微創手術在婦產科的運用
Introduction
• 1807 Bozzini: a candle light conductor
• 1880 Nitze developed the cystoscope
• 1901 Kelling : celioscope examination of a
living dog after pneumoperitoneum
• 1901 Jacobaeus: laparoscopy by direct
insertion of a Nitze cystoscope
• 1938 Veress: a new needle for inducing
pneumothorax for the treatment of TB for
pneumoperitoneum.
Introduction
• 1937 the first gynecologic report was
published by Hope on the use of the
laparoscope for diagnosis of tubal
pregnancy
• 1941 Power and Barnes : for tubal
sterilization
• 1952 : cold light
History
• 1952: Fiberoptics
• 1972 American Association of
Gynecologic Lparoscopists was formed
1987-1992 residents should document
their training in gynecologic endoscopic
procedure.
Introduction
• 1973年台大醫學院黃國恩教授使用內生殖鏡輸卵
管節育法替病人結紮。
• 1975年馬偕醫院蔡明賢醫師使用開放式腹腔鏡術
做診斷。
• 1977年中興醫院林水盛、張中全做子宮外孕的腹
腔鏡診斷,減少錯誤診斷及不必要的剖腹手術。
• 真正開始手術性腹腔鏡是由劉宗元、歐朝士兩位
教授於1991至1993年前後六次回國教授內視鏡手
術
Benefit
• Reduce peritoneal trauma
• Reduce contamination of the peritoneal
cavity
• Less adhesion
• Shortened stay
• Small wound
Potential limitation
• Operative field can be reduced
• Difficult suture
• Prolonged operating room time
• More expensive surgical equipment
• Surgical expertise
• With an adequate combination of ability,
training and experience, operative time
and complications are comparable to
those of traditional abdominal surgery
WHO suggest
• Sterilization
• Ectopic surgery
• Diagnostic
Tubal surgery
• Sterilization:
• Since 1960s
• Suture, clips, silastic rings
• Electrosurgical desiccation with bipolar
energy
• Failure rate: 5.4/1000
Ectopic pregnancy
• Laparoscopic salpingostomy,
• Laparoscopic salpingectomy
• Laparoscopic segmental resection of a
portion of the oviduct
Ovarian surgery
• Ovarian masses:
• Removal of the selected ovarian masses
• Preoperative ultrasonography
• Sonolucent, thin wall, no solid components
• CA 125
• Mature teratoma
• Ovarian torsion
• Through laparoscopic cannula and posterior
colostomy
Use retrieval bag
Endomtriosis
• Recent finding:
• Large, long term, prospective studie and
placebo controlled, randomized, controlled
trial suggest laparoscopic excision is an
effective treatment approach for patients
with all stages of endomtriosis.
Uterine surgery
• Hyeterectomy
• Total laparoscopic hysterectomy (TLH)
• Subtotal laparoscopic hysterectomy (SLH)
• Vaginally assisted laparoscopic
hysterectomy (VALH)
• Laparoscopically assisted vaginal
hysterectomy
Laparoscopic myomectomy
• Menorrhagia and anemia
• Pelvic pain and pressure
• Enlarging leiomyoma and possibility of
neoplasia
• Associated fetal wastage or infertility
• Gestational size more than 12 wks
• Obstructed ureter
The Role of laparoscopy in the
management of gynecologic
malignancy
• Ovarian cancer
• Cervical cancer
• Endometrial cancer --- favored
Laparoscopy in endometrial cancer
• Surgical staging
• Early stage
• Cell type: exclude clear cell and papillary
serous cell
• Pelvic lymph node sampling
Hysteroscope
• Diagnostic hysteroscope
• Operative hysteroscopy
• Trascervical resection of submucosal
uterine myoma
• Endometrial ablation of endometrium
• Synechiae
Conclusion
• 約80%的婦科手術可以用腹腔鏡完成
• 微創手術已成為主流
Thank you
微創手術在婦產科的運用
Introduction
Introduction
History
Introduction
Benefit
Potential limitation
WHO suggest
Tubal surgery
Ectopic pregnancy
Ovarian surgery
Use retrieval bag
þÿ
þÿ
þÿ
þÿ
þÿ
þÿ
þÿ
þÿ
Endomtriosis
Uterine surgery
þÿ
þÿ
Laparoscopic myomectomy
þÿ
þÿ
The Role of laparoscopy in the management of gynecologic malignancy
þÿ
Laparoscopy in endometrial cancer
Hysteroscope
þÿ
Conclusion
Thank you