妇科腹腔镜手术能量器械常见副损伤及防治

随着医学科学的发展,腹腔镜手术因具有手术伤口较小,恢复更快,疼痛更少和肠功能恢复较早等优点已在临床中广泛开展,在妇科肿瘤治疗领域中发挥着越来越重要的作用。腹腔镜手术是一种能量器械依赖性手术,随着各种能量器械的研发和投入使用,腹腔镜手术器械的功能越来越强大,视野越来越清晰,切割止血越来越得心应手,降低了手术难度,从而使腹腔镜手术操作日益变得步骤简化,手术范围增大,精细度提高,充分体现了微创的特点,这些进步在给手术医生提供了更多机会的同时,也使医生面临着更为艰巨的挑战。各种能量器械导致的副损伤一直是妇科手术医生关注的重要问题。本文就腹腔镜常见能量器械引起的副损伤及其防治进行了详细阐述,旨在帮助临床医生进一步了解手术中的器械,做到更精准的使用,减少副损伤。     

腹腔镜在子宫内膜癌治疗中的应用

随着腹腔镜和能量设备的不断发展以及腹腔镜手术技术的日益提高,腹腔镜下子宫内膜癌手术成为最早成熟的妇科恶性肿瘤手术方式,无论在总生存率、无瘤生存率、手术时间、术中出血以及并发症和生活质量等方面都获得了与开腹手术相同或更好的结果,其在子宫内膜癌治疗中的作用日益显现,成为医生最易于应用和患者乐于接受的首选治疗方式。     

妇科腹腔镜手术的临床进展

妇科腹腔镜手术近年来发展迅速,有损伤小、术后痛苦少、住院时间短、机体恢复快、美容效果好、医疗负担轻等优点。在妇科恶性肿瘤的诊治上,相对传统开腹手术,腹腔镜有自己独特的优势。随着手术器械设备的更新,医生经验的积累和技能的成熟,术中保护措施的研发,腹腔镜手术的并发症明显减少,安全性大大提高,临床运用范围愈加广泛。如今在传统腹腔镜手术的基础上又开发了微型腹腔镜手术,无气腹腹腔镜手术,机器人手术等新的手术方式。其各具特点,各有临床发展的潜力。就妇科腹腔镜手术近年来临床实践探索的新进展做综述。     

浅谈腹腔镜在妇产科手术中的应用

腹腔镜手术作为内镜手术的重要组成部分,已经成为外科革命的先锋。妇科腹腔镜手术近年来发展迅速,有损伤小、术后痛苦少、住院时间短、机体恢复快、美容效果好、医疗负担轻等优点。随着手术器械设备的更新,医生经验的积票和技能的成熟,术中保护措施的研发,腹腔镜手术的并发症明显减少,安全性大大提高,临床运用范围愈加广泛。     

新世纪的妇科腹腔镜手术

腹腔镜手术作为内镜手术的重要组成部分,已经成为外科革命的先锋,它把现代最先进的科学技术与现代医学结合起来,是传统的手术技术与现代电子信息技术、光导工艺技术以及各种能量传导等结合的产物;它是医生视觉和手臂的延伸,它改变了医生的思维观念、技术路线和操作技巧,且正逐步成为许多妇科手术治疗的新模式。腹腔镜手术应用广     

合理利用能量器械,提高手术效果和安全性

各种能量器械的应用推动了妇科微创手术的发展和普及。目前临床常用的能量器械包括:电能量、超声和激光等,不同的能量器械工作原理是不同的。妇科临床医生应该要熟练掌握不同能量器械的工作原理和特点。规范使用、合理使用能量器械始终是保证手术安全的惟一法宝。     

妇科腹腔镜手术的临床进展

妇科腹腔镜手术近年来发展迅速,有损伤小、术后痛苦少、住院时间短、机体恢复快、美容效果好、医疗负担轻等优点.在妇科恶性肿瘤的诊治上,相对传统开腹手术,腹腔镜有自己独特的优势.随着手术器械设备的更新,医生经验的积累和技能的成熟,术中保护措施的研发,腹腔镜手术的并发症明显减少.安全性大大提高,临床运用范嗣愈加广泛.如今在传统腹腔镜手术的基础上又开发了微型腹腔镜手术,无气腹腹腔镜手术,机器人手术等新的手术方式.其各具特点,各有临床发展的潜力.就妇科腹腔镜手术近年来临床实践探索的新进展做综述.     

