Gynaecological Surgery
The Future of Endoscopic Surgery in Gynaecology Vadim V Morozov1
and Ceana Nezhat2
1. Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine; 2. Associate Professor of Obstetrics and Gynecology, Stanford University School of Medicine and Emory University School of Medicine, and Fellowship Director, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine
Abstract
The last century and the beginning of the current one witnessed enormous progress in the surgical field with advancement of minimally invasive surgery. From simple endoscopy for exploration of the abdominal and pelvic cavities to advanced 3D articulation, gynaecological surgeons were pioneers of novel techniques. Computer-enhanced surgical systems, ‘fused’ with the latest imaging modalities and advanced energy sources, are already gaining access to operating rooms worldwide. The future of endoscopic surgery in general, and gynaecological surgery in particular, lies in the hands of the new generation of surgeons, with fewer and smaller incisions combined with 3D imaging systems and microprocessor-enhanced visualisation.
Keywords
Endoscopy, robotics, 3D surgery, single-incision laparoscopic surgery (SILS), laparoscopic single-site surgery (LESS), minimally invasive surgery (MIS), video laparoscopy, video endoscopy
Disclosure: Vadim V Morozov is a Proctor for Intuitive Surgical. Ceana Nezhat is a consultant for Conceptus, Ethicon Women's Health and Urology, Hologic, Intuitive Surgical and Karl Storz Endoscopy. He is also a medical advisor for Plasma Surgical and on the scientific advisory board for SurgiQuest. Received: 2 December 2011 Accepted: 16 January 2012 Citation: European Obstetrics & Gynaecology, 2012;7(1):51–5 Correspondence: Ceana Nezhat, Atlanta Center for Special Minimally Invasive Surgery & Reproductive Medicine, 5555 Peachtree Dunwoody Rd., Suite 276, Atlanta, GA 30342, US. E:
cnezhat@nezhat.com
From the ancient times of Egyptian medicine around 3000 BC, throughout the early history of medicine and surgery of the Chinese and Greeks, to the surgical developments of the last two centuries, fascination with the human body and internal structures was a major driving force behind tireless efforts to improve surgical outcomes. The history of endoscopic surgery closely parallels the advances and setbacks of medical progress.1
Although Avicenna (Ibn Sina) is credited with the use of natural light and reflective mirrors for the examination of the natural internal cavities, and multiple attempts at visualising body cavities were made throughout the Renaissance period, it was not until the 19th century that the true era of endoscopy began.2
Although minimally invasive surgery as we know it was mainly developed in the 20th century, with gynaecological surgeons pioneering the techniques, historically speaking Bozzini in Italy is believed by many to be the father of endoscopy. With his invention of the Lichtleiter (light conductor) in the early 19th century, he truly revolutionised the ability to perform an endoscopic examination.3
Most
importantly, his was the first successful attempt on a live patient with direct clinical benefits. It took more than 100 years and multiple industrial developments in instrumentation to bridge the gap between surgical curiosity and successful endoscopic procedures.
It is generally accepted that the first laparoscopy was performed by Kelling in Germany in early 1900s – he utilised the simple cystoscope to perform a coelioscopy.4
of light sources and camera equipment, the technique was perfected © TOUCH BRIEFINGS 2012
and further developed by Palmer and formally incorporated into the surgical arena by Semm in the second half of the 20th century.5
Although
obviously beneficial to patients, the technology was still in its infancy for many years, partially due to the difficulty of direct intra-abdominal visualisation and cumbersome manipulation of the primitive instruments. The playing field changed dramatically with the development of hand-held cameras and the microchip head attached to the laparoscope, pioneered by Camran Nezhat. The ability to operate from a remote monitor, combined with better laparoscopic instruments, brought the field of minimally invasive surgery to the level of surgical standard of care.6
Over several decades, with better development
Although the last two decades of the 20th century witnessed enormous progress in minimally invasive gynaecology, the change and adaptation of new technology was not as smooth and widely accepted as one would anticipate. Inherited difficulties of laparoscopic surgery, such as a steep learning curve, different schools of surgical thought, loss of perception of depth with a flat screen monitor and rigid and counterintuitive motions of the laparoscopic instruments were among the many obstacles to widespread adaptation of minimally invasive gynaecological procedures. The perception and acceptance of endoscopic gynaecological surgery began to shift into the positive with the invention and customisation of instruments, from utilisation of vessel-sealing devices to the use of different lasers and ultrasound dissectors. The introduction of computerised surgical systems and 3D imaging into everyday surgical practice will change the way the operating room (OR) of the future is run. Learning from the ‘labour pains’ and mistakes of the past, the future of gynaecological surgery
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