Laparoscopy is a low-traumatic operation that is performed to diagnose or treat many diseases. To carry out this procedure, special instruments are used to penetrate the peritoneum through small holes. It is important to know what laparoscopy is, how it is performed, whether there are contraindications and what possible complications after laparoscopy.
The surgeon performs this procedure through small incisions in the anterior wall of the abdomen using special instruments and a small video camera. The entire process is displayed on the monitor screen.
Laparoscopic examination is prescribed to clarify the diagnosis when it is difficult to diagnose diseases of the peritoneal organs and pelvic area, since other diagnostic methods are not able to provide such detailed information. Laparoscopic surgery should only be performed by a qualified, experienced surgeon. Previously, he must inform the patient about laparoscopy, what to do, what tests are necessary, how to prepare and how long it will take rehabilitation period after operation.
IN Lately This method is popular among surgeons. The main advantage of the method is the patient’s fairly rapid recovery and return to their normal lifestyle.
Types of laparoscopy and indications for it
In what cases is laparoscopy prescribed? The most important thing that the surgeon pays attention to is the test results, the presence chronic diseases, age and what is the indication for laparoscopy.
There are the following types of laparoscopic surgery:
- Planned.
- Emergency.
Emergency (urgent) laparoscopic surgery is prescribed in the following situations:
- with apoplexy;
- in case of ovarian torsion or the presence of a fibrous node of the uterus;
- purulent and infectious diseases organs in acute form;
- with ectopic pregnancy.
Typically, laparoscopic interventions are planned.
Laparoscopy and gynecology
Laparoscopy is most often used in gynecology. It is performed to examine and treat many gynecological pathologies. For example, diagnostic laparoscopy is prescribed for infertility. And laparoscopic operations in gynecology help get rid of, for example, ovarian cysts.
You can learn more about cyst removal using lapara in the article “”
Laparoscopy is also used in gynecology:
- to remove tumors and stimulate ovulation in polycystic disease;
- with infertility of unknown origin;
- to eliminate the adhesive process of the small pelvis;
- to remove foci of endometriosis. After this operation, pregnancy occurs in 65% of cases within six months;
- for complete or temporary sterilization. For the latter, a protective clamp is applied to the fallopian tubes;
- with fibroids, when conservative treatment did not bring any effect, there are nodules on the leg or when the patient suffers from regular bleeding;
- pathological and abnormal structures of the pelvic organs;
- at initial stage uterine cancer, while nearby lymph nodes are cut off;
- for incomplete or complete excision of the uterine body;
- for removing benign tumors large sizes. In this case, it is possible to excise the ovary with or without preserving the fallopian tube;
- incontinence as a result of stress.
For diagnostic purposes to assess patency fallopian tubes When establishing the cause of infertility, GST or laparoscopy is prescribed. So what is actually more effective: GST or laparoscopy?
Hysterosalpingography or HSG is an x-ray of the uterus and tubes. Before carrying out gynecological examination women. If necessary, the procedure is carried out with local or general anesthesia.
Many who have had laparoscopy consider this diagnostic method more effective. However, you should always follow the doctor’s prescriptions, and not the recommendations of friends.
Other Applications
In addition to diagnosing and treating gynecological diseases, laparoscopic surgery is performed on the following internal organs:
- gallbladder;
- intestines;
- stomach and others.
Indications for the procedure for pathologies of internal organs:
- treatment of the kidneys, bladder and ureters;
- appendix removal;
- removal of the gallbladder cholelithiasis or cholecystitis;
- to stop internal bleeding;
- hernia removal;
- stomach surgery.
With help this method removal of any internal organ or part thereof is carried out.
Thanks to the introduction of a miniature camera into abdominal cavity the surgeon sees everything that happens inside
Contraindications to laparoscopy
Despite the fact that this surgical intervention is low-traumatic, there are some contraindications to laparoscopy.
Conventionally, all contraindications can be divided into:
- Absolute
- Relative.