子宫颈癌微创手术的未来——放弃还是改良

1910年，瑞典医生Jacobaeus将传统腹腔镜应用于临床，为患者进行腹腔镜检查。随着冷光源、玻璃光导纤维及气腹机的问世，腹腔镜的临床应用有了很大发展。直到1961年腹腔镜开始应用于妇科手术中，Palmer和Imemdioff两位医生系统地报道了他们成功实施腹腔镜输卵管结扎绝孕术的经验。1972年，美国洛杉矶的Cedars Sinai医学中心的近1/3妇科手术使用了诊断或治疗性腹腔镜技术。 浏览更多请关注本刊微信公众号及当期杂志。     

妇科腹腔镜手术并发症临床分析

近年来，妇科腹腔镜手术发展迅速，随着医生和患者对腹腔镜手术的认识，手术例数迅速增多，手术范围越来越大。然而腹腔镜手术虽有许多优点，但同其他手术一样，同样有并发症的可能。及时认识这些并发症才能很好地预防和正确处理，否则，一些严重并发症可能危及患者生命。本文对462例腹腔镜手术中的7例并发症进行回顾性分析，以从中吸取教训。     

新世纪的妇科腹腔镜手术

腹腔镜手术作为内镜手术的重要组成部分 ,已经成为外科革命的先锋。它把现代最先进的科学技术与现代医学结合起来 ,是传统的手术技术与现代电子信息技术、光导工艺技术以及各种能量传导等技术结合的产物。它是医生视觉和手臂的延伸 ,它改变了医生的思维观念、技术路线和操作技巧 ,正逐步成为许多妇科手术治疗的新模式。腹腔镜手术应用广泛 ,技术发展迅速 ,有人甚至预言在 2 1世纪最初的 1/ 4时间过后 ,妇科的绝大多数手术都可以通过内镜来完成。我们姑且不去评论这一预言的可实现性 ,但其趋势是毋庸置疑的。诚然 ,这种外科革命也必将带来新…     

A review of total laparoscopic hysterectomy: role, techniques and complications

PURPOSE OF REVIEW: The following review examines the current role of total laparoscopic hysterectomy, which is a hysterectomy completed entirely laparoscopically. Recent advances in equipment, surgical techniques and training have made total laparoscopic hysterectomy a well tolerated and efficient technique. It is increasingly being adopted around the world because of the benefits to patients and surgeons. This study discusses the role of total laparoscopic hysterectomy, provides some technical suggestions about how to perform a total laparoscopic hysterectomy and how to avoid possible complications. RECENT FINDINGS: Only a few surgeons performing total laparoscopic hysterectomy have published their techniques and results. The terminology and techniques for total laparoscopic hysterectomy used by different surgeons, such as energy sources, the use of uterine manipulators, vaginal tubes, the method for uterine artery ligation and method of vault closure, vary. This makes objective comparison of the literature, techniques and complication rates difficult. SUMMARY: As more surgeons become trained in advanced laparoscopic surgery, the role of total laparoscopic hysterectomy will increasingly take over indications for total abdominal hysterectomy. It remains important that surgeons share their experience and publish their techniques, results and complications. Advanced laparoscopic training and supervision are paramount before embarking on total laparoscopic hysterectomy, so that complications are minimized.     

