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FAQ

How does minimally invasive gynecological surgery affect fertility?

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The impact of minimally invasive gynecological surgery on fertility varies depending on the specific type of surgery and patient circumstances.

Here are a few key points:

Fertility-sparing treatment for cervical cancer: For patients with early-stage cervical cancer, minimally invasive surgeries (such as laparoscopic conization and simple trachelectomy) often improve pregnancy rates, live birth rates, and have fewer postoperative complications.
. However, when the cervical conization length exceeds 1 cm, it may adversely affect the ability to conceive, which may be related to the destruction of cervical glands and mucosa after surgery.
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Hysteroscopic surgery: When treating diseases such as uterine fibroids and endometrial polyps, hysteroscopic technology can significantly improve patients’ symptoms and improve their quality of life without destroying the endometrial tissue of the adjacent uterine cavity, thereby helping to maintain fertility
. In addition, TCRP (transcervical resection of myoma) surgery may significantly improve the patient's fertility and increase the probability of pregnancy.
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Fertility-sparing surgery for endometrial cancer and other malignancies: For young nulliparous women, laparoscopic surgery for endometrial cancer can preserve fertility, and some studies recommend donor egg pregnancy in some cases.
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Psychological factors: Some women worry that surgery will affect function and fertility. This worry may lead to anxiety, guilt and even depression, thus affecting physical and mental health and life.
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Other factors: Certain gynecological surgeries, such as wide vaginal cervical excision, can preserve the uterus when treating early-stage cervical cancer, but whether to completely preserve fertility still requires comprehensive consideration of pathological type, degree of differentiation, lymph node metastasis and other factors.
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In summary, minimally invasive gynecological surgery can effectively protect and restore a patient's fertility in many cases, especially when the appropriate surgical approach is selected and combined with an individualized treatment strategy. However, patients should fully understand the possible risks and effects of surgery before surgery and work closely with a professional team to achieve the best results.

What is the specific impact of minimally invasive gynecological surgery on pregnancy and live birth rates in patients with early-stage cervical cancer?

Minimally invasive gynecological surgery has a certain impact on the pregnancy rate and live birth rate of patients with early-stage cervical cancer. We can conduct detailed analysis from the following aspects:

Pregnancy after radical trachelectomy (including laparoscopic radical hysterectomy, laparoscopic/robot-assisted laparoscopic radical hysterectomy, etc.) The rate ranges from 15% to 80%, indicating that different surgical methods and individual patient differences may affect the final pregnancy rate.
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Although the specific live birth rate data is not explicitly mentioned in the information I searched, it can be inferred that because minimally invasive surgery usually preserves more uterine arteries and parametrial tissue, it helps to improve early stage to a certain extent. Live birth rate among cervical cancer patients
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Some studies have shown that minimally invasive surgery is associated with higher recurrence and mortality rates. For example, the LACC trial found that compared with open surgery, the disease-free survival rate in the minimally invasive surgery group was lower (3-year disease-free survival rate 91.2% vs 97.1%), and it was not related to factors such as age, body mass index, disease stage, etc.
. Additionally, another study noted that the 4-year mortality rate for patients who underwent minimally invasive surgery was 9.1%, compared with 5.3% for patients who underwent laparotomy.
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For patients with early-stage cervical cancer, choosing the appropriate surgical method is key. The literature mentioned that for patients with tumors larger than 2 cm in diameter and a strong desire to preserve fertility, laparoscopic radical hysterectomy or robot-assisted laparoscopic radical hysterectomy can be selected

. However, these minimally invasive surgeries need to follow the principle of tumor-free, avoid using a lifting cup to cause tumor loss, and try to get pregnant at least 3 months after surgery.
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In summary, the application of minimally invasive gynecological surgery in patients with early-stage cervical cancer can improve pregnancy and live birth rates, but it may also lead to higher recurrence and mortality rates.

How does hysteroscopic surgery improve the fertility of nulliparous women, especially the change in pregnancy probability after TCRP?

