MIGSC-Hualien,Taiwan.

MIGSC-Hualien,Taiwan. Minimally Invasive Gynecology Surgery Center, Hualien Tzu Chi Hospital, Hualien, Taiwan, R.O.C.

Hualien Tzu Chi Hospital’s Da Vinci Surgery System Upgraded The Da Vinci procedure has become very popular in minimall...
21/11/2023

Hualien Tzu Chi Hospital’s Da Vinci Surgery System Upgraded

The Da Vinci procedure has become very popular in minimally invasive gynecological surgery. Since its introduction in 2005, Hualien Tzu Chi Hospital has performed more than 100 da Vinci surgeries for gynecology or gynecological cancer. In September 2023, the Da Vinci surgical system was further upgraded to the latest fourth-generation Xi model, injecting new treatment energy into the remote rural area of Eastern Taiwan.
Different from traditional surgery and laparoscopic surgery, the Da Vinci surgical system allows the surgeon to sit in front of the operating console and control the robotic arms to perform minimally invasive surgery. Da Vinci's imaging system can present a 3D operative view, which can display a clearer surgical field of view than traditional laparoscopy. The robotic arm can perform flexible movements, such as rotation, grabbing, and pinching, and can perform fine movements in a small space. , eliminating the trembling of human hands and making it more stable. It helps in cutting and suturing during surgery. Compared with traditional surgery, the blood loss during the process is smaller, the wound is smaller, and the recovery is faster.
The Da Vinci third-generation Si system has evolved and upgraded to the fourth-generation Xi "Da Vinci Xi" system, which has greatly evolved:
(1) The newly designed suspended robotic arm can enter the body cavity at various angles and different anatomical positions, making it easier to flexibly transform.
(2) The new digital endoscope lens design is relatively lightweight and flexible, and also greatly improves image resolution and magnification, making surgical images more refined and clearer.
(3) The endoscope can be installed on either arm to provide a more flexible field of view of the surgical site.
(4) A lighter arm design, coupled with a newly designed joint wrist, gives the robotic arm an unprecedented wide range of movement.
(5) The design of longer instruments allows doctors to operate within a larger and deeper surgical range.
In addition, the design of the fourth-generation Da Vinci Xi system is more automated and user-friendly, although the operation method is almost the same, even simpler. For example, the hand console system has added humanized reminders. If the robotic arm is not in the operation screen, the system will give prompts, allowing the surgeon to better grasp the position and movement of the robotic arm. A laser positioning system is added to facilitate the positioning and installation of the robotic arm. The robotic arm is lighter, has a larger movement angle, and is more flexible, making surgical operations smoother.
The emergence of Da Vinci has made difficult gynecological surgeries easier to be performed. Now, after evolution, more patients will be able to enjoy the advantages of minimally invasive surgeries, such as smaller wounds, less pain, faster recovery, etc. Difficult gynecological surgeries, such as multiple uterine fibroids or fibroids located behind the cervix or on the pelvic floor, severe uterine prolapse requiring pelvic floor reconstruction surgery, etc., can be performed without depth or angular problems using the Da Vinci fourth-generation Xi system.When surgery is less difficult iIt will be safer to take the test.
Ms. Chen, 43 years old, came to the outpatient clinic due to menstrual pain, heavy menstrual bleeding and long-term anemia. Ultrasound examination revealed 5 uterine fibroids, with sizes of 8.0, 7.6, 6.4, 5.0 and 3.2 cm respectively. The two largest ones were on the posterior wall of the uterus and cervix. Deep in the posterior pelvic cavity. Although she has given birth, Ms. Chen still hopes to preserve her uterus. In this case, laparoscopic myomectomy would be difficult, as the operation would take a long time, result in heavy bleeding, and the risk of complications would be relatively high. After the doctor recommended it, Ms. Chen finally chose Da Vinci for myomectomy surgery. The operation was completed smoothly, with only 150cc of bleeding, and I was discharged from the hospital two days after the operation. After the operation, Ms. Chen expressed that she was very satisfied because the uterus was preserved and the problems of menstrual pain and heavy menstrual bleeding were also resolved. She also feels very lucky that Hualien has such advanced minimally invasive surgical treatment.

20/10/2023

First “MRgHIFU therapy” the precise and wound-free treatment for uterine fibroids and adenomyosis

--Hualien Tzu Chi Hospital’s Gynecological Minimally Invasive Surgery Center
"MRgHIFU" uses focused ultrasoundgenerate thermal energy to ablate benign uterine tumors. It has no wounds, fast recovery period, and can preserve the uterus and fertilization functions, meeting the needs of modern women.

