Laparoscopy and Hysteroscopy in China

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Dr. Hugo Verhoeven: “My name is Hugo Verhoeven from the Center for Reproductive Medicine in Dusseldorf, Germany. I’m a member of the Editorial Board of OBGYN.net and I’m reporting today from the 10th Annual Congress of the International Society for Gynecologic Endoscopy in Chicago. Today, I have the exceptional honor to talk with two very prominent ladies and doctors from China and with Mr. Xaver Liebold from the Olympus Company here in the United States. Let me first introduce the two of you; Professor Xia, you are the Director of the Department of Obstetrics and Gynecology at the Beijing Tiantan Hospital and Professor Feng Limin, you are the Advise Director and also Associate Professor at the same hospital. I know that you are very experienced and well known and because of your affiliation and your good connections with the AAGL - the American Association of Gynecological Laparoscopists and we know from Jordan Phillips and especially from Mary how high the standard of endoscopy and endoscopic surgery is in China. Let’s go back a little bit in time - when was hysteroscopy, laparoscopy, hysteroscopic surgery, and laparoscopic surgery introduced into your country?”

Professor Enlan Xia: “For laparoscopic surgery, Dr. Jordan Phillips sent us two sets of the instruments in 1979. Since then, laparoscopic surgery has spread throughout all of China. In our country it spread very well but hysteroscopy is not so popular and only in the last ten years hysteroscopic diagnosis and operations have started to spread, especially for the sponsor company, Olympus Company. Their hysteroscopic instruments and the equipment are quite excellent in this field, and they give us a lot of help.”

Dr. Hugo Verhoeven: “But if you go back into time, what was the first indication that Jordan Phillips told you would be for doing laparoscopies in China - was that sterilization like we know from countries like India or was it more for chronic pain? For what indication did you use laparoscopy in those early years, some 20-25 years ago?”

Professor Enlan Xia: “For laparoscopic indications twenty-five years ago most of them were sterilization. Now because in our country a family or a couple can only have one child, many indications aren’t sterilization, I think the main indication is for an ovarian cyst, fibroids, or for LAVH - that’s an important indication.”

Dr. Hugo Verhoeven: “No infertility?”

Professor Enlan Xia: “No.”

Professor Feng Limin: “There are many cases for infertility.”

Professor Enlan Xia: “I think that’s very rare.”

Dr. Hugo Verhoeven: “It is my knowledge that every woman in China has the right to have one child but not more than one, so if she is infertile everything should be done so she at least conceives once but that’s then the limit. Is that correct?”

Professor Enlan Xia: “Yes.”

Dr. Hugo Verhoeven: “As in each country where a new technique is introduced, you probably had at the beginning a lot of problems - instruments, instructors, and of course you had the big problem of the training. You were trained by American doctors, by Jordan Phillips, and you probably also trained quite a lot of other doctors. Could you tell us something about the initial problems you had and how you’re managing now for a huge country like China to instruct and to teach that many doctors in hysteroscopy and laparoscopy?”

Professor Enlan Xia: “Yes, the training of the laparoscopic procedures and the hysteroscopy procedures is quite important. For laparoscopic surgeries, Dr. Jordan Phillips gave us and gave China a lot of help. He traveled every year to every city, even rural areas, and he spread the excellent skills and he set up many workshops in China and Asia every year. A lot of Chinese doctors came to his workshops and the Congress was important. For hysteroscopy, it’s not the same. Jordan Phillips gave us a lot of help, and in my university, we set up the workshop once every year for the high level hysteroscopic treatment workshop. But for hands-on for the lower level doctors, we set up two to three hands-on workshops to spread the techniques."

Dr. Hugo Verhoeven: “What is Cal-a-man disease? I know but our readers will not.”

Professor Enlan Xia: “Cow-man disease is fibroids leiomyoma, do you understand?”

Dr. Hugo Verhoeven: “Yes.”

Professor Enlan Xia: “Fibroids, abnormal uterine bleeding, and all dysfunctional uterine bleeding are the main indication for diagnostic hysteroscopy and hysteroscopic operations.”

Dr. Hugo Verhoeven: “But Jordan Phillips and the AAGL and the ESGE can only provide you with knowledge, you also need huge amounts of instruments. Where are those instruments coming from? Maybe you can switch that question to Mr. Liebold or you can also answer the question.”

Mr. Xaver Liebold: “I think Professor Xia is the one who could really answer that question.”

Professor Enlan Xia: “If we want to spread the skill and the technique of hysteroscopic procedures there are three main questions. The first one is equipment and the instrument, the second one is training, and the third one is who will do these operations because hysteroscopic skill is more difficult than the laparoscopic procedures. In the world, I think Olympus hysteroscopy instruments and equipment are excellent, and they have many, many good gentlemen to help us; for example, Mr. Winter and Mr. Sender, They give us a lot of help and they’re suppose to sell the service.”