Hysteroscopic surgery (such as TCRP) has a significant effect in improving fertility in nulliparous women, especially when dealing with causes of infertility such as endometrial polyps, atypical polypoidal adenomyoma, and intrauterine adhesions. Here's a detailed explanation:

Endometrial polyps and adenomyomas are common causes of female infertility. Through hysteroscopic surgery, these diseased tissues can be visually observed and removed, thereby restoring the normal shape and function of the endometrium and improving the possibility of pregnancy.
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Intrauterine adhesions are adhesions or fibrosis caused by the shedding and damage of the basal layer of the endometrium, which can cause problems such as amenorrhea, reduced menstruation, and infertility. Uterine adhesions separation is one of the most effective ways to treat uterine adhesions. Preoperative pretreatment and energy device intervention can promote endometrial repair, reduce the risk of surgical complications, and prevent recurrence of adhesions.
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TCRS is a reconstructive surgery that does not destroy the normal anatomical structure of the uterus and can effectively restore the normal shape of the uterine cavity while maintaining the integrity of the uterus. This allows patients to conceive in a short period of time and have a normal pregnancy
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After hysteroscopic surgery, corresponding follow-up evaluation should be performed, especially hysteroscopic exploration to confirm the recovery of the endometrium. In addition, high-quality nursing intervention also plays an important role in improving patients' nursing satisfaction and reproductive function recovery rate. Research shows that patients who undergo hysteroscopic and laparoscopic surgeries and use high-quality care have significantly higher rates of post-operative fertility recovery
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After TCRS, it is recommended to use antibiotics to prevent infection, insert an intrauterine device (IUD), and take 2-3 artificial cycles of medication. Hysteroscopy is performed 2-3 months after the operation and the intrauterine device is removed. If a residual mediastinum of less than 1cm at the bottom of the uterus is found, it can be left untreated and pregnancy should be carried out as soon as possible.
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Hysteroscopic surgery can significantly improve the fertility of nulliparous women by intuitively diagnosing and treating various lesions in the uterus and restoring the normal shape and function of the endometrium.

What research supports the types of fertility-sparing surgery for endometrial cancer and its impact on fertility?

The types of fertility-preserving surgery for endometrial cancer and their impact on fertility, according to multiple studies and guidelines, mainly include the following methods:

This approach is suitable for patients with early-stage, localized endometrioid adenocarcinoma. Hysteroscopic resection of tumor lesions, the endometrium near the lesions, and the underlying myometrium can effectively control the disease and preserve fertility.
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FSS refers to the preservation of the uterus and at least one (part of) one ovary during a comprehensive staging surgery. For patients with ovarian endometrioid cancer in FIGO stage I, especially those who wish to have children, it is recommended to undergo this type of surgery and to use assisted reproductive technology to complete childbirth as soon as possible after surgery.
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Including the use of progestins (such as medroxyprogesterone acetate and megestrol acetate), levonorgestrel intrauterine device (LNG-IUS), etc. These drugs inhibit the growth of the lining of the uterus, thereby preserving fertility. For patients who cannot tolerate high-dose progesterone therapy or have excessive BMI, LNG-IUS combined with gonadotropin analogs or aromatase inhibitors may be an option
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In some cases, where the patient has completed childbearing or requires further treatment to prevent recurrence, IVF-ET or intracytoplasmic sperm injection (ICSI) may be considered to achieve pregnancy.
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After completion of childbearing, regular follow-up and monitoring are recommended, including endometrial biopsy every 6 months to assess complete remission of the disease. If disease recurs or is unresponsive, surgery may be needed
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Regarding the effects of these treatments on fertility, research shows:

Progesterone therapy can effectively control the development of endometrial cancer and does not significantly affect the patient's fertility during treatment
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The application of assisted reproductive technology can help patients achieve pregnancy after completion of childbirth, but it should be noted that a history of multiple uterine operations may increase the risk of postpartum hemorrhage, so special attention needs to be paid to perinatal management
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Oocyte cryopreservation is also a viable option and may be chosen based on patient specific circumstances or ethical considerations.
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In short, the types of fertility-preserving surgeries for endometrial cancer and their impact on fertility have been well supported by research. These methods not only improve patients’ quality of life, but also provide more fertility opportunities.

What are the relevant studies on how psychological factors affect women’s life and fertility after minimally invasive gynecological surgery?