Uterine fibroids and adenomyosis are the most common benign gynecological tumors. What is the difference between them?
Dr. Ding Dah-Ching, the director of the Obstetrics and Gynecology Department at Hualien Tzu Chi Hospitall, said: "These two diseases are actually very common in women. The difference between the two lesions lies in the different pathohistology; fibroids grow from muscle layer cells, and adenomyosis grow from endometrial glandular cells diffused whitin the muscular layer cells. It is the glands in the endometrium that abnormally goes into the muscles layers. When we have menstruation, the menstrual flow ordinally flow out via the cervix, but if the glands or menstrual blood whitin muscle layers, they cannot flow out. So, it will be formation of blood clots whitin muscular layers and cause pain. This is a big difference between the two diseases.
Therefore, the surgicaltreatment for the two leiosn will be different. Fibroids can be removed completely. Because adenomyosis is not a real tumor, but it is scattered and has no clear border, they cannot be totally removed unless the uterus is removed. "

Can uterine fibroids and adenomyosis easily lead to infertility?
Dr. Chen Ying-His, visiting staff from the Obstetrics and Gynecology Department of Hualien Tzu Chi Hospital said: "This depends on the location of the fibroids and adenomyosis. As long as the shape of the endometrial cavity or normal function has change or it is compressed, it may affect the chance of subsequent successful pregnancy."
Most patients with adenomyosis suffer from menstrual cramping pain. In the early stages, patients are advised to use anti-inflammatory and analgesic drugs, which are the simplest and most convenient way to treat the symptoms. But some patients have menstrual pain that cannot be controlled by painkillers. At this time, oral contraceptives are recommended to reduce the frequency of menstruation and inhibite endometriosis progression. In addition, if medications are not effective, more invasive treatments will be considered.
Although traditional laparoscopic surgery can partially resect adenomyosis, as mentioned before the boundary between adenomyosis within the uterine muscle layer is not clear, so the surgeon removed the lesions based on their experience. The lesion should be removed as much as possible, but the it is still has a high change of recurrence.

What are the common symptoms of patients with uterine fibroids?
Dr. Wei Yu-Chi, the director of Obstetrics department of Hualien Tzu Chi Hospital, said: The most common symptom of fibroids is excessive menstrual blood or long menstruation period, which may lead to blood loss and anemia. In some people, the uterine fibroids grow too large and cause compression. For example, if the fibroids grow at anterior wall of uterus it may compress on the bladder, the patient may have urinary frequency. Besides, If the fibroids grow posteriorly it may compress on the re**um, the patient may have constipation or incomplete defecation.
The treatment for uterine fibroid will be chosen based on the patient’s needs or conditions. In the past, when minimally invasive surgery(MIS) was not popular, open surgery was used.The disadvantages of open surgery are: more post-op adhesion formation and a longer recovery period. The advantage of minimally invasive surgery is small wound, but if you encounter large, multiple, and deeply located fibroids, MIS will be more difficult to treat and the blood loss will be more, unless using Da Vinci approach is more feasible. After myomectomy surgery, your uterus is more likely to have rupture due to uterine contractions during labor.

What is “MRgHIFU”?
Dr. Hong Mun-Kun, the director of the Gynecology Department as well as the chief of the Minimally Invasive Gynecological Surgery Center at Hualien Tzu Chi Hospital, said: " MRgHIFU uses MRI (magnetic resonance imaging) for guidance and positioning, focusing high-frequency ultrasound on a point to generate a thermal energy to ablate the lesion. Besides, MRI can have a good temperature monitoring during treatment, so over-treatment can be avoided, so it a safer and effective treatment process."

Dr. Li Pei-Chen, the director of the Obstetrics and Gynecology Ward, further explained: “Generally, after thermal ablation with MRgHIFU, fibroids or adenomas will slowly shrink and be absorbed by the body on their own, usually it takes three to nine months. You can observe the shrinkage of fibroids, and at the same time, the accompanying symptoms, such as menstrual pain, heavy menstrual bleeding, or compression symptoms will also be alleviated."

MRgHIFU has the following advantages compared with traditional surgery:
(1) Non-invasive treatment:no woundno bleeding, the entire recovery process will be fast and less painful.
(2) Since MRgHIFU therapy will nothave any skin wound a relatively ideal condition can be achieved in terms of the beauty of the body.
(3) Normal uterine function can be preserved. MRgHIFU can accurately treat lesions without harming the normal uterus next to it and improve the chances of conception.
(4) Complications of surgery can be avoided. No anesthesia is required during the treatment, which can also reduce the complications of anesthesia. There are no wounds in the surgery, so there will be no problem of surgical adhesion, no bleeding and pain will be greatly reduced. Therefore, complications will be greatly reduced.

