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KMID : 0377619960610060503
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Korean Jungang Medical Journal
1996 Volume.61 No. 6 p.503 ~ p.505
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Endoscopic Surgeries in Gynecology
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Park Sai-Rok
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Abstract
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General Review
For the last five years, the rapid expansion of operative laparoscopy has resulted from the availability of more suitable equipments and the enthusiastic acceptance by gynecologist. Most individuals can return to full activities within one or two weeks, in contrast to four to six weeks recovery period after abdominal surgery. The widespread acceptance of such procedures has prompted even more extensive applications of operative laparosocpy. Not only are vaginal hysterectomies with bladder and vaginal vault suspension possible, but extensive cancer surgeries including lymphadenectomies also are performed. In the present environment, efforts to maintain cost control in all aspects for the health delivery process make "outpatient surgeries" all the more attractive. Advances in endoscopic techniques have facilitated the outpatient approach. Now we are on the verge of a revolution in gynecologic surgery. Some authorities predicted that gynecologic surgery as we know it today will no longer exist in another decade or will be significantly modified.
It is mandatory to have hand-eye coordination to perform more complicated endoscopic surgeries, which will be obtained only by repeated practice. It is also necessary for gynecologists to fully familiarize the anatomies to avoid serious complications.
Anatomical Review
1. deep and superficial abdominal wall vasculatures - inferior epigastric artery.
2. pelvic organs - aorta, iliac artery, hypogastric and uterine artery, ureter, bladder.
Laser application ; CO2, YAG, KTP, Argone edometrial ablation, metroplasty
endometriosis, lysis of adhesion, LUNA
tuboplasty, *LAVH, myomectomy
Endoscopic Surgeries
operative hysteroscopy - endometrial ablation, myoma resection, metroplasty
Bleeding, refractory to medical and surgical theraphy Patient, dissatisfied with hormonal theraphy Patient, refused hystereotomy
Patient, high surgical and anesthetical risk Contraindication
Pelvic and endometrial infection
Cervical and endometrial carcinoma/atypia Known or suspected pregnancy
Complication
Trauma - perforation of uterus
Injury - bowel and other organ
Bleeding, infection
Fluid overload - hyponatremia, hypervolemia, pulmonary and cerebral edema
Central pontine myelinolysis due to rapid correction of hyponatremia Method
YAG laser
Electrods - roller ball, roller bar, loop cutting current-100?110 W coagulation - 80?100 W more hazardous area - roller ball blended current 80?100W
Pre-op preparation
Progestin for 6 weeks Danoacrine 800mg 6?8weeks GnRH agonist
Mechnical preparation - suction curretage Result Amenorrhea 50
Hypomenorrhea 26 %, 93 % improved Eumenorrhea 17 % Failed 7 %
Myoma resection in addition to ablation symptomatically improved 91 lower incidence of amenorrhea 39 %
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KEYWORD
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