序一

这是一部关于妇科内镜技术的新书。近年，经自然腔道内镜手术（NOTES）开展得方兴未艾，如火如荼。本书之出版，可谓恰逢其时，既有雪中送炭之功，亦有锦上添花之力。可喜可贺！

内镜技术是医生视觉之扩展，手臂之延伸，符合创伤小、恢复快之微创原则，受到医生和患者的青睐，已成为妇科的主流手术方式。

NOTES，无论是经脐部（LESS），或是经阴道（V-NOTES），或是宫腔镜手术，皆为内镜手术增添了美学光彩，应该是外科技术与美学观念的合拍节律，它改变了我们的思维方式、技术路线、价值企望，极有发展前途。

本书是以美国贝勒医学院贝勒医院关小明教授、广州医科大学附属第三医院刘娟教授为主编，联合国内众多妇科内镜技术专家编撰的一部专著。内容全面充实，图文并茂，突出实用、突出规范、突出先进，可以说是中西合璧、四方联手的美轮美奂的技术工程，人性仁爱的医疗关怀。

感谢著作者的良苦用心，辛勤劳作。

对于我个人，又是学习，也是推助。

奉上赘言，权作为序。

2020年8月19日　中国医师节

Preface Two

Over the past three decades, gynecologists worldwide have witnessed a major shift in gynecological surgery. The traditional open surgery has been widely replaced with the minimally invasive approach. Large abdominal incisions for gynecological surgery have almost become obsolete in the western world. This surgical evolution in gynecology has benefited patients in significant ways, including rapid recovery after surgery, minimal post-operative pain and discomfort from somatic muscle and fascial disruption, and improved cosmetic appearance without unsightly incisional scars.

The pioneers of laparoscopic surgery in France, Germany, and the United States began using the laparoscope therapeutically in the late 1970s and early 1980s. The laparoscope was used to lyse adhesions, remove ectopic pregnancies, and treat ovarian cysts and endometriosis. Also in the late 1970s, the laparoscope was innovatively used to evacuate and drain antibiotic resistant pelvic abscesses with remarkable results. Then in the late 1980s, the use of operative laparoscopy increased exponentially after the first hysterectomies and cholecystectomies were successfully performed.

This rapid foray of laparoscopic surgery into the mainstream of surgical practice was phenomenal. First, the increased sophistication in surgical electronic videography, especially the development of light weight chip video cameras, permitted unparalleled magnification of intra-peritoneal structures.

The deep pelvis and various fascial planes, which previously eluded visualization in traditional open laparotomy, could now be viewed in minute detail through the laparoscope. Then as laparoscopic operative skills improved, the technology continued to evolve and progress, with pelvic anatomy clearer on the HD or 3 D monitor, which in turn allowed the gynecologist to enter the surgical planes much more easily and develop increased proficiency in operations. Many of the important operative techniques used in laparoscopy, such as aqua-dissection, laparoscopic use of various energy source, and suturing with curved needles, owe their existence to our pioneers, who, despite cynicism and backlash, persevered in developing and perfecting these techniques. We are indeed indebted to these individuals for their determination, without which we would not be where we are today. We now can perform laparoscopically practically everything that heretofore required open surgery.

The discipline of gynecological endoscopy is dynamic and continues to evolve. Modifications of standard surgical procedures performed at routine gynecological endoscopy have historically been introduced into clinical practice as a gradual process that seldom required special training. However, recent modifications of intraperitoneal access in laparoscopy (e. g. LESS and NOTES) and its specific instrumentations require specialized training. Such specific surgical orientation, techniques, and procedures are new and, as such, require the individual surgeon to undergo additional training. The primary purpose of this additional surgical education is to ensure safe, effective, and high quality outcomes for the patient.

As a pioneer in advanced laparoscopy, I am pleased to see a textbook in Chinese on LESS and NOTES, edited by my dear friends and colleagues, Professors Guan Xiaoming and Liu Juan. This comprehensive guide on LESS and NOTES includes a historical perspective of LESS and NOTES, outline of surgical anatomy, specific instrumentation and equipment for the procedure, entry techniques, controversial procedures, and contra-indications, as well as complications and management of the complications. The editors’goal was to provide a resource for Chinese gynecologists to learn current LESS and NOTES procedures that they may integrate these techniques into their practice in minimally invasive gynecology. The authors have admirably achieved their goal.

C. Y. Liu, M.D., F.A.C.O.G.
December 2020