Minimally invasive technology, as the name implies, is minimally invasive, i.e., using laparoscopy, hysteroscopy, colposcopy and other technologies to replace traditional open surgery, through a small 3 mm hole in the patient’s abdomen, the application of high-tech electronic imaging system, on the display screen to observe the lesions magnified tens of times, precise, rapid removal of lesions, without any damage to healthy tissue. After the surgery, a band-aid can cover the wound . It has the characteristics of less bleeding, light post-operative pain, quick recovery, and subtle or no scarring. It emphasizes the transformation of the mode of treating the disease alone to the mode of treating the person, thus achieving a humane treatment purpose.
Disadvantages of traditional surgery.
First: surgery is painful and recovery is slow. The thought of a cold operating table and scalpel will make many people shudder, and the pain of surgery need not be mentioned, and the post-operative recovery will take a long time, seriously affecting women’s normal work and life.
Secondly, the surgery is very damaging and affects women’s ability to conceive again. Many women suffering from gynecological diseases also have such doubts, whether the surgery should remove the uterus, even if not remove the uterus will not affect fertility, to be able to conceive life is a sign of women, is also the supreme right, but traditional surgery is often mercilessly deprived of women’s privileges.
Third: High risk of post-operative infection. Traditional surgery has a large invasive surface, and the chance of post-operative infection increases. A series of post-operative complications caused by infection is also an important reason why women reject surgery.
Fourth: the wound is not beautiful. Although the scars of gynecological surgery are usually not visible, there are still many women who seek for perfection will mind the unsightly scars on their stomachs.
Advantages of minimally invasive treatment compared to traditional treatment.
Traditional surgery, due to its own operational characteristics, will inevitably bring greater trauma to the patient while treating the disease. Not as big as wounds, long operation time, long hospital stay, complications and slow recovery; it is difficult to ensure the normal function of the uterus and ovaries, and the postoperative period is often painful; this trauma itself can cause serious consequences to the patient. Therefore, when surgery is mentioned, the first thing that comes to mind is the opening of the belly and the light of the knife. A late phobia develops!
Minimally invasive therapy gynecological minimally invasive surgery is characterized by no incision, safe and easy, no pain during the operation, short operation time (usually 5-15 minutes), short hospital stay (usually 0-3 days), minimal trauma to the patient, no complications, and quick recovery after the operation. Preserving the normal functions of the uterus and ovaries is the biggest difference from traditional surgery.
The characteristics of minimally invasive gynecological surgery:
It is non-invasive, safe and easy, painless, short operation time (usually 5-15 minutes), short hospital stay (usually 0-3 days), minimal trauma to the patient, no complications, and fast post-operative recovery. Preserving the normal function of the uterus and ovaries is the biggest difference from traditional surgery.
Long-term clinical trials abroad have proven that it is an advanced technical device that can be universally adopted. Of course, science is a double-edged sword, which can become a disaster if not used properly, so the use of minimally invasive technology must be guaranteed by physicians who are skilled in mastering the technical essentials.
Introduction to hysterolaparoscopy
Laparoscopic surgery is performed in a closed abdominal cavity with the physician looking directly at the monitor screen. Its differences from traditional surgery are: the abdominal cavity is not cut open and the organs are not exposed to air; with the help of the camera system, the surgical field of view is exposed more fully than in traditional surgery; there is no unnecessary interference with operations outside the surgical site; incision, ligation and hemostasis depend mainly on electrocoagulation surgery and ultrasound knife to complete; the pelvic and abdominal environment is less disturbed, etc.
Hysteroscopic techniques, i.e., diagnosis of various diseases in the uterine cavity, such as endometrial polyps, submucosal fibroids, uterine adhesions, longitudinal uterus, etc., are performed under direct vision. It can also be performed directly under the microscope for intubation of proximal tubal obstruction, separation of adhesions, removal of fibroids and polyps with electrodesection, and electrodesection of endometrium and longitudinal uterus.
Advantages of the lumpectomy technique
Combines diagnostic and therapeutic roles – allows the physician to perform diagnosis while simultaneously treating the gynecological disorders encountered under the scope, thus greatly reducing the riskiness of the procedure. The birth of laparoscopic technology has replaced most exploratory cesarean surgeries, such as pelvic adhesion masses, ectopic pregnancy, and ovarian rupture, which can be diagnosed through laparoscopy while undergoing microscopic surgical treatment.
Patients recover quickly after surgery – laparoscopic surgery is performed in the pelvic and abdominal cavities, the internal environment is minimally disturbed, and patients suffer far less trauma than in open surgery and recover quickly after surgery.