Psychological factors have a significant impact on women's life and fertility after minimally invasive gynecological surgery. According to multiple studies, these impacts are mainly reflected in the following aspects:

Most patients will feel anxious, low self-esteem, and depressed after surgery. These negative emotions not only affect their quality of daily life, but may further lead to dysfunction.

. For example, a randomized controlled study on patients with cervical cancer showed that psychological nursing intervention can effectively alleviate patients' anxiety and depression, thereby improving the quality of their life.
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Many patients worry about the impact on their life after hysterectomy, which often leads to post-operative problems such as loss of desire, vaginal dryness and pain during intercourse.

. However, research shows that these problems can be improved if effective psychological support and guidance are provided.
. In addition, hysterectomy itself will not have a major impact on function, mainly due to psychological factors
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Social support is crucial to alleviate patients’ psychological burden and prevent the occurrence of mental disorders
. Support and encouragement from family members can help patients better adapt to post-operative life and reduce their anxiety and fear
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Psychological care plays an important role in the postoperative recovery process. Through psychological counseling and intervention for patients, we can effectively improve their mental state, enhance their confidence in overcoming the disease, and increase their trust in treatment and care.
. For example, psychological nursing intervention for hysterectomy patients can significantly improve their anxiety and depression, and improve the quality of their life after surgery.
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For women of childbearing age, hysterectomy will lead to loss of fertility. This is not only a physiological change, but also a huge psychological blow.
. Lack of social support and psychological care may increase their psychological burden and even cause mental disorders
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Psychological factors have a profound impact on women's life and fertility after minimally invasive gynecological surgery.

What are the evaluations of the fertility-sparing effectiveness of wide vaginal cervicectomy in the treatment of early-stage cervical cancer?

When vaginal wide cervical excision (VRT) is used to treat early-stage cervical cancer, the evaluation of the fertility-preserving effect is mainly reflected in the following aspects:

Wide vaginal cervical resection combined with laparoscopic pelvic lymphadenectomy was successfully performed in 50 patients, of which 2 patients were switched to concurrent chemoradiotherapy due to tumor involvement. All 48 patients completed the operation, the operation time was 185±35 minutes, and the intraoperative blood loss was 310±131 ml. During the follow-up period, 6 cases recurred, with a recurrence rate of 12.5%. Among them, patients with tumors larger than 2 cm in diameter had a higher recurrence rate (7.5% vs 3%). The recurrence rate of patients with adenocarcinoma or adenosquamous carcinoma was also higher than that of patients with squamous cell carcinoma. (7.1% vs 3%)
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Among the 35 patients with fertility requirements, 13 achieved pregnancy and carried out 17 pregnancies, with a pregnancy rate of 37.1%; 9 patients successfully delivered 10 newborns, with a fertility rate of 25.7%

. Another study pointed out that patients with early-stage cervical cancer with lesions >2 cm could effectively control the tumor and improve fertility outcomes by reducing the tumor volume with early chemotherapy and then undergoing transvaginal radical trachelectomy. Seven pregnancies occurred among the five patients in the study, and four neonates were successfully delivered, but two were born prematurely.
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Transient incomplete intestinal obstruction may occur after surgery but usually resolves with conservative treatment
. In addition, extensive cervical resection may affect the blood supply of the uterus, leading to cervical sclerosis, endometrial atrophy and other problems. However, studies have shown that there is no significant difference between the uterine artery preservation group and the non-preservation uterine artery group.
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Factors such as pathological type, pathological differentiation degree, and whether lymphovascular space involvement is associated with recurrence have nothing to do with recurrence. Despite this, 6 patients with adenocarcinoma or adenosquamous carcinoma recurred in this study, accounting for half of all patients with recurrence.
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The pregnancy rate after extensive cervical resection is generally between 41% and 70%, but the miscarriage rate in the second trimester is higher, reaching 7%, and may be related to premature birth and premature rupture of membranes before term.
. In addition, there is currently no unified opinion on the choice of surgical method (such as transvaginal, open, laparoscopic, etc.), and the choice should be based on personal surgical experience.
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Wide vaginal cervical excision can effectively preserve the patient's reproductive function when treating early-stage cervical cancer, but its effect is affected by multiple factors such as tumor size, pathological type, and postoperative management.

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