” surgery be complete?
Minimally invasive laparoscopic surgery does not require an open abdomen, and the incision is only about 5mm in size, especially like a keyhole, so it is called “keyhole surgery”. However, some patients do not know much about laparoscopy and have some concerns, thinking that “keyhole” surgery is not as intuitive and reliable as open surgery. Laparoscopic surgery is made easier and more reliable by improving the surgical operation method and surgical instruments. Laparoscopic surgery has a clearer field of view, more detailed surgical operation, and less possibility of complications. At present, the United States, Singapore and other countries have legislation, if the doctor can not first use the “keyhole” surgery, to the patient increased pain, it is considered illegal.
4. Can laparoscopic surgery be performed on obese patients for gynecological diseases?
Obese patients are more suitable for laparoscopic surgery. Obese patients to implement open surgery, because the incision is large and deep, subcutaneous fat is easy to liquefy, so it is easy to cause postoperative incision infection, incisional hernia, etc.. In addition, the respiratory function of obese patients is significantly lower than that of those with normal weight, and postoperative complications such as pulmonary infection and pulmonary atelectasis are significantly higher than those with normal weight. If laparoscopic surgery is performed, there is no difference between obese patients and normal weight patients in terms of wound size, duration of surgery, damage to the muscle and incidence of postoperative complications. The incidence of complications such as incisional infection and pulmonary infection is lower in laparoscopic surgery than in open surgery. Therefore, obese patients are more suitable for laparoscopic surgery.
5. How to remove large pelvic masses (such as uterine fibroids, ovarian cysts, etc.) from the small opening?
Many people find it hard to believe that such a large mass can be removed from a small opening in the abdominal wall. If it is a cystic ovarian mass, the fluid inside the cyst can be sucked out first with a thin puncture needle to shrink the mass and remove it from the small opening in the abdominal wall. In the case of larger solid masses, such as uterine fibroids, the masses can be cut into strips with special instruments and then removed through a small incision in the abdominal wall. All of the above specimens should be placed in a specimen bag and removed through a small incision in the abdominal wall. The entire mass can also be removed from the vagina. The large mass is removed without a large scar on the abdominal wall, only 3 small incisions of about 5 mm, and after healing no trace of surgery is visible at all.
6. Can the fallopian tubes be preserved in laparoscopic treatment of ectopic pregnancy?
For those with unbroken tubal pregnancy, pregnancy mass <75px in diameter, who require preservation of reproductive function, blood HCG ≤2000IU/L, no abnormal liver or kidney function, no intra-abdominal bleeding, and intrauterine pregnancy excluded, the fallopian tubes can be preserved by laparoscopic intra-tubal injection to kill the embryo, or by laparoscopic removal of the fallopian tubes to remove the embryo, thus preserving the fallopian tubes and preserving reproductive function. The fallopian tubes can be removed to preserve the fertility function.
7. Can laparoscopic removal of ovarian cysts preserve the ovulatory function of the affected ovary?
Laparoscopic removal of ovarian cysts can generally preserve the ovulatory function of the affected ovary. Depending on the condition of the ovarian cyst, the cyst can be removed and part of the normal ovary can be preserved, so that the endocrine function of the ovary is not affected.
9. Can patients with polycystic ovary syndrome be treated by laparoscopy?
The answer is yes. Polycystic ovary syndrome is a complex group of syndromes caused by abnormal hormone secretion and regulation between the hypothalamus-pituitary-ovary. It is characterized by the patient’s ovaries not ovulating. Clinical symptoms include menstrual disorders, obesity, hirsutism, and bilateral ovarian enlargement. The traditional surgical treatment is open surgery with wedge excision of the ovaries. Laparoscopic treatment of polycystic ovary syndrome can restore ovulation in 90% of patients, with a postoperative pregnancy rate of up to 70%, and is simple to perform with few postoperative pelvic adhesions. At present, laparoscopic treatment of polycystic ovary syndrome has replaced open ovarian wedge resection.
10.Can laparoscopy treat pelvic inflammatory disease and pelvic abscess?
Yes. Most surgical explorations for pelvic inflammatory disease via open treatment are considered inflammatory tissue edema, increased tissue fragility, surgery is easy to tear, tissue congestion, capillaries bleed very easily, hemostasis is not ideal, therefore, intraoperative blood transfusion is often required. Postoperatively, the presence of infection spread and incisional infection make the dosage of antibiotics larger. In contrast, the minimally invasive laparoscopy has little damage, no need for blood transfusion, and postoperative medication is reduced, which is a good method with little damage and diagnostic and therapeutic effects, and can be used for the diagnosis and treatment of pelvic inflammatory disease and pelvic masses.
11. Are there any requirements for laparoscopic treatment?
Although laparoscopic minimally invasive surgery has various advantages, it is not suitable for every patient. In general, laparoscopic treatment can be applied as long as the operator has no serious cardiovascular disease, no cardiopulmonary insufficiency, no middle or late pregnancy, no coagulation dysfunction and no blood disorders. It is necessary to consult the attending physician in detail before and after treatment and not to conceal one’s medical history from the physician in order to avoid delaying treatment and bringing moral and financial losses to oneself.