産婦人科内視鏡の進展と教育・臨床・研究(特別講演1,第66回日本産科婦人科学会・学術講演会)

NDLデジタルコレクション
  • 深谷,孝夫
    高知大学産科婦人科:東北薬科大学病院産婦人科

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タイトル別名
  • Gynecological Laparoscopic Surgery : Proceeding, Education and Research

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Since Kurt Semm established methods of modern endoscopic surgeries, development of surgical skills becomes remarkable year by year. Accordingly, Mouret, one of the pioneer of laparoscopic cholecystectomy, described "before that (laparoscopic cholecystectomy) there was nothing, after that there was laparoscopic surgery. Indeed, we are now facing the era of glory days of endoscopy, which promise minimally invasive treatment for many diseases. Now, not only physicians but also patients are familiar with the excellent expansion of the endoscope into abdominal cavity, thoracic cavity and etc., which were once thought inaccessible without larger incision of body surface. Among surgical fields, gynecologic laparoscopy has been thought as the top runner since the beginning of modern endoscopic surgery. Notably, Semm, called as "the Magician from Kiel", was the pioneers and funder of this new method. He has introduced laparoscopic operation for ovarian cystectomy, adhesiolysis, ectopic pregnancy, and tubal ligations and so on in the early 1960's. Among his noteworthy achievements, the most significant innovation was the produce of automatic insufflator, which certifies much safer operative procedure under laparoscopy. At the present time, many advanced operative procedures such as hysterectomy, supracervical hysterectomy, management of extensive endometriosis, pelvic lymphadenectomy, repairment of the ureter and bladder, paraortic lymphadenectomy, radical hysterectomy, robotic surgery are accepted world wide. In the past 20 years, the development of technical advances of laparoscopic approach allowed to perform the many gynecological surgical procedures. Moreover, several advantages have been endorsed by patient, namely, the reduction of postoperative pain, ileus, and day of hospitalization and less adhesion formation. However, in the modern procedure of laparoscopic surgery, there are many complexities as well as innovativ e instruments, which sometimes causes serious complication. It is therefore, systematic continuous education not only trainee but also expert to perform laparoscopic surgery is required. In the future, we need the sophisticated methods of training, and consistent scoring systems in order to perform reliable and safety laparoscopic operation. In this point, the trainings using both dry box and animal laboratory may be promising. Nowadays, laparoscopic surgery is recognized as one of important tool in modern surgical treatment. Moreover, we always have to remember that this important tool is encouraging for scientific clinical research. In this presentation, author showed two interesting results, 1) improved outcome of fecundity by laparoscopic laser drilling for PCO patients, 2) effect of peritoneal environment on regurgitated endometrial tissue processing in patients with and without endometriosis. These scientific researches were never performed unless laparoscopic procedure and it is obvious that this modern method must inspire for many research field.

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