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If you are looking for minimally invasive surgery medical instruments with good quality, competitive price and reliable service. Wanhe medcal is manufaturing these for you. We provide general and professional laparoscopic instruments with CE, FDA approved.

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FAQ

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Which patients are not suitable for minimally invasive gynecological surgery?

Related report: American Society for Reproductive Medicine Laparoscopy and Hysteroscopy Patient Guidelines

Based on multiple evidences, the following patients are not suitable for minimally invasive gynecological surgery:

Patients with severe internal and surgical complications who cannot tolerate surgical operations: Such patients cannot bear the risks and stress of surgery due to their poor physical condition.

Patients with acute pelvic inflammation and vaginal inflammation: During the acute phase, the patient's infection symptoms may worsen, increasing the difficulty and risk of surgery.

Patients with active uterine bleeding or severe anemia: These conditions increase the risk of bleeding during surgery and may affect postoperative recovery.

Patients with normal pregnancy: There is a high risk of surgery during pregnancy, so it is recommended to avoid minimally invasive gynecological surgery during this period.

Patients with a recent history of uterine perforation: Such patients may have a psychological burden on undergoing similar surgery again, and the surgical risk is high.

Patients with invasive cervical cancer or genital tuberculosis who have not been treated with anti-tuberculosis: These diseases require special treatment methods and are not suitable for conventional minimally invasive surgery.

Acute patients with heart, liver, and kidney failure: The physical condition of these patients does not allow any surgical operation, including minimally invasive surgery.

For patients whose surgery is intended to relieve symptoms rather than radical treatment and who do not have good psychological tolerance: Such patients may not be able to accept long-term management and follow-up treatment after surgery.

Patients with submucosal fibroids with a diameter of less than 5 cm: Although surgery can be considered in some cases, it is usually not recommended as the first choice of treatment.

Patients without fertility requirements: For those who clearly state that they do not need to preserve fertility, other non-surgical treatments can be chosen.

Patients whose cervical scars cannot be fully expanded: In this case, the hysteroscope cannot enter the uterine cavity smoothly, and the surgery cannot be completed.

Patients with excessive uterine curvature and the hysteroscope cannot enter the uterine fundus: This is also due to anatomical problems, which makes surgery impossible.

Patients with acute genital tract infection: In the acute infection period, the infection needs to be controlled before surgery, otherwise the risk of infection spreading will increase.

Patients with skin cancer, genital cancer, or any other cancer: These patients are not suitable for surgery due to impaired immune systems or other serious diseases.

Patients with neurological disorders such as mental illness, epilepsy, and neurosis: The neurological problems of these patients will affect the surgical process and postoperative recovery.

Patients with severe heart failure and coronary heart disease: These cardiovascular diseases increase the risk of surgery and should avoid surgery.

Patients with infectious diseases and infectious skin diseases: These patients are prone to spread diseases through surgery and should avoid surgery.

Women during menstruation: The body is in a special state during menstruation, which is prone to complications, so it is not recommended to undergo surgery during this period.

Summarizing the above information, it can be seen that when choosing whether to perform minimally invasive gynecological surgery, doctors need to comprehensively consider factors such as the patient's health status, the type of disease and its severity. For patients with the contraindications listed above, they should be carefully evaluated and other appropriate treatment options should be adopted.

What are the risks and complications of minimally invasive gynecological surgery?

Although minimally invasive gynecological surgery is less invasive and has a fast recovery, it still has certain risks and complications. The following are several common minimally invasive gynecological surgeries and their related risks and complications:

Laparoscopic surgery:

Postoperative abdominal distension: Discomfort caused by gas accumulation in the abdominal cavity.
Deep vein thrombosis: Long-term bed rest may lead to thrombosis of the lower limb veins.
Urinary retention: You may not be able to urinate normally after surgery and need catheterization.
Anemia caused by intraoperative blood loss: Although the amount of bleeding is usually small, blood transfusion is still required in some cases.
Urinary tract injury: If the bladder or ureter is damaged, further examination or surgical treatment may be required.
Damage to large blood vessels: Serious complications such as organ necrosis may occur.
Infection: Including pelvic or wound infection, which needs to be treated promptly to prevent spread.
Secondary bleeding: Bleeding may occur again after surgery and requires emergency treatment.
Intestinal obstruction: Postoperative intestinal dysfunction may lead to intestinal obstruction, which requires surgical relief.

