Evolution of Operative Laparoscopy in Gynecology: A Mirage or a Challenge?

摘要

The first successful surgical treatment of ectopic pregnancy was described in 1883 by Tait 1. It was not until over a century after this (1973) that Shapiro and Adler described treatment of ectopic pregnancy by laparoscopy, the emergence of laparoscopy as a credible therapeutic intervention in the early 1980s heralded a new surgical age and today it is fast replacing most of the traditional gynaecological abdominal operations2, 3, 4. Technical developments in optics, illumination, video technology and instrumentation has further extended the frontiers from diagnostic to operative laparoscopy5. As the list of laparoscopic procedures grows, many of the traditional abdominal or pelvic surgical procedures can be done via minimal invasive approach using the laparoscope6. Advanced laparoscopic surgery is gradually evolving and may become the mainstay of operative management in gynaecologic oncology such as staging, lymphadenectomy, and radical surgery as well as in advanced endometriosis. Laparoscopic surgery contributes to remarkable improvement in cancer patients care, allows for quicker recovery and faster initiation of chemotherapy when indicated. The short hospital stay and recovery time have a positive impact in a cancer patient's quality of life, as they return to normal activities rapidly7. Furthermore, the advent and expanding roles of robotics in minimally invasive gynaecologic surgery, the future of laparoscopy promises to be brighter as this provides a means to overcome the limitations of conventional laparoscopy through the use of 3-dimensional imaging and more dextrous and precise instruments. Current studies clearly demonstrate the feasibility and safety of applying robotics to the entire spectrum of gynecologic procedures8. Laparoscopic surgery has gained ground due to its many advantages over laparotomy. To the patient; avoidance of the discomfort of a large abdominal incision, reduction of post-operative pain, reduction of wound complications and better cosmetic effect. Others are early mobilization, early discharge from the hospital, early resumption of routine activities and less adhesion formation4, 7, 8. It thus minimizes the burden on patients, their employers and their families 9. On the part of the surgeon, improved visualisation offers the opportunity of more precise and accurate surgery 10. As the shift of minor treatment to day, ambulatory or even office care is becoming inexorable, and major surgeries performed via laparoscopy, the resultant reduced length of