Absolute contraindications
TO absolute contraindications methods include:
- stroke or myocardial infarction;
- pathologies of the cardiovascular and respiratory systems;
- poor clotting;
- hemorrhagic shock;
- renal and liver failure;
- coagulopathy that cannot be corrected.
Remember! If you have one of the above diseases, the doctor will not prescribe laparoscopy.
Relative contraindications
It is important to note the following relative contraindications:
- infectious diseases of the pelvic organs;
- diffuse peritonitis;
- neoplasms on the ovary larger than 14 cm;
- ovarian and fallopian tube cancer;
- adhesions;
- concerns about malignant neoplasms in the uterine appendages;
- polyvalent allergy;
- large fibroids;
- pregnancy after 16 weeks.
In addition, this procedure is not effective for the following conditions:
- if a large number of dense adhesions have formed in the peritoneum;
- for organ tuberculosis reproductive system pelvis;
- advanced endometriosis in severe form;
- large hydrosalpinx.
After an ultrasound diagnosis has been performed and all tests have been completed, the specialist, taking into account all the factors, decides whether laparoscopy can be performed on each individual patient. Since in certain cases to achieve desired result After laparoscopy it is quite difficult; laparotomy is prescribed for treatment.
Preparation for laparoscopy
Before appointment and elective surgery, the doctor tells the patient in detail what lapara is, why it is performed, how to prepare for laparoscopy, the approximate duration of the surgical intervention and possible negative complications after the operation.
Preliminary preparation
Before laparoscopy, the patient must undergo a mandatory examination and do the following laboratory tests:
- blood and urine tests;
- analysis to determine blood clotting;
- fluorography and cardiogram.
During an emergency operation, the blood must be checked for coagulability and group and the pressure measured.
Patient preparation
After the examination has been completed and the results obtained, the patient begins to prepare for laparoscopy. Most often, planned procedures are prescribed in the morning. The day before surgery, the patient must limit evening food intake. In the evening and morning before the operation, the patient is given an enema. On the day of the operation, it is forbidden not only to eat, but also to drink.
Surgical instruments for laparoscopy
How is laparoscopy performed?
How is the operation itself performed? The doctor makes small incisions through which he inserts special micro-instruments. The location of the incisions depends on the organ being operated on. For example, to remove a cyst, they are performed in the lower abdomen. During laparoscopy of the stomach, gallbladder or other internal organs, incisions are made at the location of the organ. The next step is to inflate the patient’s abdomen with gas to allow the instruments to move freely in the peritoneum. The patient’s preparation is now complete, and the doctor begins the operation. In addition to the small incisions, the doctor makes one slightly larger incision through which the video camera will be inserted. Most often it is done in the navel area (above or below). After correct connection camera and the introduction of all instruments, an enlarged image is displayed on the screen. The surgeon, focusing on it, carries out the necessary actions in the patient’s body. It is difficult to immediately say how long such an operation lasts. The duration can vary from 10 minutes to an hour.
After surgery in mandatory install drainage. This necessary procedure after laparoscopy, which is intended to remove bloody postoperative remains, the contents of ulcers and wounds from the peritoneum to the outside. Installation of drainage helps prevent possible peritonitis.
Is it painful to have laparoscopy? The operation is performed under general anesthesia. Before administering a sleeping pill, the anesthesiologist takes into account age characteristics, height, weight and gender of the patient. After the anesthesia has taken effect, so that various sudden situations do not occur, the patient is connected to the device artificial respiration.
What is transvaginal hydrolaparoscopy
Quite often, patients come across the term transvaginal hydrolaparoscopy. What does this term mean? This is a procedure that allows you to examine all the internal genital organs in more detail. A probe is inserted into the uterus through incisions, allowing you to examine the organs of the reproductive system, and even perform micro-surgery, if necessary.
Is laparoscopy dangerous?
You can hear from many patients: “I’m afraid of laparoscopy!” Should I be afraid, is this procedure dangerous?