Ergonomics of laparoscopic graspers and the importance of haptic feedback: the surgeons’ perspective

Haptic feedback is drastically reduced in laparoscopic surgery compared to open surgery. Introducing enhanced haptic feedback in laparoscopic instruments might well improve surgical safety and efficiency. In the design process of a laparoscopic grasper with enhanced haptic feedback, handle design should be addressed to strive for optimal usability and comfort. Additionally, the surgeons’ perspective on the potential benefits of haptic feedback should be assessed to ascertain the clinical interest of enhanced haptic feedback. A questionnaire was designed to determine surgeons’ use and preferences for laparoscopic instruments and expectations about enhanced haptic feedback. Surgeons were also asked whether they experience physical complaints related to laparoscopic instruments. The questionnaire was distributed to a group of laparoscopic surgeons based in Europe. From the 279 contacted subjects, 98 completed the questionnaire (response rate 35 %). Of all respondents, 77 % reported physical complaints directly attributable to the use of laparoscopic instruments. No evident similarity in the main preference for graspers was found, either with or without haptic feedback. According to respondents, the added value of haptic feedback could be of particular use in feeling differences in tissue consistencies, feeling the applied pressure, locating a tumor or enlarged lymph node, feeling arterial pulse, and limiting strain in the surgeon’s hand. This study stresses that the high prevalence of physical complaints directly related to laparoscopic instruments among laparoscopic surgeons is still relevant. Furthermore, the potential benefits of enhanced haptic feedback in laparoscopic surgery are recognized by laparoscopic specialists. Therefore, haptic feedback is considered an unmet need in laparoscopy.     

The singer, not the song

Recently, data have been published on the possible damage to the healthy ovarian tissue determined by surgery for the excision of endometriomas. We believe that, besides endometriosis in itself, the overall quality of surgery may have a major role in determining damage to the ovary. In recent years, surgeons dedicated to the treatment of endometriosis have refined the technique of laparoscopic surgery for the excision of endometriomas, with particular attention in developing the correct plane of cleavage and in the judicious use of electrosurgery. Quality of the surgery, and not surgery per se, may be important. Surgery is the gold standard treatment for ovarian endometriomas, but it should be performed with proper techniques by specifically trained surgeons. It's the singer, not the song.     

Economics and Energy Sources

Energy-based instrumentation has not only facilitated the rapid adoption of laparoscopic surgery, but could be considered essential for the completion of abdominal and pelvic procedures under endoscopic guidance. For decades, relatively simple and generic reusable monopolar and bipolar systems were the only options available. More recently, the available options for energy-based surgical instrumentation have become more crowded with the introduction of ultrasound-based cutting and sealing instruments and proprietary, impedance monitoring radiofrequency coagulation devices. Such instrumentation is presented as being easier to use as well as providing greater safety and efficacy. However, these new instruments typically require the expenditure of capital for proprietary energy generators and are usually designed to be for single use, a circumstance that increases per case costs, a circumstance that begs the question of value. Do the additional costs expended for the more expensive devices translate into reduced complications, faster operating time, or even wider access to minimally invasive procedures because they enable more surgeons to offer the service? Herein is explored the complex economic issues associated with the use of energy-based surgical devices as they apply to minimal access surgery in general and to laparoscopic procedures specifically.     

腹腔镜技术在盆底重建手术中的应用

腹腔镜下盆底重建手术具有深部的手术野暴露清晰、缝合区域的解剖部位精确、手术成功率高、术后复发率低等优点.但是,腹腔镜下盆底修复过程缝合技术要求高,术者学习曲线较长,手术耗时也较长,且高龄患者是腹腔镜手术的禁忌证.目前,腹腔镜下盆底重建手术疗效的评价尚缺乏长期的、随机对照研究.各种腹腔镜下的手术方式术后的解剖结构的有效性...     

