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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