First, laparoscopy is primarily a surgery, which means there are risks that can happen with any surgery. However, this operation is not considered dangerous, since during its implementation there is a lower risk of developing any complications than after other types of operations. Therefore be afraid this operation no need. The main thing is to follow all the doctor’s recommendations during preparation for surgery and during rehabilitation.
Advantages of the method
What better laparoscopy or abdominal surgery? The main advantages of the method include:
- Short rehabilitation period after surgery.
- Minor tissue injury.
- After laparoscopy, the risk of adhesions, infection or suture dehiscence is several times lower than after strip surgery.
By following all the doctor’s advice, the postoperative period will be short and painless. And don’t be afraid, because laparoscopy is the least traumatic operation.
All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.
Laparoscopy is a modern and minimally invasive method of accessing the organs of the abdominal cavity, pelvis, and retroperitoneum, which has been successfully used by surgeons around the world over the past decades.
Laparoscopic surgical techniques have become popular and are preferred over conventional open operations not only by surgeons, but also by patients themselves who do not want to develop scars on the skin, adhesions in cavities and experience all the hardships of the postoperative period as after open interventions.
Due to its many advantages, laparoscopy is widely used in abdominal surgery, gynecology and even in some oncological processes, if this does not come at the expense of radicalism and the principles of ablastics. The method is gradually replacing open interventions; most surgeons are proficient in it, and the equipment has become available not only to large clinics, but also to ordinary city hospitals.
Today, laparoscopy can be used to diagnose the most various diseases and at the same time treat them, causing minimal trauma to the patient while reducing complications and surgical risks. In this way, it is possible to remove entire organs, large tumors, and perform plastic surgery.
Many patients in serious condition, elderly and old age, with some concomitant diseases, open surgery may be contraindicated due to high risk complications, and laparoscopy makes it possible to reduce the likelihood of adverse consequences and carry out surgical treatment, as they say, “with little bloodshed.”
At the same time, we should not forget that laparoscopic surgery is also a surgical treatment, so it should also be carried out before proper preparation, a thorough examination of the patient and assessment of possible contraindications.
Advantages and disadvantages of laparoscopy as a method of access
Undoubtedly advantages laparoscopic access during operations and at the stage of diagnosing diseases are considered:
Besides important advantages For the patient, laparoscopy provides a number of advantages for the surgeon. Thus, the use of optics and magnifying technology makes it possible to study the affected organ in more detail, examine it from different angles with a 40-fold magnification, which improves the quality of diagnosis and subsequent treatment.
At the same time, like any intervention in the body, accompanied by even minimal trauma, laparoscopy can also have flaws , among which:
- Limited visibility and ability to move instruments in some hard-to-reach areas;
- Subjective and not always accurate perception of the depth of penetration and parameters of internal organs;
- Lack of tactile contact and the ability to manipulate only instruments without touching internal tissues with your hand;
- Difficulty in mastering the skills of laparoscopic intervention;
- Possibility of tissue injury from cutting instruments in conditions of limited visibility and mobility in a confined body space.
One of the disadvantages of the method can be considered the high cost of equipment and the high cost of the operation itself in comparison with traditional surgery, therefore such treatment may not be available to some patients, especially in remote areas. populated areas with a low level of equipment in medical institutions.
As the skills of surgeons improved, laparoscopy became possible for emergency operations, removal of not only benign, but also malignant tumors, performing interventions in patients with high obesity and a number of other severe concomitant diseases. The most complex operations on internal organs are performed laparoscopically while maintaining the principle of minimally invasiveness and low overall operational risk.
Instruments used for laparoscopy
If for a normal open operation the surgeon only needs his own hands and the usual tools in the form of scalpels, clamps, scissors, etc., then laparoscopy requires completely different, complex and high-tech equipment, which is not so easy to master.
The traditional set of instruments for laparoscopy includes:
- Laparoscope;
- Light source;
- Video camera;
- Optical cables;
- Suction systems;
- Trocars with manipulators.
Laparoscope
- the main instrument through which the surgeon gets into internal cavity body, introduces a gas composition there, examines tissues thanks to a system of lenses. A halogen or xenon lamp provides good illumination, because you have to act in complete darkness and it is simply impossible to carry out an operation without light.