11/10/2023

Illuminates the healthcare landscape in Eastern Taiwan with the introduction of the " MR guided high intensity focused ultrasound (MRgHIFU) "

Hualien Tzu Chi Hospital has been dedicated to rural healthcare for 37 years. In May 2023, they took a remarkable step by introducing Eastern Taiwan's first "MRI-guided High-Intensity Focused Ultrasound," known as MRgHIFU. This groundbreaking technology specializes in "non-invasive treatment" for common women benign disease such as uterine fibroids and adenomyosis, while also preserving the uterus and fertility. This not only benefits female patients but injects a fresh wave of energy into the healthcare sector of Eastern Taiwan.

Dr. Ding Dah-Ching , the director of the Obstetrics and Gynecology Department at Hualien Tzu Chi Hospital, highlighted three major challenges in promoting healthcare in rural areas. First, difficulties in patient access to medical care. Patients often face obstacles due to distance and transfer times when seeking medical attention urgently. Second, the challenge of recruiting medical professionals. To overcome these difficulties, Hualien Tzu Chi Hospital established Yuli Tzu Chi branch andKuanshan Tzu Chi branch Hospital in southern Hualien. This reduced the distance for patients seeking medical care and facilitated the development of healthcare talent through education, thus creating a more robust healthcare system for Eastern Taiwan.

Third, addressing the diversity of the population, which includes indigenous people, Han Chinese, and Hakka. Hualien County mirrors a miniature Taiwan, and Dr. Ding emphasized, "It's crucial to make sure that these diverse groups are aware of Tzu Chi's medical services." The goal is to ensure that more, if not all, local residents are familiar with Hualien Tzu Chi Hospital's offerings.

Hualien Tzu Chi Hospital is the only medical center in Eastern Taiwan and the first healthcare institution in Taiwan to receive "ISO National Quality Certification." It actively strives for excellence in clinical care, administration, research, and more. Dr. Ding mentioned the hospital's advanced medical equipment. Apart from tumor treatment equipment such as CT and MRI, they are also planning to introduce one of the very few Heavy Ion Radiatherapy machines globally. This commitment ensures that patients in Eastern Taiwan receive cutting-edge and high-quality healthcare.

In May 2023, the Minimally Invasive Gynecological Surgery Center at Tzu Chi Hospital introduced a novel “ MR guided high intensity focused ultrasound “ --(MRgHIFU), hailed as a significant boon for patients with benign gynecological tumors.

Uterine fibroids and adenomyosis can have an impact on fertility based on their location.
These conditions are the most common benign tumors in women, with an average occurrence rate of 3 out of 10 individuals. Dr. Chen Ying-Hsi, from the Obstetrics and Gynecology Department at Hualien Tzu Chi Hospital, explained that uterine fibroids come in various forms, and when they grow close to the endometrium, they can affect its form or function. Even if pregnancy occurs successfully, it might impact embryo development or compress the fetal growth space. On the other hand, although adenomyosis tends to be less invasive to the endometrium, when it grows diffusely within the muscular layer, the uterus is essentially in a state of chronic inflammation, which can also affect fertility.
In the treatment of adenomyosis, since many patients experience painful periods, symptomatic treatment often starts with pain relief medication. Additionally, oral contraceptives are prescribed to alleviate the symptoms of endometriosis. When medication fails to provide significant relief, more invasive treatments like surgery are considered.

Dr. Ding mentioned, "The treatment approach for adenomyosis differs from uterine fibroids. The latter can be removed through surgical excision, but adenomyosis is not exactly a tumor; it tends to be diffuse in nature. So, to completely remove it, the entire uterus would need to be excised, which most women prefer to preserve."

Dr. Chen Ying-Hsi stated, "Traditional laparoscopic surgery can partially remove adenomyosis. However, the drawback is that the boundaries of adenomyosis within the uterine muscle layer are not very distinct. Surgeons have to rely on clinical experience to judge and cut as much as possible. The downside is that it's difficult to completely rsect the lesions, leading to a certain recurrence rate."

Advantages and Disadvantages of Open and Minimally Invasive Surgery in the Treatment of Uterine Fibroids
The treatment for uterine fibroids varies based on the patient's condition. Dr. Wei Yu-Ch, Director of Obstetrics department of Hualien Tzu Chi Hospital, explains, "If patients are troubled by heavy bleeding or suffer from anemia due to uterine fibroids, they can take birth control pills to reduce bleeding. However, if the fibroids grow too large and cause problems such as pressing against the bladder leading to frequent urination or pressing against the re**um resulting in constipation, it becomes necessary to address the compression issue."

