Laparoscopic surgery can treat the following gynecological diseases: hysteromyoma, hysteromyoma, ovarian tumor, ovarian teratoma, endometriosis, endometrial cancer, ectopic pregnancy, infertility and so on.
Hysteroscopy minimally invasive treatment of uterine fibroids, patients with subserous uterine fibroids or intramural fibroids should choose myomectomy, and patients with multiple uterine fibroids and uterine fibroids complicated with cervical lesions should choose hysterectomy. In the previous laparoscopic hysterectomy in our hospital, the maximum weight of the uterus removed was 1700g, which was equivalent to the size of the uterus after 6 months of pregnancy. Laparoscopic myomectomy can remove up to 8 large and small myomas, which basically achieves the purpose of open surgery.
The working principles of hysteroscopy and laparoscopy are basically the same. The operation process is as follows: after the patient is anesthetized, the doctor puts it into the hysteroscope through the patient's vagina and cervical canal, and connects it to the TV screen through a miniature camera; Then the doctor looks at the screen and operates through the cutting instrument of hysteroscope; Finally, the excised lump or lesion is taken out of the vagina through the cervix with tweezers, leaving no surgical scar on the abdomen.
Diseases suitable for hysteroscopic surgery: submucous hysteromyoma, intermuscular hysteromyoma protruding into uterine cavity, functional uterine bleeding, uterine mediastinum, endometrial polyps, intrauterine adhesions and decomposition, infertility caused by tubal obstruction, and removal of intrauterine devices.
3 Vaginal surgery Vaginal surgery uses the natural passage of vagina for surgery, which has the advantages of less trauma, less intestinal interference, less postoperative pain, quick recovery and no surgical scar on the abdomen. At the same time, appendectomy, vaginal anterior and posterior wall repair, urethral plastic surgery, vaginal contraction and other operations can be performed. In clinical application, most hospitals are limited to vaginal hysterectomy for patients with uterine prolapse, mainly because the surgical field of vision is narrow and the indications and contraindications are difficult to grasp; Doctors lack profound operating skills and suitable surgical instruments; Patients lack understanding of the choice of surgical methods. With the development of laparoscopic technology, doctors can broaden their horizons and directly understand the situation in abdominal cavity. With the help of laparoscopy, the scope of vaginal hysterectomy is expanding.
Vaginal surgery can treat the following gynecological diseases: no obvious adhesion between uterus and pelvic cavity, good uterine mobility, and diseased uterus that needs to be removed, such as hysteromyoma, hysteromyoma, adenomyosis, endometrial lesions, stress urinary incontinence, etc.
4 the premise of minimally invasive minimally invasive, generally refers to less surgical trauma, less bleeding, less pain, quick recovery and so on. In this respect, it is the basic concept and principle of surgical operation. If you want to achieve minimally invasive surgery, the key is to choose a good surgical approach and method. For example, there are three ways of gynecological surgery: laparotomy, transvaginal surgery and endoscopy. For some diseases, all three approaches can be selected, while for other diseases, one approach may not be suitable or difficult to use. Therefore, the choice of surgical approach and mode is particularly important.
Choice of approach-Apart from decision-making, approach is the 1 step of operation, and it can best embody the concept of minimally invasive surgery. It can generally be considered that the influence on the body through vagina-endoscope-laparotomy is from small to large. For example, if it is not a big hysterectomy, if it can be taken out of the vagina, there is no need for laparotomy or even laparoscopic assistance. If it is necessary to deal with more difficult adnexal problems, laparoscopic-assisted hysterectomy can be performed. A very large uterus is suitable for laparotomy. Of course, the operation method should be individualized, first consider transvaginal, then endoscopic, and finally laparotomy.
Choice of surgery-the purpose of surgery is to remove the lesion, but it is not necessarily that the larger the resection range, the wider the better. A typical example is the operation of vulvar cancer. Traditional extensive vulvar excision and bilateral inguinal lymphadenectomy form "big butterfly" incision and wound, which has great damage and delayed healing is very common. Later, it was improved to "three incisions", and inguinal lymph node dissection was mainly concentrated in the superficial part of femoral triangle. If the sentinel lymph node is negative, the operation will not be expanded and pelvic lymph node resection will not be carried out, which will reduce the injury and achieve good curative effect.
The concept of minimally invasive surgery runs through the whole operation, which is embodied in incision and one stroke and one type. When we do microsurgery or endoscopic surgery, we often mention several technical principles, such as keeping moist, keeping no bleeding, keeping patency, keeping gentleness and keeping speed, which are basically to keep minimally invasive. Therefore, these technical principles can also be applied to any surgical operation.