The image from the video camera gets onto the screen, with the help of which the specialist examines the organs, controls the movements of the instruments and the manipulations carried out inside the body.
Trocars - These are hollow tubes that are inserted through additional punctures. Tools get inside through them - special knives, clamps, needles with suture material etc.
The effectiveness of laparoscopic surgery can be increased by the use of modern visualization methods, which are especially relevant if the pathological focus lies not on the surface of the organ, but inside it. For this purpose, interventions are carried out in so-called hybrid operating rooms, equipped with both laparoscopic instruments and additional diagnostic equipment.
A computer or magnetic resonance imaging scanner allows you to determine the location of tumors of the kidneys, liver, and pancreas. The use of angiography helps to clarify the location of the tumor and the characteristics of its blood supply. An operating microscope makes it possible to examine affected tissues under high magnification, improving the quality of diagnosis.
Robotic systems, in particular the well-known Da Vinci robot, are considered the latest developments in modern surgery. This device has not only standard manipulators, but also micro-instruments that allow you to operate in the surgical field with high precision. The video camera produces a color image in three-dimensional space in real time.
access points to abdominal organs
The surgeon carefully uses the instruments, and the robot makes his movements even smoother and more precise, which makes it almost impossible to damage blood vessels, nerve bundles and tissues in the intervention area, increasing the efficiency and safety of treatment.
Types of laparoscopic operations and indications for them
Depending on the purpose pursued, laparoscopy can be:
- Diagnostic;
- Medicinal.
In addition, the operation can be planned or emergency.
Diagnostic laparoscopy used to examine organs and tissues in cases where no non-invasive diagnostic method allows diagnosis accurate diagnosis. It is indicated when closed damage abdominal cavity, suspected ectopic pregnancy, infertility of unknown origin, to exclude acute surgical and gynecological pathology, etc.
The advantage of laparoscopic diagnostics is the possibility of a more detailed examination of organs thanks to magnifying devices, as well as inspection of even poorly accessible remote parts of the abdomen and pelvis.
Therapeutic laparoscopy planned for a specific purpose - to remove an organ affected by the disease, a tumor, adhesions, restore reproductive function, etc. Diagnostic laparoscopy, if technically possible, can turn into therapeutic.
Indications for laparoscopy of the abdominal cavity include a variety of diseases of the internal organs:
- Acute and chronic cholecystitis, asymptomatic stones in the gallbladder;
- Polyps, cholesterosis of the gallbladder;
- Acute or chronic inflammation appendix;
- Adhesions in the abdomen;
- Tumors of the liver, pancreas, kidneys;
- Injuries, suspected internal bleeding.
Laparoscopy in gynecology is performed especially often, which is associated with low tissue trauma and a lower probability of subsequent proliferation of connective tissue adhesions compared to traditional surgery. Many interventions are indicated for young women who have not given birth or who suffer from infertility, and additional trauma and adhesions can aggravate the course of the pathology, so laparoscopy for infertility is not only a valuable diagnostic procedure, but also an effective and low-traumatic method of treatment.
In addition to laparoscopy, another method of minimally invasive diagnosis and treatment is used in gynecology -. In fact, laparoscopy and hysteroscopy pursue the same goals - to clarify the diagnosis, take a biopsy, remove altered tissue with the least trauma, but the technique of these procedures is different. During laparoscopy, instruments are inserted into the abdominal cavity or pelvis, and during hysteroscopy, a flexible endoscope is placed directly into the uterine cavity, where all the necessary manipulations take place.
Indications for laparoscopy in gynecology are:
- Infertility;
- Uterine fibroids;
- Tumors and tumor-like lesions (cystoma) of the ovaries;
- Endometriosis;
- Ectopic pregnancy;
- Chronic pelvic pain of unknown etiology;
- Malformations of the genital organs;
- Chronic inflammatory processes in the pelvis;
- Adhesive disease.