Hysteroscopic surgery:

Uterine perforation: This is the most common complication of hysteroscopic surgery, with an incidence of about 0.26% to 0.58%. Perforation may cause bleeding or other organ damage.
Adhesions: Endometrial adhesions may occur after surgery, affecting fertility.
Infection: Including intrauterine infection and pelvic infection, which require antibiotic treatment.
Air embolism syndrome: a serious complication caused by gas entering the blood circulation system, although rare but extremely harmful.
Uterine distention fluid overabsorption syndrome: related to the fluid used to expand the uterus, which may cause pulmonary effusion, blood clots, etc.

Colposcopy and loop electrosurgical excision procedure (LEEP):

Bleeding: common and usually mild, but sometimes more serious.
Infection: uncommon, but still need to be prevented.
Burns to surrounding tissues: rare, but beware of damage to surrounding tissues by electrocautery.
Damage to nearby organs: such as bladder damage, further treatment is required.
Deep resection increases the risk of miscarriage or premature birth: especially for women planning future pregnancies, this is a potential risk factor.

Other precautions:

Anesthesia complications: including heart disease, stroke and venous thrombosis, etc., need to be evaluated in detail before surgery.
Shoulder pain: Some patients may feel shoulder pain after surgery, which is related to the distribution of carbon dioxide gas in the body.

How to evaluate whether a patient is suitable for minimally invasive gynecological surgery?

The evaluation of whether a patient is suitable for minimally invasive gynecological surgery requires comprehensive consideration of multiple factors, including pathological type, clinical stage, patient age and health status. The following are detailed evaluation steps:

Pathological type and grading:

For endometrial cancer, family history, general evaluation and comorbidity history, geriatric assessment (if applicable), clinical examination (including pelvic examination), and vaginal or rectal ultrasound or pelvic magnetic resonance imaging under expert opinion must be performed before surgery.
Minimally invasive surgery for cervical cancer should be selected for low-risk cases, such as small lesions, well-differentiated, and no deep stromal infiltration; for high-risk cases, laparotomy is recommended
.
Clinical staging:

For early-stage disease, the preferred minimally invasive surgery is for patients with high-risk endometrial cancer. Any abdominal tumor spillage, including tumor rupture or cysts, should be avoided.
Lymph node staging: For patients with low-risk/intermediate-risk disease, sentinel lymph node biopsy can be considered for staging. If there is no muscle invasion, systematic lymph node resection can be omitted. For patients with high-risk/high-risk diseases, lymph node staging should be performed.

Patient health status:

Anesthesiology clinics need to be evaluated and screened, and standards should be established to ensure patient safety.
For ovarian preservation and salpingectomy, ovarian preservation is recommended in premenopausal women under 45 years old without obvious ovarian or other peripheral diseases.

Informed consent:

Patients should be informed of the latest research progress, the pros and cons of minimally invasive surgery and laparotomy, and explain that laparotomy is still the safest option at present.
Fully informed consent and respect the patient's choice.

Doctor qualifications:

Minimally invasive surgery for gynecological malignancies should have strict access requirements, and gynecological tumor surgery should not be performed by physicians who are still in training or have unqualified training.

Other imaging examinations:

Based on clinical and pathological risks, additional imaging examinations should be considered to evaluate metastatic diseases in the ovaries, lymph nodes, peritoneum, and other sites.

Indications for surgery:

For benign diseases, single-port laparoscopic surgery (LESS) is a major indication, and with the development of technology, LESS will occupy an important position in the field of gynecological surgery.

How long does it usually take to recover from minimally invasive gynecological surgery?

The recovery period after minimally invasive gynecological surgery is usually short. According to multiple evidences, minimally invasive surgery has a small incision (0.5 to 1 cm), leaves almost no scars, and has less pain after surgery, and greatly reduces damage to organs and functional interference.

