Laparoscopic surgery

Hysteroscopy is an optical instrument used to observe, diagnose, and treat uterine cavity. Hysteroscopy can be divided into diagnostic and surgical types, as well as soft and hard. The soft diagnostic hysteroscope is made of advanced optical fiber. It has small diameter and can be bent at will. It is easy to observe and diagnose the whole uterine cavity. The inspection process is fast (about 2~5 minutes), it does not hurt, it does not hurt the uterus. . Laparoscopic surgery is a newly developed minimally invasive method and an inevitable trend in the development of future surgical methods. With the rapid advancement of industrial manufacturing technology, the integration of related disciplines has laid a firm foundation for the development of new technologies and methods. Coupled with the increasingly skilled operation of doctors, many past open operations have now been replaced by endoscopic surgery. Greatly increased the chance of surgery selection. Treatment of diseases: cervical cancer renal cyst Indication Hysteroscopy 1, abnormal uterine bleeding. 2, infertility or repeated abortion. 3, uterine malformations. 4, foreign bodies in the uterine cavity. 5, the diagnosis of intrauterine adhesions. 6, the diagnosis of intrauterine device. 7, hysteroscopic treatment indications. 8, dredge the fallopian tube opening. 9, sputum inside the neck tube. Laparoscopic 1, pelvic mass: ovarian cyst opening window, drainage, ovarian tumor stripping, attachment resection, tubal mesenteric cystectomy. 2, uterine fibroids: uterine fibroids, adenomyoma stripping, adenomyosis, hysterectomy and so on. 3. Early diagnosis of ectopic pregnancy with conservative or radical surgery. 4, infertility in the diagnosis of the cause of pelvic adhesions and fallopian tube plastic surgery. 5. Electrocoagulation or resection of endometriosis lesions. 6, the examination of the source of pelvic infectious diseases, and at the same time pelvic adhesions, abscess incision and drainage, tubal ovarian cystectomy. 7. Family planning: removal of the birth control ring, uterine perforation wound repair, sterilization, and fallopian tube anastomosis. 8, reproductive assisted aspects: mature egg aspirate, gametophytic fallopian tube transplantation, polycystic ovary puncture, drilling. 9, genital malignant tumor surgery: early endometrial cancer, cervical cancer, ovarian cancer surgery, including extensive hysterectomy, pelvic and para-aortic lymphadenectomy, omentum and appendectomy. Contraindications Hysteroscopy There are no clear absolute contraindications, the following are relative contraindications. 1, vaginal and pelvic infections. 2, a lot of uterine bleeding. 3, want to continue pregnancy. 4, the current uterine perforation. 5, the uterine cavity is too narrow or the cervix is too hard, it is difficult to expand. 6, acute subacute inflammation of the reproductive tract 7, severe heart, liver, lung and kidney disease 8, cervical invasive cancer, 9, genital tuberculosis without anti-caries treatment 10, patients with serious medical problems, it is difficult to tolerate the expansion of the operator. 11, genital tuberculosis, without anti-caries treatment. 12. Those who have no follow-up treatment for blood diseases. Laparoscopic 1. Severe heart, lung, liver and kidney dysfunction. 2, huge mass in the basin, abdominal cavity: the upper boundary of the tumor exceeds the level of the umbilical hole or the uterus of the pregnancy is greater than 16 weeks of gestation. When the volume of the uterine fibroids exceeds the pregnancy in April, the space for the operation of the basin and the abdominal cavity is limited, and the mass obstructs the vision and establishes the gas. Abdominal or puncture may cause the rupture of the mass. 3, abdominal cramps or crossbow: artificial pneumoperitoneum pressure can press the contents of the abdominal cavity to crush the pupil, causing the incarceration of the abdomen. The contents of the abdominal cavity enter the chest through the sputum, which can affect the heart and lung function. 4, diffuse peritonitis with intestinal obstruction: due to the obvious expansion of the intestine, pneumoperitoneum or trocar puncture is easy to cause intestinal perforation. 5. Inexperienced surgeons. 6, severe pelvic adhesions: multiple operations such as intestinal surgery, multiple uterine fibroids stripping, etc. caused by dense, extensive adhesions around important organs or tissues, such as ureter, intestinal flexion, caused by separation of adhesions Damage to important organs or tissues. Preoperative preparation Hysteroscopy 1, for cardiopulmonary examination, blood pressure, pulse, check the white belt routine, cervical smear. 2, the choice of inspection time: In addition to special circumstances, generally within 5 days after menstruation is clean. Surgical procedure Hysteroscopy 1. Anesthesia and analgesia: You can choose any of the following: (1) Indomethacin suppository: 50-100mg of indomethacin suppository is inserted into the deep anus 20 minutes before the examination. (2) Cervical nerve block anesthesia: 5% of procaine was injected into each side of the cervix. (3) Cervical mucosal surface anesthesia: a 2% lidocaine solution was inserted into the cervical canal with a long cotton swab, and the inner cervix was leveled for 1 minute. (4) Uterine mucosal spray anesthesia: 0.25% bupivacaine 8ml was sprayed on the surface of the endometrium through a special lumen injector, and examined after 5 minutes. 2, inspection method: take the stone position, routine disinfection of the vulva and vagina, use the cervical forceps to clamp the anterior lip of the cervix, probe the depth and direction of the uterine cavity, according to the outer diameter of the sheath to expand to 6.5-7. Commonly used 5% glucose solution or saline to expand the palace, first empty the air between the mirror sheath and the optical tube, slowly put into the hysteroscopy, open the light source, inject the uterine fluid, the expansion pressure 13-15kPa (1kPa = 7.5mmHg ), after the uterine cavity is filled, the field of vision is bright, the mirror can be rotated and observed in order. First check the uterine fundus and the anterior, posterior, left and right wall of the uterine cavity and then check the uterine horn and the fallopian tube opening. Pay attention to the morphology of the uterus, the presence or absence of endometrial abnormalities or space-occupying lesions, the necessary uterine morphology, the presence or absence of endometrial abnormalities or space-occupying lesions, local biopsy if necessary, and careful examination of the cervix when slowly pushing out the scope Inner mouth and cervical canal. Laparoscopic Laparoscopic surgery is to make a small incision of 5 to 12 mm in diameter in different parts of the abdomen. Through these small incisions, a camera lens and various special surgical instruments are inserted into the abdominal cavity of the intraperitoneal cavity. The image of the device is transmitted to the TV screen, and the surgeon performs the operation by observing the image and operating it in vitro with various surgical instruments. Hysteroscopy 1, hysteroscopic surgery is generally best after 3-7 days of menstrual clean. 2. Sex life is prohibited after menstruation or 3 days before surgery. 3, preoperative urine can be appropriate to facilitate intraoperative B-ultrasound monitoring. 4, preoperative examination of hysteroscopic surgery: infectious disease examination (hepatitis B surface antigen, HIV, HCV, RPR), small liver function, kidney function, electrocardiogram, hematuria, coagulation four, vaginal discharge routine. 5, 1 week after surgery to the hospital to take pathological results and see a doctor. 6, a small amount of vaginal bleeding within 2 months after hysteroscopic resection, the third month is normal to menstruation. Laparoscopic Patients should pay attention to personal hygiene. It is best to remove the dirt in the umbilicus with a cotton swab dipped in soapy water or vegetable oil. Preoperatively, it should be based on light and easily digestible foods. Avoid large fish and large meat to prevent postoperative flatulence. At the same time, pay attention to adjusting the psychological state to ensure adequate sleep.