Originally, this was not a problem, but some online arguments have confused and caused problems for many patients, with some doctors saying that “laparoscopy is minimally invasive on the abdominal wall, but massively invasive in the stomach” and “laparoscopic surgery is not clean”. If this issue was discussed 30 years ago, it may be justified, because at that time, endoscopic surgery had just entered China, and there were very few doctors who could do laparoscopy, and general gynecological surgery was done through open surgery. ” The questions often mentioned at that time were “Is laparoscopy clean?”, “What about the specimens taken during laparoscopy?” The questions often raised at that time were “Is laparoscopy clean? . But after many years, because of the minimally invasive laparoscopic surgery and the rapid recovery of patients, laparoscopic surgery has gradually gained popularity in the field of gynecology, and more and more doctors have started to learn and master laparoscopic surgery, and laparoscopic, hysteroscopic and negative surgery, which are minimally invasive surgical methods, can account for almost 90% of benign gynecological diseases, and patients have started to benefit. laparoscopic or open is better, almost the voice is unanimous, where minimally invasive surgery is possible, minimally invasive is not appropriate before considering open. The advantages of laparoscopic surgery are as follows: 1, small abdominal wounds: general laparoscopic surgery is to make 3 to 4 0.3 to 1.5cm incisions in the abdominal wall, doctors through the long arm to carry out surgical operations, compared to open surgery often more than 10cm surgical wound, the scar is much smaller; now laparoscopic surgery can even do a single-hole laparoscopic surgery, the wound is completely hidden inside the navel, the abdominal wall on the The wound is invisible, wearing a bikini is no problem at all. 2, pain light: general laparoscopic surgery after surgery is not necessary to use painkillers, pain is relatively mild, if the VAS (visual scoring method, with 0-10 points to indicate the level of pain, 0 points is no pain, 10 points is the unbearable pain experienced in this life) score, generally is in the degree of 2-3 points, but open surgery is relatively speaking, the degree of pain is much heavier, in general The VAS score should be 8-10. In the past, when we had routine open surgery, the most frequent medical order that the night shift doctor on duty had to deal with was the order to prescribe painkillers, but now these are much less frequent in laparoscopic surgery. 3, fast recovery: compared to open surgery, laparoscopic surgery we have a lot of patients on the ground the same day after surgery, but open surgery is more difficult to get down on the ground on the second day; laparoscopic surgery can generally return to work in 2 weeks after surgery, but open surgery usually takes 4-6 weeks to return to normal work. This is not my opinion, the most valuable conclusion is from the results of large-scale clinical studies, let’s look at a few interesting results (the following results are expressed in a more academic way, these are the results obtained after a large sample of randomized controlled studies, OR or RR = 1 indicates no difference, but with 95% confidence interval to identify, if the 95% confidence interval across 1 indicates that there is no statistical difference, if they are all greater than 1 indicates a positive effect and all less than 1 is a negative effect). 1, 12 randomized controlled studies of 769 patients suggest that when comparing laparoscopic and open surgery for benign ovarian tumors, laparoscopic surgery has a lower chance of surgical complications (including fever and intraoperative injury) (OR 0.3, 95% confidence interval CI 0.2 to 0.5), less postoperative pain (VAS score WMD -2.4, 95% CI confidence interval -2.7 to – 2.0), and less postoperative pain (VAS score WMD -2.4, 95% CI confidence interval -2.7 to – 2.0). 2.0), pain-free 2 days postoperatively (OR 7.42, 95% CI confidence interval 4.86 to 11.33), and shorter hospital stay ( WMD -2.88, 95% CI -3.1 to -2.7). 2. 9 randomized controlled studies of 808 patients comparing laparoscopic and open surgery to remove uterine fibroids on, laparoscopic surgery was less painful (VAS difference 6 hours postoperatively: MD -2.40, 95% CI -2.88 to -1.92; difference 2 days postoperatively MD -1.90, 95% CI -2.80 to -1.00), and the proportion of fever was lower for laparoscopic surgery compared to open 50% (OR 0.44, 95% CI 0.26 to 0.77, I² = 0%). 3. Laparoscopic surgery was associated with a lower chance of wound infection (RR relative risk: 0.21; 95% CI confidence interval, 0.07-0.65) and a lower chance of incisional hernia (RR relative risk: 0.11, 95% CI, 0.03-0.35) when compared with open surgery on cholecystectomy. 4. 