Minimally invasive surgery is currently a hot spot in international and domestic medical research and clinical practice in surgery, with the advantages of less trauma, less pain, faster recovery and better efficacy. Minimally invasive gynecological surgery is the use of laparoscopy, hysteroscopy or transvaginal surgery instead of open surgery in the past. Compared to ordinary open surgery, minimally invasive gynecologic surgery does not require incision of the abdominal wall. Specifically, laparoscopic surgery requires only a few small 0.5-1 cm holes in the abdomen; hysteroscopic surgery is performed on disease sites in the uterine cavity through the natural vaginal-uterine channel; transvaginal surgery is performed on diseases of the cervix and uterus through the vagina. This is the more rapidly developing and increasingly widely used surgical procedure in the world of medicine.
Laparoscopy
Laparoscopic surgery is performed in a closed pelvic and abdominal cavity, with the physician looking directly at the monitor screen and manipulating the insertion of pelvic and abdominal surgical instruments outside the abdominal cavity. simple gynecologic laparoscopic surgery was performed in the late 1970s and early 1980s. total laparoscopic hysterectomy was first reported by Reich in 1989, and by the 1990s most classical gynecologic surgery was performed laparoscopically. Laparoscopy is the gold standard for the diagnosis of some gynecologic diseases. Such as pelvic inflammatory disease, ectopic pregnancy, endometriosis, etc.
1. Advantages of laparoscopic surgery
Ø Diagnostic and therapeutic balance. For example, if the tubal pregnancy (ectopic pregnancy) does not rupture and bleed in the early stage, the symptoms are not typical for early diagnosis, but the lesion can be found under laparoscopy, and the conservative surgery can be performed to preserve the tubal and function of the lesion.
Ø Quick recovery after surgery. The operation is performed through perforation holes (5mm-10mm in diameter, 3-4 in total) in the abdominal wall, and the surgical instruments are inserted from outside the abdominal cavity.
Ø Light postoperative discomfort. There is no long incision in the abdominal wall, so the postoperative pain is light, and the patient can eat normally after surgery and keep the catheter for a short time. The first postoperative day can be appropriate activities, and the time of infusion and medication are shorter than that of open surgery.
Ø Decrease in hospitalization days and medical costs. No special circumstances 3 to 4 days after moderate surgery can be discharged.
Ø No obvious scars after abdominal wall surgery to achieve cosmetic effect, less postoperative pelvic and abdominal adhesions, light impact on fertility.
2.Disadvantages of laparoscopic surgery
1, laparoscopic equipment expensive operation is more complex. Need laparoscopic surgery retraining, the surgeon has technical requirements.
2.It is difficult to estimate the operation time before surgery, and special cases need to be changed to open surgery during the operation.
3, laparoscopic surgery in special circumstances increased surgical risk.
4, laparoscopic surgery indications and contraindications than open surgery requirements are more stringent.
3.Surgical indications
Diagnostic laparoscopic indications: (emergency) acute abdominal pain, uterine perforation. (Non-emergency) chronic pelvic pain, infertility.
Therapeutic laparoscopic indications: tubal ligation, ectopic pregnancy, endometriosis, ovarian endometriosis cyst, benign ovarian teratoma, ovarian cyst, myomectomy, hysterectomy, etc.
Hysteroscopy
Hysteroscopy has been developed for more than 100 years, until the end of 1970s when hysteroscopy successfully removed submucosal fibroids and later electrocoagulated endometrium was used for the treatment of uterine bleeding, etc.
1. Diagnostic hysteroscopy: abnormal uterine bleeding. Infertility. Recurrent miscarriage. Endometrial lesions, foreign bodies, adhesions, malformations. Diagnosis of cervical and vaginal diseases in young girls or virgins. Pre-operative hysteroscopic examination and post-operative follow-up. Diagnosis of intrauterine contraceptive device.
2.Therapeutic hysteroscopy: unblocking of the tubal opening and selective intubation and lavage, hysteroscopic injection for tubal pregnancy, removal of abnormal contraceptive devices or residues in the uterine cavity, etc.
3.Surgical hysteroscopy: endometrial resection, uterine mucosal polyp removal, myomectomy, longitudinal hysterectomy, uterine adhesiolysis, cervical canal excision.
Contraindications to hysteroscopy: T37.5 degrees or above, active uterine bleeding, acute and subacute inflammation of the reproductive tract, recent post-perforation repair of the uterus, severe heart, liver, lung and kidney diseases, cervical invasive cancer, genital tuberculosis without anti-TB treatment, and cervical canal stenosis.
Transvaginal surgery
Modern minimally invasive gynecology advocates maximum treatment with minimal trauma, and the use of transvaginal surgery reflects this concept. As one of the minimally invasive gynecological procedures, transvaginal surgery avoids abdominal incisions to the greatest extent. It means that except for vaginal and cervical surgeries, other surgeries that can be performed vaginally should be performed vaginally as much as possible.
Transvaginal surgery can be performed for common gynecological conditions such as uterine fibroids, moderate to severe pelvic floor prolapse (including anterior vaginal wall prolapse, posterior vaginal wall prolapse, uterine prolapse, and consequent urinary incontinence). In general, the main types of diseases that are suitable for transvaginal surgery are the following: uterine fibroids, myometrium, uterine fibroids protruding into the plasma layer of the uterus, and urinary incontinence. Since most of these surgeries are performed extraperitoneally with fewer intra-abdominal operations, the disturbance to the abdominal organs can be reduced and the incidence of postoperative bowel obstruction is lower. In addition, since there is no incision in the abdomen, surgical complications caused by abdominal incisions, such as incisional infection, fat liquefaction, and incisional hernia of the abdominal wall, are avoided. Patients can get out of bed earlier after surgery, intestinal function recovers faster, and patients can eat normally earlier.