Specifically, patients can usually be discharged from the hospital within 3 to 5 days after minimally invasive surgery. This is compared to traditional open surgery, which requires a 7 to 15-day hospital stay and a slower recovery. In addition, minimally invasive surgery usually does not cause bleeding or the amount of bleeding is very small, which further improves patient comfort.

However, for certain types of minimally invasive gynecological surgery, such as laparoscopically assisted vaginal hysterectomy (LAVH) or laparoscopically assisted partial hysterectomy (LASH), the recovery period may be 2 to 4 weeks. During this time, patients need to avoid activities such as strenuous exercise, heavy lifting, and swimming, and should follow the doctor's instructions for appropriate activities and care.

In summary, the recovery period after minimally invasive gynecological surgery is usually 3 to 5 days, but some complex surgeries may require a longer recovery period, generally 2 to 4 weeks.

What is the success rate of minimally invasive gynecological surgery for patients with a history of uterine perforation?

There is no clear data on the success rate of minimally invasive gynecological surgery for patients with a history of uterine perforation. However, some relevant information can be analyzed from the information I searched.

In an article in the bimonthly journal of Public Health and Preventive Medicine, the clinical data of 14 patients with uterine perforation during hysteroscopic surgery were analyzed, and the results showed that the incidence of perforation was 64.29%.

This shows that uterine perforation is a relatively common complication in hysteroscopic surgery, especially in cases with a history of surgery or other risk factors.

On the other hand, the clinical trial results of the laparoscopic single-port surgical system (Class III) mentioned in the technical review report for medical device product registration showed that the surgical success rate was 100%, the 95% confidence interval was (93.84%, 100%), and the lower limit of the 95% confidence interval of the surgical success rate was greater than 89%.

This data is for a specific type of minimally invasive surgical system, and does not specifically indicate whether it includes patients with a history of uterine perforation.

Based on the above information, although the specific statistical data are not completely consistent, it can be seen that patients with a history of uterine perforation may face higher risks and complications when undergoing minimally invasive gynecological surgery.

How to deal with patients in the acute phase of heart, liver, and kidney failure during minimally invasive gynecological surgery?

When dealing with patients in the acute phase of heart, liver, and kidney failure for minimally invasive gynecological surgery, it is necessary to consider many factors and take corresponding measures. The following is a detailed treatment method:

Preoperative evaluation and preparation:

Comprehensive evaluation: Perform a comprehensive physical examination and laboratory examination on the patient, including blood routine, urine routine, renal function test (such as creatinine clearance and blood urea nitrogen), electrolyte balance, etc.
Control of underlying diseases: For patients with diabetes, blood sugar levels need to be controlled and switched to subcutaneous injection of short-acting insulin; for patients with adrenal cortical insufficiency, hydrocortisone should be used before surgery and continued until the stress reaction of surgery is over before it can be discontinued.

Intraoperative management:

Maintain stable circulation: For patients with acute heart failure, appropriate drugs should be used to maintain stable circulation, such as diuretics, angiotensin-converting enzyme inhibitors or beta-blockers.
Monitoring vital signs: Closely monitor the patient's blood pressure, heart rate, respiratory rate and blood oxygen saturation, and promptly detect and deal with possible complications.

Postoperative management:

Renal replacement therapy: For patients with acute renal failure, dialysis or other renal replacement therapy methods are selected according to the severity of the disease. Early diagnosis and timely intervention are key.
Respiratory support: For patients with respiratory failure, mechanical ventilation support is provided when necessary to ensure adequate gas exchange.
Nutritional support: Supplement calories, protein and vitamins to promote postoperative tissue repair and wound healing.

Handling of special situations:

Avoid high-risk operations: In the acute phase, try to avoid high-risk operations such as punctures or lacerations to reduce the incidence of postoperative complications.
Psychological care: Inform patients of disease-related knowledge, anesthesia and surgery-related knowledge, guide patients to perform relevant adaptive exercises before surgery, quit smoking, maintain oral hygiene and keep warm, etc.

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