The past, present and future of minimally invasive endoscopy in gynecology: A review and speculative outlook

Abstract

Over the last twenty-five years, minimally invasive surgery (MIS) has evolved in a relatively short period of time to overtake the centuries-old visionary and pioneering groundwork of our outstanding colleagues in all surgical disciplines. This overview on the development of gynecological endoscopy, at the invitation of SMIT, highlights past achievements and describes present challenges. It emphasizes future opportunities and possibilities to foster interdisciplinary collaboration and integrate emerging endoscopic, imaging and stereotactic surgical technologies to improve patient safety, enhance quality of care and advance surgical education. This article will introduce younger colleagues to the exciting world of contemporary gynecologic endoscopy and help them appreciate the immense technology-laden opportunities that the future holds for those who are prepared to follow in the footsteps and aspirations of our founding surgical colleagues.

Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: Case report and review of the literature

“…Pneumoperitoneum is the basis of conventional laparoscopy as the constant pressure of about 14 mmHg CO 2 provides optimal field exposure by lifting the abdominal wall (9). However, pneumoperitoneum in combination with Trendelenburg position enhances a considerable reduction of ventilation which may limit minimally invasive surgery in cardiopulmonal high risk patients and in obese patients.…”

Method for minimising rolling joint play in the steerable laparoscopic instrument prototype DragonFlex

“…Even though the play values exhibit a significant drop from the original to the optimised joint curvature at the 90 bend (Figure 5c), the steering angle of the new real-scale DragonFlex prototype ( Figure 6) was limited to ±80 in the interest of avoiding the instability at the former extremes. When looking at the state-ofthe-art steerable MIS instruments (17,20,21), the steering angle usually spans within ±60 as in the case of Autonomy Laparo-Angle (CambridgeEndo, Framingham, MA, USA) or Miflex (DEAM, Amsterdam, The Netherlands) (7) and even reaches ±80 in SILS Hand (Covidien, Mansfield, MA, USA) (22) and 90 in half a DOF (articulation in a single plane and direction) in r2 DRIVE (Tuebingen Scientific, Tuebingen, Germany) (23). Thus, the ±80 steering angle in the new DragonFlex prototype should not pose any restriction.…”

Complications of Laparoscopy in Connection with Entry Techniques

“…Depending on the patient's medical history, it would be important to take anatomical malformations, midline abdominal incisions, and/or a history of peritonitis or inflammatory bowel disease into account. 3,4 …”