Short hospital stay – No matter how complicated laparoscopic surgery is, it does not require a long hospital stay, and the average hospital stay is shorter than that of open surgery. And patients can return to work in a short time.
Good cosmetic abdominal results and less pelvic adhesions – laparoscopic surgery only involves a 0.3 to 1 cm puncture in the abdomen below the umbilicus, without the long scars of transabdominal surgery. More importantly, laparoscopic surgery causes less pelvic disturbance, with no gauze and no hand-to-tissue contact and few sutures. The pelvic cavity is adequately flushed during surgery, so patients have far less pelvic adhesions after laparoscopic surgery than after transabdominal surgery.
Smaller patient expenses – Because the surgery is minimally invasive, postoperative recovery is rapid. Postoperative medications are significantly reduced, and medical costs are naturally lower. As a “non-open” surgery, laparoscopic technology undoubtedly has a broad development prospect.
The application of laparoscopy in gynecological surgery
1, all kinds of ectopic pregnancy, tubal sterilization.
2. infertility, uterine perforation and sterilization ring outflow.
3, ovarian cysts, tumors, ovarian corpus luteum rupture, polycystic ovary syndrome.
4, uterine fibroids, uterine prolapse, dysfunctional uterine bleeding.
5, endometriosis, myometriosis, ovarian chocolate cysts.
6, pelvic inflammatory disease and pelvic abscesses.
7, chronic pelvic pain of unknown etiology, preoperative diagnosis of masses of unknown nature, ovarian tissue biopsy, etc.
Indications for hysteroscopy.
1, abnormal uterine bleeding before and after menopause.
2, Diagnosis or decision on whether submucosal fibroids or endometrial polyps can be removed trans-cervically from the uterus.
3. localization or removal of a lost intrauterine device.
4. evaluation of abnormal images on hysterosalpingography.
5. assessment of abnormal uterine echoes or occupying lesions on ultrasound
6. diagnosis of uterine adhesions and trial separation.
7. examining the cervical canal or intrauterine causes of multiple habitual miscarriages or pregnancy failures
8, examination of intrauterine causes of unexplained infertility.
9.Early diagnosis of endometrial cancer, etc.
Indications for hysteroscopic treatment
1, functional bleeding, increased menstrual flow, endometrial polyps and other benign diseases in the uterus that have not been treated for a long time can be treated by hysteroscopic endometrial electrodesis.
2. submucosal fibroids with or without a clitoris, or interstitial fibroids protruding into the uterine cavity can be removed from the uterine cavity via hysteroscopy.
3, congenital malformations in the uterine cavity such as longitudinal uterus can be corrected by hysteroscopic electrodesection.
Contraindications to hysteroscopic surgery
1.Acute inflammation of the internal and external genitalia that is not controlled
2.Uterine bleeding in moderate amount or more, or during menstruation
3.Severe cardiopulmonary, vascular and hematologic disorders
4.History of uterine wall surgery, especially those with recent uterine perforation
5.Diagnosed with invasive cancer of the uterine cervix
6.When the uterine cavity is 250 px deep or more, combined with a large mass in the pelvis.
Hysteroscopy should be performed 3-7 days after menstruation, when the endometrium is in the early stage of hyperplasia, with fewer blood vessels, less mucus secretion and less shedding of endometrial pieces, and a clearer field of view, but the uterus can be examined at any time for abnormal bleeding.
Hysteroscopy, prone to fluid expansion complications: such as soreness and swelling in the lower abdomen, shock in those who are allergic to the expansion fluid, expansion with CO2, which can lead to emphysema or pneumothorax. There are also mechanical injuries.
Complications of hysteroscopy
1.Injury
(1) Excessive stretching and dilatation of the cervix can cause cervical injury or bleeding.
