The trends of minimally invasive surgery for benign gynecologic lesions, 1997-2007 in Taiwan

The use of minimally invasive surgery (MIS) has grown over the past two decades in Taiwan and worldwide. Laparoscopic surgery has been applied to manage the adnexal mass, and ectopic pregnancy since 1989, followed by the first case series of laparoscopic-assisted vaginal hysterectomy (LAVH) in 1992 in Taiwan. These cases successfully advanced the development of the laparoscopic field. The most significant finding for hysterectomy is the significant increase of laparoscopic hysterectomy (LH) from 5.75% to 37.50%, which is accompanied by the decrease of total abdominal hysterectomies (TAH) from 77.93% to 48.12%, in 1997 and 2007, respectively. Laparoscopic surgery increased significantly from 35.78% to 71.66% for benign ovarian tumor; laparoscopic procedures significantly increased from 18.9% in 1997 to 73.95% in 2007 for ectopic pregnancy. Surgeon acceptance and a rapid evolution of instrumentation have enabled the use of laparoscopy to flourish in recent years. Based on nationwide population-based studies, the choices of surgical procedures are found to be dependent on patient factors, surgeon factors, and hospital factors. The academic activities launched by the MIS-related medical associations significantly lower the threshold for entering the field of endoscopy for gynecologists. This review demonstrates a considerable shift in the use of laparoscopic surgery as MIS in the approaches of benign gynecologic conditions, hysterectomy, ovarian tumor, and ectopic pregnancy, during the past 15 years in Taiwan. As a minimally invasive approach, laparoscopic surgery represents a profound change in patients, surgeons, and hospitals where the surgeries were performed.