The second striking aspect of endometriosis/chronic pelvic pain (CPP) in China is the quality of the surgery. There were three outstanding surgeons in the unit that I visited who, for various reasons, made surgery in the UK look slightly “primitive”.
The first point was the sheer scale of their work. There are ten gynaecological operating theatres doing 60 major operations every day. All of these operations are done using simple, keyhole techniques. Every resident starts on their first day by performing keyhole surgery. The three consultants performing the advanced cases, are on a different level to our surgeons simply because they are doing 3-4 operations each day (rather than 3-4 per month). Their set-up is different. They place two instruments on the left side of the abdomen so they are have good ergonomic control. They use 5 millimetre ports until they get to the tissue extraction phase (when they enlarge one to insert the locally-made, reusable morcellator). They use re-usable instruments. All have access to the harmonic scalpel but they find it too bulky and expensive to use for most jobs. All their suturing is using dextrous, intra-corporeal techniques – at which they are very good.
The Chinese are getting good at many things – they are VERY good at minimal access surgery in the right units. All three speak very good English – so there are few barriers to having MAS in China, if surgery is indicated in your condition.