Njira Yosokoneza ya Medical Endoscopy mu Gynecology ndi Reproductive Medicine Kuzindikira ndi Chithandizo

1, Kusintha kosinthika muukadaulo wa hysteroscopy

(1) Mpeni wozizira wa hysteroscopy system

Kusokonezeka kwaukadaulo:

Kukonzekera kwamakina (monga MyoSure) ®) : Tsamba lozungulira lomwe lili ndi liwiro la 2500rpm limachotsa ndendende ma fibroids kuti mupewe kuwonongeka kwa magetsi kwa gawo lamkati lamkati.

Kuthamanga kwa madzi: Sungani mphamvu ya chiberekero pakati pa 50-70mmHg (electrocautery yachikhalidwe> 100mmHg) kuti muchepetse chiopsezo cha madzi ochuluka.

Mtengo wachipatala:

Nthawi yokonza endometrium pambuyo pa submucosal fibroid resection yafupikitsidwa kuchokera pa masabata 12 mpaka masabata anayi pambuyo pa electrocautery.

Mimba yachibadwa ya odwala osabereka pambuyo pa opaleshoni inawonjezeka kufika 58% (poyerekeza ndi 32% yokha mu gulu la electrocautery).

(2) 3D hysteroscopy navigation

Zowunikira zaukadaulo:

Real time 3D modelling (monga Karl Storz IMAGE 1 S Rubina): kuwonetsera kuya kwa nyanga ya chiberekero ndi mawonekedwe a kutsegula kwa fallopian chubu.

Kuphatikizidwa ndi deta ya MRI isanakwane, kulondola kwa kuzindikira zolakwika za chiberekero (monga mediastinum yathunthu) ndi 100%.

Zochitika zantchito:

Stereoscopic quantitative grading of intrauterine adhesions (Asherman syndrome).

(3) Fluorescence staining hysteroscope

Kupambana kwaukadaulo:

5-ALA imayambitsa chotupa cha protoporphyrin IX fluorescence, ndi chidziwitso cha 91% cha khansa yoyambirira ya endometrial (65% yokha pansi pa microscopy yoyera).

Malinga ndi kafukufuku wochokera ku National Cancer Center ku Japan, zotupa za atypical endometrial hyperplasia zosakwana 1MM zimatha kupezeka.

2, Kumanganso kwa Paradigm kwaukadaulo wa laparoscopic

(1) Single port robotic laparoscope (SPRS)

Da Vinci SP System:

Kudula kamodzi kwa 25mm kumagwiritsidwa ntchito kumaliza hysterectomy yonse, yomwe imawonjezera digiri ya zodzikongoletsera ndi 80% poyerekeza ndi opaleshoni ya porous.

Chida chapamanja chovomerezeka chimakwaniritsa ntchito ya 7-degree-ya-ufulu, ndikusoka ndi kuluka molondola kwa 0.1mm.

Zambiri zachipatala:

Kusungidwa kwa minyewa yachibadwa ya ovarian panthawi ya cystectomy ndi yoposa 95% (laparoscopy yachikhalidwe ndi pafupifupi 70%).

(2) Pafupi ndi infrared fluorescence navigation (NIR)

ICG lymphatic mapu:

Kuwonetseratu nthawi yeniyeni ya sentinel lymph nodes panthawi ya opaleshoni ya khansa ya khomo lachiberekero kumachepetsa dissection ya lymph node yosafunikira ndi 43%.

Fudan University Affiliated Cancer Hospital Plan: Kuphatikiza zolemba zobiriwira za indocyanine ndi nanocarbon wapawiri, kuchuluka kwadzidzidzi kwakwezedwa mpaka 98%.

(3) Kukweza kwa Akupanga Mphamvu Platform

Harmonic ACE+7:

Kusintha kwanzeru kwa ma frequency a vibration (55.5kHz ± 5%), kudula ndi kutseka mitsempha yamagazi 5mm nthawi imodzi.

Kuchuluka kwa magazi pa opaleshoni yochotsa uterine fibroids ndi zosakwana 50ml (traditional electrocautery>200ml).

3, Njira zochepa zowononga mankhwala obereketsa

(1) Hysteroscopy kulowererapo pakukonzanso machubu a fallopian

Kuphatikiza kwaukadaulo:

0.5mm Ultra-fine fiber galasi (monga Olympus HYF-1T) ophatikizidwa ndi kalozera waya wowonjezera hayidiroliki.

Njira yeniyeni yowunikira kuthamanga kwanthawi (<300mmHg) kuti mupewe kuphulika kwa chubu cha fallopian.

Zochizira:

The recanalization mlingo wa proximal obstruction ndi 92%, ndipo mwachibadwa mimba mlingo pa 6 miyezi opaleshoni ndi 37%.