(2) Uterine perforation: the rate of uterine perforation for diagnostic official laparoscopy is about 4%, and the American Association of Gynecologic Laparoscopists recently reported that the rate of uterine perforation for surgical hysteroscopy is 13.0%. Severe uterine adhesions, scarred uterus, excessive anterior or retroflexion of the uterus, after cervical surgery, atrophic uterus, and lactating uterus are all prone to uterine perforation. Sometimes the perforation goes undetected and the surgical operation continues, which may lead to severe intestinal injury. Perforations tend to occur at the base of the uterus. Simultaneous monitoring with laparoscopy may reduce the incidence of perforation. Once perforation occurs, the operation should be stopped, the instruments should be withdrawn, the perforation should be estimated, and abdominal pain and vaginal bleeding should be carefully observed. 5 mm perforation of the examining scope has no significant sequelae, whereas perforation during official laparoscopic surgery requires consideration of open or laparoscopic examination. Special care should be taken for perforations due to electrocoagulation and lasers, which have been used in recent years. During hysterectomy, the intestinal canal attached to the surface of the uterus may be damaged by heat transfer, or the electrocoagulator may perforate into the abdominal cavity and burn the intestinal canal, ureter and bladder. Simultaneous laparoscopic monitoring during hysteroscopic electrosurgery can assist in evacuating the bowel and confirming bladder emptiness to reduce complications. Hysteroscopic intubation of the fallopian tube may damage the horn of the uterus, and carbon dioxide gas expansion of the uterus may cause rupture of the hydrocele and gas entering the broad ligament to form an emphysema.
2. Bleeding
There is usually a small amount of vaginal bleeding after hysteroscopy, which clears up within a week. Hysteroscopy may cause excessive bleeding due to deep cutting, poor contraction or incomplete intraoperative hemostasis, which can be stopped by electrocoagulation or by compression with a Foley catheter for 6-8 hours.
3.Infection
The incidence of infection is low. Master the indications and contraindications, preoperative and postoperative appropriate application of antibiotics, strict sterilization of instruments, can avoid the occurrence of infection.
4, the complications caused by expansion of the uterus
Excessive absorption of the expansion fluid is a common complication when expanding the uterus, mostly occurs in hysteroscopic surgery, and expansion of the uterine pressure is too high, the endometrial damage area is larger. Excessive pressure is not beneficial to the clarity of the visual field, but rather promotes the absorption of a large amount of fluid through the veins or through the fallopian tubes into the abdominal cavity. Excessive operating time can also easily lead to excessive absorption, resulting in excessive blood volume and hyponatremia, causing a series of systemic symptoms, which can lead to death in severe cases. The use of carbon dioxide as an inflation medium may lead to serious complications or even death if the inflation rate is too fast. At present, a special inflatable device is used, and the inflation speed is controlled at 100 ml/min to avoid the occurrence of complications. Postoperative shoulder pain due to carbon dioxide inflation is caused by carbon dioxide stimulation of the diaphragm.
Proper care after hysteroscopic surgery and its precautions
1. Early activity: Except for high-risk patients, patients can be instructed to turn over properly in bed within 6 hours after surgery, and can get out of bed after 6-8 hours and gradually increase the amount of activity.
2, pain care: postoperative patients can have different degrees of pain, patients are instructed to perform relaxation surgery can mostly be relieved by themselves, if they cannot be relieved, analgesics can be given.
3, observation of urination: early supervision, guidance and assistance to patients to urinate, really difficult to urinate can induce urination, if necessary, give catheterization.
4.Dietary care: Nutritious soft food can be introduced after surgery, and the intake of stimulating food can be reduced.
5, routine care: that is, remove the pillow and lie flat for 6 hours, so as not to prematurely elevate the head resulting in cerebrospinal fluid from the puncture site to exude outside the spinal cavity, resulting in low cerebral pressure, stretching intracranial venous sinuses and meninges and other tissues and causing headaches.
6. Perineal care: After surgery, use 1/5000 potassium permanganate or 0.1% chlorhexidine solution to scrub the perineum twice a day to avoid retrograde infection of the uterine cavity during tube placement.
7. Observe vaginal bleeding: For patients with large surgical trauma and bleeding, a postoperative balloon catheter is placed in the uterine cavity and 8~10ml of saline is injected into the balloon to stop bleeding. After the operation, we should pay attention to observe the vaginal bleeding, if there is a large amount of fresh blood, we should report to the doctor and follow the medical advice to deal with it. If there is no abnormality, the uterine balloon catheter is usually withdrawn 24 hours after surgery.
From “minimally invasive gynecology” to “minimally invasive gynecology
”Minimally invasive gynecology” and “minimally invasive gynecology” are both minimally invasive techniques, while the latter reflects a new minimally invasive concept. The correct minimally invasive concept emphasizes the rational application of different technical means to achieve minimally invasive, i.e. minimal damage to the patient, and is not limited to which technology is used. Achieving the transformation from minimally invasive gynecology to minimally invasive gynecology depends not only on the minimally invasive technique but also on the overall decision making of the whole treatment. Doctors should make a comprehensive analysis and develop an individualized treatment plan based on the patient’s age, symptoms, fertility requirements, size and location of the lesion, general condition, financial ability, personal wishes and the technical strength of the hospital.