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RISS 인기검색어
- 검색키워드
- 저자 : ( Sai Rok Park ) (검색결과 2 건)
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Endoscopic Surgeries in Gynecology
Park, Sai Rok 中央醫學社 1996 中央醫學 Vol.61 No.6
General Review For the last five years, the rapid expansion of operative laparoscopy has resulted from the availability of more suitable equipments and the enthusiastic acceptance by gynecologist. Most individuals can return to full activities within one or two weeks, in contrast to four to six weeks recovery period after abdominal surgery. The widespread acceptance of such procedures has prompted even more extensive applications of operative laparosocpy. Not only are vaginal hysterectomies with bladder and vaginal vault suspension possible, but extensive cancer surgeries including lymphadenectomies also are performed. In the present environment, efforts to maintain cost control in all aspects for the health delivery process make "outpatient surgeries" all the more attractive. Advances in endoscopic techniques have facilitated the outpatient approach. Now we are on the verge of a revolution in gynecologic surgery. Some authorities predicted that gynecologic surgery as we know it today will no longer exist in another decade or will be significantly modified. It is mandatory to have hand-eye coordination to perform more complicated endoscopic surgeries, which will be obtained only by repeated practice. It is also necessary for gynecologists to fully familiarize the anatomies to avoid serious complications. Anatomical Review 1. deep and superficial abdominal wall vasculatures - inferior epigastric artery. 2. pelvic organs - aorta, iliac artery, hypogastric and uterine artery, ureter, bladder. Laser application ; CO2, YAG, KTP, Argone edometrial ablation, metroplasty endometriosis, lysis of adhesion, LUNA tuboplasty, *LAVH, myomectomy Endoscopic Surgeries operative hysteroscopy - endometrial ablation, myoma resection, metroplasty Bleeding, refractory to medical and surgical theraphy Patient, dissatisfied with hormonal theraphy Patient, refused hystereotomy Patient, high surgical and anesthetical risk Contraindication Pelvic and endometrial infection Cervical and endometrial carcinoma/atypia Known or suspected pregnancy Complication Trauma - perforation of uterus Injury - bowel and other organ Bleeding, infection Fluid overload - hyponatremia, hypervolemia, pulmonary and cerebral edema Central pontine myelinolysis due to rapid correction of hyponatremia Method YAG laser Electrods - roller ball, roller bar, loop cutting current-100?110 W coagulation - 80?100 W more hazardous area - roller ball blended current 80?100W Pre-op preparation Progestin for 6 weeks Danoacrine 800mg 6?8weeks GnRH agonist Mechnical preparation - suction curretage Result Amenorrhea 50 Hypomenorrhea 26 %, 93 % improved Eumenorrhea 17 % Failed 7 % Myoma resection in addition to ablation symptomatically improved 91 lower incidence of amenorrhea 39 %
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