内視鏡手術の現況 婦人科領域における内視鏡手術

Abstract

There are many women with fibroids or endometriosis. Since endoscopic surgery was approved for insurance coverage in Japan, these procedures have increased dramatically. Recently the incidence of laparoscopic surgery for benign disease has reached over 95 percent in our hospital, Nihon University Surugadai Hospital, and our institution is designated as a high performance level hospital in Japan. As there is the important problem of cost-benefit, e.g. because of the high cost of disposable instruments, we use reusable forceps in our hospital. It is clinically important to carefully evaluate benign tumors. After the preoperative status of uterine fibroids and ovarian tumors has been evaluated regarding tumor size, location and possibility of malignancy, we determine whether laparoscopic surgery or laparotomy is the best operation for the patient. The ultimate aim of infertility management is for women to go to term safely upon becoming pregnant. Although malignant tumors are contraindications for laparoscopic surgery at present, we believe that in the future malignant tumors are going to be treated laparoscopically following careful evaluation of each case. Difficult operations are more easily performed than previously, due to the increase of skills. Meanwhile, there have been various reports on several unexpected accidental complications. We must improve the management of emergencies and the prevention of accidental complications.