8 studies of 3644 cases comparing laparoscopic and open surgery in the treatment of endometrial cancer showed no difference in disease survival and recurrence rates (overall survival HR = 1.14, 95% CI confidence interval: 0.62 – 2.10 and recurrence rate HR = 1.13, 95% CI: 0.90 – 1.42), with comparable intraoperative complications and less blood loss in the laparoscopic group (mean blood loss 106.82 mL, 95% CI: -141.59 to -72.06) and a lower incidence of postoperative adverse events in the laparoscopic group (RR = 0.58, 95% CI: 0.37 to 0.91). The above text is for physicians and researchers to see, and to explain it in layman’s terms, laparoscopic surgery is superior to open surgery in every way. Are there no disadvantages to laparoscopic surgery? Yes, the main disadvantage is the high technical requirements of the surgeon. In open surgery, the surgeon’s hand directly holds the forceps and scissors to do the operation, and he can use his hand to hold the gauze to press the bleeding area, and through the touch of his fingers he can sense the lesion inside the organ. The relative difficulty of the operation is greatly increased, especially for suture operations, and the surgeon must undergo a lot of training to complete the suture operations to a degree comparable to open surgery, but the technique can be learned, and as long as you have the will to do so, you can master it through a period of training. laparoscopic techniques for difficult operations. In general, laparoscopic suturing should not be a particular problem for doctors with about 5 years of laparoscopic experience, and with experienced operators, laparoscopic suturing can achieve results comparable to open surgery. Again, if we take the data, the current randomized controlled study did not find that laparoscopic fibroid surgery was worse than open surgery. Of course, I personally feel that it is very much related to the experience of the operator; if you are a beginner, suturing is often difficult, and if you have a poor suture repair, you have a relatively higher chance of postoperative problems. Laparoscopic surgery lacks the tactile sensation of open surgery, which is not easy to overcome. For example, in the case of uterine fibroid removal surgery, small fibroids may be left in the uterus under laparoscopic surgery, but careful preoperative manipulation or MRI and intraoperative vaginal ultrasound to indicate fibroids when necessary will help reduce the chance of missing them. However, the advantages of minimally invasive laparoscopy compared to open surgery are greatly overshadowed by the pain of open surgery, and even in cases where open surgery is very clean to remove the fibroids, there is still a 5-year 30% chance of recurrence, so if this is considered, the advantages of open surgery are not obvious. The laparoscopic surgery requires technology to remove a relatively large specimen from a small hole, and usually we use a machine shredder to cut the cut tissue specimen into small pieces and then remove it from the incision on the stomach. However, if the disease is found to be malignant before surgery, laparoscopic surgery will probably not be used (laparoscopic surgery is now possible for endometrial cancer, cervical cancer and early ovarian cancer, but laparoscopic surgery is not suitable for tumors that need to be removed by crushing, as endometrial cancer and cervical cancer are all completely removed from the uterus and then the uterus is removed from the vagina. Endometrial cancer and cervical cancer are removed from the uterus after complete removal of the uterus, so the chance of malignant tumor specimen contamination will be smaller.) Preoperatively benign, postoperatively found to be malignant, such a chance is not too great, especially for uterine fibroids, we are looking at the incidence rate, only 1 in 6000 patients with uterine fibroids will encounter a case of uterine sarcoma, for patients to be operated, about 1 in 500 patients with uterine fibroids is a sarcoma, then we want to prevent such a chance of sarcoma dissemination, to let 499 patients follow to do open surgery This is obviously unreasonable. Of course if the number of fibroids is too high and the suturing time is too long, one needs to consider abandoning laparoscopy for open surgery. Whether a technology is viable or not is definitely not based on the technical difficulty of the doctor, a technology that can be learned to improve the technology can benefit patients is a promising technology, doctors should strive to learn and master, for example, single-port laparoscopy, the scar can be completely hidden, there is no scar on the stomach, because of the beauty of female patients, but for doctors, technology I think doctors should not reject it because of the increased technical difficulty, but we can learn to do it as long as it is beneficial to the patient. Those doctors who still think that open surgery is better than laparoscopic surgery will be eliminated if they don’t think about progress.