Manual for Laparoscopic and Hysteroscopic Gynecological Surgery L Mettler
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1GENERAL2

IntroductionCHAPTER ONE

L Mettler
In the last three decades minimally invasive endoscopic surgery has developed as an alternative to classic conventional surgery in quite a few specialties. Its growth in gynecology took substantially longer than its development in general surgery, even though gynecology represents the real cradle of operative endoscopy. Particularly in Germany, for a long time the advocates of classic gynecological surgery were reserved towards the methods of minimally invasive surgery. Nonetheless its rapid, almost explosive dissemination occurred because of its obvious advantages. After a phase of almost uncontrolled trials of all operative possibilities, followed a time of consolidation with the laying down of exactly outlined indications and the standardization of practical interventions.
The microsystem technique, microsensors, computer, robot and video technology as well as the use of new instruments and energy sources had substantially influenced the spread of this new technology. In the areas of conflict between doctor, patient and industry new methods and further areas of applications were developed. New access methods with catheters, rigid and flexible endoscopes, with improved two- and three-dimensional video units, optimized hemostasis (endocoagulation, high frequency technique, sutures, stapling techniques, laser coagulation and ultrasound) as well as the development of instruments offering more freedom have made the wide use of the endoscopic surgery possible in almost all operative and invasive diagnostic specialties.
The application of minimally invasive surgery brings many advantages for our patients, particularly demonstrated in an improved quality of life. Another advantage includes the social dimension with short hospitalization and fast integration back into the family and professional life is also included. Compared to laparotomy, the minimally invasive access to the operating area reduces unpleasant side effects such as intestinal atony. Consequently, the minimally invasive surgery also decreases postoperative discomfort.
In this book, operative methods of endoscopic gynecology are presented which have been developed and established over the years by surgically well-versed authors. Subsequent to great demand, the main emphasis is on the description of the individual surgical steps and their practical application.
The selection of topics and detailed description of the individual operative steps were undertaken not only with the intention of offering operating gynecologists and surgeons a template to work with but also to impart as extensive an insight as possible into the gynecological laparoscopy to younger interested doctors.
Compared to its development in general surgery, this technology took substantially longer to establish in gynecology, even though gynecology represents the real cradle of operative endoscopy.