There are two main surgical approaches commonly used to treat uterine fibroids: traditional open surgery and minimally invasive surgery. The drawback of open surgery is that it involves a larger incision and requires a longer recovery period, making it less popular today. On the other hand, laparoscopic surgery, which uses only three small incisions or even a single incision, offers the advantages of smaller wounds, faster recovery, and improved aesthetics. However, it may pose challenges when dealing with larger or multiple fibroids, especially those deep within the uterine tissue.In this circumstances, minimally invasive robotic approach myomectomy is feasible. Larger incisions in open surgery can lead to poorer healing, and post-operative adhesions can affect future pregnancies.

Moving from "Minimally Invasive" to "Non-Invasive," Eastern Taiwan Welcomes its First Targeted Ultrasound Knife at Tzu Chi Hospital
Dr. Hong Mun-Kun, the director of the Obstetrics and Gynecology Department as well as the Minimally Invasive Gynecological Surgery Center at Hualien Tzu Chi Hospital say ‘’Traditional treatment methods for uterine fibroids and adenomyosis mainly involve medication or surgical removal. However, there is now an alternative "non-invasive" treatment option known as the MRgHIFU. This innovative approach is gaining recognition for its ability to provide effective treatment without the need for surgery.

What Are the Features of the MRI guided high intensity focused ultrasound(MRgHIFU)?

Dr. Hong explains, "Compared to minimally invasive surgery, the MRgHIFU is a non-invasive treatment, there are no incisions on the patient's skin, and the risk of surgery-related complications is significantly reduced." In the past, the common approach was to remove the entire uterus. Nowadays, even in modern times when many women no longer have a need for childbirth, most still prefer to preserve their uterus as it is a symbol of female identity. Epidemiological research has also shown an increased risk of bladder, re**al, va**nal prolapse, and early menopause after a total hysterectomy. The MRgHIFU not only preserves uterine function but also leaves no visible scars, making it an alternative treatment option.

What Are the Advantages and Treatment Principles of the MRgHIFU?

Dr. Hong explains, " MRgHIFU uses MRI as guidance and positioning to focus high-frequency ultrasound at a specific point, creating a heat point of 60-80 celcius, and then gradually ablate the lesion." The temperature monitoring advantages of MRI during the treatment is much better, so it can safely and precisely target the lesion, minimizing damage to normal tissues.

Dr. Li Pei-Chen, the director of the Obstetrics and Gynecology Ward, highlights four advantages of undergoing MRgHIFU treatment:

1. Non-surgical, anesthesia-free, and no incisions required.
2. Significant improvement in the symptoms of uterine fibroids and adenomyosis, along with a reduction in the size of uterine lesions, alleviating compression symptoms.
3. Preservation of the uterus and fertility, maximizing protection of the endometrium.
4. Discharge from the hospital next day after therapy, enabling a swift return to regular life.

The Goals of our Minimally Invasive Gynecological Surgery Center:
"Safety," "Precision," and "Comfort"

Director Dr. Ding explains that with MRgHIFU advantages, patients who fear surgery or have chronic medical conditions or allergies to anesthesia can find solution. Additionally, the preservation of the uterus and fertility is a significant advancement in gynecological tumor treatment for women.

As the hospital promotes healthcare services, a group of dedicated "Tzu Chi volunteers" plays an indispensable role. Take Ms. Chen Hui-Ping, for example. Besides being known as a Tzu Chi senior sister, she is also a nurse who actively participates in organizing free clinics, health seminars, and various charitable activities. Upholding the compassionate spirit of Tzu Chi, these volunteers provide the highest quality emotional support and humanitarian care to the public and patients, helping Hualien Tzu Chi Hospital continue to be a healthcare stronghold in Eastern Taiwan.

"Transva**nal Natural Or***ce Transluminal Endoscopic Surgery (vNOTES)"Transva**nal Natural Or***ce Transluminal Endosco...
11/07/2023

"Transva**nal Natural Or***ce Transluminal Endoscopic Surgery (vNOTES)"

Transva**nal Natural Or***ce Transluminal Endoscopic Surgery (vNOTES) is a minimally invasive surgical technique that utilizes the body's natural orifices, such as the va**na, stomach, esophagus, bladder, and re**um, for route of endoscopic surgery. The most commonly used approach is through the va**na, as it offers advantages such as scarless, less pain minimal bleeding, and faster postoperative recovery. In the past ten year, vNOTES has become increasingly mature and widely used in gynecological minimally invasive surgery. It can be used for procedures such as hysterectomy, ovarian tumor removal, and tubal surgery. However, not every patient is suitable to receive vNOTES, preoperative evaluation by gynecology endoscopist is very important. In addition to ensuring aesthetics and effectively reducing hospital stay, vNOTES provides a new surgical option for gynecological patients.

Image reference: JMIG

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