The Present State of Gynecologic Endoscopic Surgery

Masaji Nagaishi, Hisao Osada, Tatsuo Yamamoto
In: Journal of Nihon University Medical Association · 2008 · vol. 67(2) , pp. 103–109 · doi:10.4264/numa.67.103 · W2329904608
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

Endoscopic surgery for benign gynecologic conditions has dramatically increased in Japan, with hospitals like Nihon University Surugadai Hospital achieving over 95% laparoscopic rates and focusing on cost-benefit and complication prevention.

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This article reviews the current status of gynecologic endoscopic surgery in Japan, describing how insurance coverage has led to a dramatic increase in laparoscopic procedures for benign conditions and reporting that, at the authors’ hospital, laparoscopic use for benign disease has exceeded 95%. It discusses perioperative evaluation of uterine fibroids and ovarian tumors by size, location, and malignancy risk to decide between laparoscopy and laparotomy, and highlights considerations such as cost-benefit, including use of reusable forceps due to the expense of disposable instruments. The paper notes that although malignancy is currently a contraindication for laparoscopy, the authors expect future laparoscopic treatment after careful case-by-case assessment, while emphasizing the need to manage emergencies and prevent unexpected accidental complications. Relevance to endometriosis: the paper explicitly mentions endometriosis among the benign conditions for which endoscopic surgery has increased, though its focus is a broad overview of gynecologic endoscopic surgery rather than endometriosis specifically.

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Abstract

There are many women with fibroids or endometriosis. Since endoscopic surgery was approved for insurance coverage in Japan, these procedures have increased dramatically. Recently the incidence of laparoscopic surgery for benign disease has reached over 95 percent in our hospital, Nihon University Surugadai Hospital, and our institution is designated as a high performance level hospital in Japan. As there is the important problem of cost-benefit, e.g. because of the high cost of disposable instruments, we use reusable forceps in our hospital. It is clinically important to carefully evaluate benign tumors. After the preoperative status of uterine fibroids and ovarian tumors has been evaluated regarding tumor size, location and possibility of malignancy, we determine whether laparoscopic surgery or laparotomy is the best operation for the patient. The ultimate aim of infertility management is for women to go to term safely upon becoming pregnant. Although malignant tumors are contraindications for laparoscopic surgery at present, we believe that in the future malignant tumors are going to be treated laparoscopically following careful evaluation of each case. Difficult operations are more easily performed than previously, due to the increase of skills. Meanwhile, there have been various reports on several unexpected accidental complications. We must improve the management of emergencies and the prevention of accidental complications.
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特集 「内視鏡手術の現況」 婦人科領域における内視鏡手術 2008 年 67 巻 2 号 p. 103-109 詳細 抄録 There are many women with fibroids or endometriosis. Since endoscopic surgery was approved for insurance coverage in Japan, these procedures have increased dramatically. Recently the incidence of laparoscopic surgery for benign disease has reached over 95 percent in our hospital, Nihon University Surugadai Hospital, and our institution is designated as a high performance level hospital in Japan. As there is the important problem of cost-benefit, e.g. because of the high cost of disposable instruments, we use reusable forceps in our hospital. It is clinically important to carefully evaluate benign tumors. After the preoperative status of uterine fibroids and ovarian tumors has been evaluated regarding tumor size, location and possibility of malignancy, we determine whether laparoscopic surgery or laparotomy is the best operation for the patient. The ultimate aim of infertility management is for women to go to term safely upon becoming pregnant. Although malignant tumors are contraindications for laparoscopic surgery at present, we believe that in the future malignant tumors are going to be treated laparoscopically following careful evaluation of each case. Difficult operations are more easily performed than previously, due to the increase of skills. Meanwhile, there have been various reports on several unexpected accidental complications. We must improve the management of emergencies and the prevention of accidental complications. © 2008 日本大学医学会

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endometriosisinfertility

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