Robotics and Gynecologic Oncology: Review of the Literature

The objectives of this article were to review the published scientific literature about robotics and its application to gynecologic oncology to date and to summarize findings of this advanced computerenhanced laparoscopic technique. Relevant sources were identified by a search of PUBMED from January 1950 to January 2009 using the key words Robot or Robotics and Cervical cancer, Endometrial cancer, Gynecologic oncology, and Ovarian cancer. Appropriate case reports, case series, retrospective studies, prospective trials, and review articles were selected. A total of 38 articles were identified on the subject, and 27 were included in the study. The data for gynecologic cancer show comparable results between robotic and laparoscopic surgery for estimated blood loss, operative time, length of hospital stay, and complications. Overall, there were more wound complications with the laparotomy approach compared with laparoscopy and robotic-assisted laparoscopy. There were more lymphocysts, lymphoceles, and lymphedema in the robotic-assisted laparoscopic group compared with the laparoscopy and laparotomy groups in patients with cervical cancer. Infectious and lung-related morbidity, postoperative ileus, and bleeding or clot formation were more commonly reported in the laparotomy group compared with the other 2 cohorts in patients with endometrial cancer. Computer-enhanced technology may enable more surgeons to convert laparotomies to laparoscopic surgery with its associated benefits. It seems that in the hands of experienced laparoscopic surgeons, final outcomes are the same with or without use of the robot. There is good evidence that robotic surgery facilitates laparoscopic surgery, with equivalent if not better operative time and comparable surgical outcomes, shorter hospital stay, and fewer major complications than with surgeries using the laparotomy approach.     

Laparoscopic surgical anatomy for pelvic floor surgery

Understanding anatomy is one of the pillars for performing a safe, effective, and efficient surgery, but recently, it is reported that there has been a decline in teaching anatomy during the preclinical years of medical school. There is also evidence that by the time a medical student becomes a clinician, a considerable proportion of the basic anatomy knowledge is lost. Hence, it is crucial for surgeons performing or assisting in pelvic floor surgery to revisit this integral clinical aspect of pelvic anatomy for performing a safe surgery.Pelvic organ prolapse repair, especially abdominal laparoscopic sacrocolpopexy, which is the gold standard of pelvic organ prolapse repair, presents a significant challenge to surgeons because the technique requires thorough and meticulous negotiation through abdomino-pelvic vascular structures and nerves supplying the pelvis, rectum, and ureters. The abdominal laparoscopic sacrocolpopexy surgery requires surgeons to have a deep understanding of anatomy to prevent potential life-threatening complications, which is as critical as it is for a pilot to understand the navigation route for a safe landing. This review is an extensive look and a great reminder to laparoscopic surgeons working in the pelvic cavity, especially those performing a pelvic floor surgery, about the anatomical safe routes for performing laparoscopic pelvic floor repairs.For easy reading and clear understanding, we have described step by step the safe anatomical journey a surgeon needs to take during laparoscopic sacrocolpopexy. We divided the technique into five critical anatomic locations (landmarks), which serves as our “flight map” for performing safe and efficient laparoscopic sacrocolpopexy.     

The role of lasers in advanced operative laparoscopy.

Lasers, electrosurgery, and conventional pelviscopic techniques all provide the accomplished endoscopic surgeon with a sophisticated approach to advanced operative laparoscopy. The different lasers, as well as other energy delivery systems and conventional techniques, offer a wide choice of pathways through which a desired end result may be achieved. The sophisticated laparoscopic surgeon is able to choose the best instrument and technique to fit the purpose of the operation and skills of the surgeon. As in conventional surgery, different surgeons prefer different instruments and use different techniques. These various instruments and operative techniques should be considered synergistic rather than competitive, because they have greatly increased the scope and safety of laparoscopic surgery.     

Robot-assisted techniques and outcomes in the realm of pelvic reconstructive surgery

Robotic-assisted surgery for the treatment of pelvic organ prolapse continues to grow in popularity as more surgeons adopt this technology. Encompassing all of the benefits of laparoscopic surgery, robotic-assisted techniques allow more surgeons the ability to perform complex tasks such as meticulous deep pelvic dissection and extensive suturing without having to resort to laparotomy. This chapter reviews the techniques involved in the robotic approach to pelvic reconstructive surgery and discusses the currently available information focusing on the outcomes of this procedure.