Description
Advancements in minimally invasive gynecological surgery have revolutionized women's healthcare, offering procedures with reduced recovery times, minimal scarring, and fewer complications compared to traditional open surgeries. Techniques such as laparoscopic and robotic-assisted surgery allow for precise interventions, improving outcomes in conditions like endometriosis, fibroids, and ovarian cysts. Enhanced imaging technologies and smaller, more flexible instruments contribute to the effectiveness and safety of these procedures. These innovations not only lead to better patient satisfaction but also enable quicker return to daily activities, significantly enhancing the quality of life for women undergoing gynecological surgery. As technology continues to evolve, the future holds even greater potential for improving surgical outcomes and patient care in gynecology.
Résumé
- The session began with a historical overview of breast cancer surgery, starting from 200 AD and progressing through superar radical surgeries to breast preservative surgeries. Early descriptions from Egypt defined the condition as bulging tumors with no cure, considered a punishment from God. The Roman and Greek era, including Hippocrates, linked it to excess black bile, discouraging surgery. The Middle Ages saw only paste applications for tissue necrosis, still declaring no cure, merely delaying death.
- The 16th century marked the emergence of mastectomy, carried out without anesthesia or antisepsis. Modern science in the 19th century, led by Halsted, described breast cancer's systematic spread, advocating radical surgery for confined cases. Halsted's work involved removing the breast, skin, pectoral muscles, and axillary lymph nodes, though wounds were left for secondary healing. Later, superar radical mastectomies, aiming to increase cure rates, instead increased morbidity.
- The concept of organ preservation emerged, with Pan Ocean Clause describing preserving the pectoral major muscle. Modified radical mastectomy, which is performed now, involves elliptical incision, removal of the skin, complete breast, and lymph nodes.
- Recent advances include breast conservative surgery (BCS), sentinal node biopsy, and breast reconstruction. BCS involves removing the lump with a 1 cm margin, yielding equal oncological outcomes to mastectomy but with better quality of life. Various techniques like donut mastopexy and grer to flap are used in BCS. The age of the patient does not play any contraindication for the process.
- Sentinal node biopsy identifies the first draining lymph node(s). If negative, full axillary clearance is avoided, reducing morbidity. Radioiodine or methylin blue is injected to identify these nodes. Breast reconstruction, categorized as displacement (using surrounding tissue) and replacement (using tissue from elsewhere), addresses volume loss and cosmetic concerns. Examples include LD flaps and free flaps using abdominal or leg tissue.
- Genetic testing, particularly for BRCA1 and BRCA2 mutations, informs prophylactic bilateral mastectomy and risk reduction surgeries. For the patient's family, mutation status is vital to determining if one or more generations are at risk of cancer. Metastatic breast cancer is managed differently, prioritizing quality of life and disease control over survival, employing chemotherapy and hormonal treatments, and reserving surgery for complications.
Exemple de certificat
À propos des intervenants
Dr Vipin Goel
Directeur clinique et chef de service, département d'oncologie chirurgicale, chirurgien laparoscopique et robotique, Star Hospitals, Hyderabad
Divulgation financière
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