Dr. Hugo Verhoeven: “That’s very important.”

Professor Enlan Xia: “It’s very important. They give us a lot of help because as doctors we have the knowledge of anatomy and the skills to perform the operation but we don’t understand the electrical, the light source, and how to eliminate the special dye. Sometimes when we perform an operation, the electrical source doesn’t work, the light doesn’t work, and I can’t perform it. They give us a lot of help.”

Dr. Hugo Verhoeven: “But that is the problem all over the world if in surgery the technique doesn’t work. So let’s now go back to your specialty - hysteroscopy and hysteroscopic surgery. Please give us an idea of how high the demand for that kind of hysteroscopic surgery is. In other words, are the people coming in big masses to you and for what indication? We’re talking now just on hysteroscopy and hysteroscopic surgery. You already mentioned the laparoscopic and resection of the uterus, but that’s for laparoscopy so let’s talk on hysteroscopy. What is the main indication of the people coming to see you?”

Professor Enlan Xia: “The main indication is abnormal uterine bleeding, and for diseases like fibroids, polyps, and hyper-menorrhagia. For the post-menopausal woman the main indication is bleeding too. Sometimes they suffer from polyps, adenocarcinoma, and endometrial atrophy. Except for the malignant disease, we can cure the benign intrauterine cavity disease by hysteroscopy. It’s very fast; saves time, saves costs, faster recovery, and they go back to their work.”

Dr. Hugo Verhoeven: “So I assume all those procedures are outpatients.”

Professor Enlan Xia: “Sometimes outpatient but for a diagnostic operation all of them are outpatient. The outpatients sometimes have to stay in the hospital for one or two days.”

Dr. Hugo Verhoeven: “What about the ablation of the endometrium?”

Professor Enlan Xia: “Ablation is very popular.”

Dr. Hugo Verhoeven: “It’s very popular?”

Professor Enlan Xia: “In our hospital and her hospital we will do this operation on 4-7 cases every day from Monday to Friday.”

Dr. Hugo Verhoeven: “Four to seven cases - what technique are you using? Are you doing a resection of the endometrium or are you going to do a heat ablation, a cryoablation, or an ultrasound? What technique are you using?”

Professor Enlan Xia: “Most of them we use a resectoscope and that’s very useful because we can use it to resect the endometrium and to resect the fibroids, polyps, and even for adenomyosis but for MEA - microwave endometrial ablation, rollerball, uterine balloon therapy, and HTA we have used them before but they can’t resect the fibroids or polyps and that’s a problem but it’s very useful for ablation.”

Dr. Hugo Verhoeven: “What kind of anesthesia are you using for hysteroscopic surgery?”

Professor Enlan Xia: “Sometimes a spinal, sometimes an epidural, and sometimes a local.”

Dr. Hugo Verhoeven: “Do you know why I ask these questions - we are always fascinated with what you Chinese doctors are doing under acupuncture.”

Professor Enlan Xia: “We don’t use acupuncture for hysteroscopic procedures; perhaps you can use it.”

Dr. Hugo Verhoeven: “Of course, the next problem for you is that your country is so huge that what you’re talking about is probably only possible in the big centers that are in the big cities or is the development of your infrastructure so good that even in the smaller hospitals the normal gynecologist can do routine hysteroscopy and hysteroscopic surgery or is that only a dream that will be realized in the next decade?”

Professor Enlan Xia: “That’s no dream, the dream will be carried out soon, because in our country, as you know, we have a lot of women and they welcome these procedures. In our clinic and her clinic a lot of patients come; our clinics are crowded. They do want us to perform the operations to cure their disease by hysteroscopy, with no incision, and not to remove the uterus. In our center, we have used hysteroscopic procedures to diagnose and to treat some diseases just as I told you before. Now the Chinese Health Ministry, which is the highest level, gives every bureau of health of every province a document. That means you have to use hysteroscopic surgeries to diagnose and to operate for benign uterine cavity disease. There’s a document that now requires every province, and there’s thirty provinces, to spread this technique because it is very useful and welcome.”

Dr. Hugo Verhoeven: “What a huge market - my conclusion is we should buy stock of the Olympus Company. I always try to finish my interviews with the same question - what are your dreams for the future in your professional life?”

Professor Enlan Xia: “My dream is to spread hysteroscopic surgeries to every place of our country, even in the rural areas. I think the dream will be carried out soon.”

Dr. Hugo Verhoeven: “Professor, thank you very much.”

Professor Enlan Xia: “Thank you very much.”

Dr. Hugo Verhoeven: “You didn’t say that much but I think you agree with what Professor Xia said. It was a real pleasure, thank you very much.”

Professor Enlan Xia: “Thank you very much.”