(2) Kuzizira kwa minofu ya ovarian + endoscopic transplantation

Njira yosokoneza:

Khwerero 1: Pezani ovarian cortex kudzera mu transvaginal laparoscopy (peŵani laparotomy).

Khwerero 2: Vitrification ndi kusungirako kuzizira.

Khwerero 3: Autologous transplantation mu ovarian fossa pambuyo pa chemotherapy kubwezeretsa ntchito ya endocrine.

deta

Pulogalamu ya Brussels ku Belgium: Ovulation mlingo wa 68% pambuyo pa kuikidwa kwa odwala omwe ali ndi zaka zaunyamata.

(3) Kuyesa kwa endometrial receptivity (ERT)

Tekinoloje ya molecular endoscopic:

Sonkhanitsani minofu ya endometrial pansi pa hysteroscopy ndikuwona zenera la implantation kudzera mumayendedwe a RNA.

Kupititsa patsogolo mimba yachipatala ya odwala omwe ali ndi zolephera zobwerezabwereza kuchokera ku 21% mpaka 52%.

4, Kupanga kosokoneza pang'ono pakukonza pansi pa pelvic

(1) Transvaginal Mesh Implantation (TVM)

Chisinthiko chaukadaulo:

3D kusindikiza makonda polypropylene mauna ndi porosity> 70% amachepetsa chiopsezo cha matenda.

Roboti inathandizira kuyika bwino kuti asawononge mitsempha ya obturator.

Zochizira:

Zaka 5 zobwerezabwereza za prolapse organ prolapse (POP) ndi zosakwana 10% (opanga opaleshoni yachikhalidwe 40%).

(2) Sacral mitsempha regulation endoscopic implantation

InterStim ™ Dongosolo losokoneza pang'ono:

Sacral 3-hole puncture pansi pa cystoscopy, yogwira ntchito yopitilira 80% panthawi yoyezetsa isanakhazikitsidwe kosatha.

Chiwopsezo chowongolera mkodzo pochiza kulephera kwa mkodzo ndi 91%.

5. Mayendedwe aukadaulo amtsogolo

(1)Kuzindikira kwanthawi yeniyeni kwa zilonda zam'mimba za AI: Dongosolo la EndoFinder lochokera ku Samsung lili ndi mulingo wolondola wa 96% pozindikira ma polyps a endometrial ndi khansa.

(2) Bracket electronic Absorbable:Sicaffold yochokera ku magnesium yopangidwa ndi Northwestern University ku United States imatsitsa ndikutulutsa zinthu zomwe zimalimbikitsa kukula mkati mwa miyezi 6.

(3) Organ chip simulation transplantation: Kubwereza uterine transplantation vascular anastomosis strategy pa microfluidic chip.

Table Yofananira ya Phindu Lachipatala

Zowawa za njira zamakono zamakono / zogwira ntchito zosokoneza njira

Cold mpeni hysteroscopy/electrosurgical kuvulala kwa endometrial stem cell/ postoperative adhesion rate yachepetsedwa kuchoka pa 28% mpaka 5%

Opaleshoni imodzi yokha ya robotic laparoscopic/mabowo ambiri okhala ndi zipsera zoonekeratu / kubwezeretsanso moyo watsiku ndi tsiku maola 24 mutatha opaleshoni

Kuchuluka kwabodza kwa fluorescence falloposcopy / hysterosalpingography / kutanthauzira molondola kwa kutsekeka kwenikweni mpaka 0.1mm

Kuzizira kwa minofu ya ovary / pambuyo pa chemotherapy kulephera kwa ovarian msanga / kuchira kwa msambo> 60%

Malangizo okonzekera njira

Zipatala za pulayimale: zokhala ndi matanthauzo apamwamba a hysteroscopy ndi dongosolo la mpeni wozizira, wophimba 90% ya zotupa za intrauterine.

Reproductive Center: Khazikitsani malo ophatikizika a machubu a fallopian endoscopy ndi kusamutsa mluza.

Katswiri wa Oncology: Limbikitsani kuchotsa chotupa molondola pogwiritsa ntchito navigation ya NIR fluorescence.

Ukadaulo uwu ukufotokozeranso miyezo ya maopaleshoni am'mimba osasokoneza pang'ono kudzera m'njira zitatu zazikuluzikulu: kulondola kwa mulingo wa mamilimita, kuwonongeka kwa zero, komanso kukonzanso magwiridwe antchito a thupi. Zikuyembekezeka kuti pofika chaka cha 2027, 90% ya maopaleshoni achikazi omwe ali ndi matenda achikazi adzakwaniritsa chithandizo cha "masana".