Listed above are only the most common reasons for laparoscopic intervention, but there are quite a few of them. In case of damage to the gallbladder, minimally invasive cholecystectomy is considered the “gold standard” of treatment, and laparoscopy for infertility has both diagnostic value, making it possible to clarify its cause, and therapeutic value, when during the same intervention the surgeon establishes the nature of the pathology and immediately begins its radical treatment .
Contraindications to laparoscopic access are not much different from those during open surgery. These include decompensated diseases of internal organs, blood clotting disorders, acute infectious pathology and skin lesions at the site of intended punctures.
Specific contraindications related to the technical features of the method include long periods of pregnancy, high obesity, widespread tumor process or cancer of certain localizations, severe adhesive disease, diffuse peritonitis. Some contraindications are relative, while others are safer to do open surgery. In each case, the question of the appropriateness of minimally invasive access is decided individually.
Video: laparoscopy in the treatment of female infertility
Preparation for surgery and pain relief methods
Proper preparation for laparoscopy is no less important than for classical interventions, because minimally invasiveness does not negate the fact of tissue injury, albeit minimal, and general anesthesia, for which the body must also be prepared.
After the surgeon has prescribed laparoscopy, the patient will undergo numerous examinations and consultations with specialists. The list of procedures that can and should be done before hospitalization includes:
- General and biochemical tests blood;
- Urine examination;
- Determination of blood clotting;
- Fluorography or x-ray of the lungs;
- Electrocardiogram;
- Testing for HIV, syphilis, hepatitis;
- Ultrasound examination of the abdomen and pelvis;
- Vaginal smears and cervical cytology during laparoscopy in gynecology.
To clarify the nature and localization of the pathology, all kinds of clarifying studies can be prescribed - CT, MRI, angiography, colonoscopy, hysteroscopy of the uterus, etc.
When all examinations have been completed and there are no changes that would interfere with the planned laparoscopy, the patient is sent to a therapist. The doctor determines the presence concomitant pathology and the severity of its course, if necessary, prescribes appropriate treatment or consultations with other specialists - an endocrinologist, cardiologist, oncologist and others.
The final decision on laparoscopy remains with the therapist, who determines the safety of further surgical treatment. Blood thinning drugs are discontinued approximately 2 weeks before surgery, and those recommended for continuous use antihypertensive drugs, diuretics, hypoglycemic drugs etc. can be taken as usual, but with the knowledge of the attending physician.
On time and with ready results diagnostic procedures the patient comes to the clinic, where the surgeon talks to him about the upcoming operation. At this moment, the patient should ask the doctor all the questions that interest him regarding the course of the operation itself and the postoperative period, even if they seem stupid and frivolous. It is important to find out everything so that during treatment you do not experience groundless fears.
On the eve of laparoscopic surgery, an anesthesiologist is required to talk with the patient, determine the type of anesthesia, find out what, how and when the patient takes medications, what obstacles there are to the administration of specific anesthetics (allergies, negative experiences with anesthesia in the past, etc.).
For laparoscopic operations, intubation anesthesia is most appropriate. This is due to the duration of the intervention, which can last an hour and a half or even more, the need for adequate pain relief during manipulations in the abdomen, retroperitoneum or pelvis, as well as the injection of gas into the body cavity, which can be quite painful under local anesthesia.
In very rare cases and if there is serious contraindications to general anesthesia, the surgeon can go for local anesthesia, if the operation does not take much time and does not require deep penetration inside the body, however, such cases are still the exception rather than the rule.
Before the intervention, the patient should prepare for the upcoming pneumoperitoneum and subsequent restoration of bowel function. For this it is recommended light food, excluding legumes, fresh baked goods, fresh vegetables and fruits that cause constipation and gas. Porridge will be useful dairy products, lean meat. On the eve of the operation, a cleansing enema is performed to remove all excess from the intestines.
During laparoscopy in gynecology there is a serious risk of thrombosis and embolism, so elastic bandaging of the legs is indicated the evening before the operation or in the morning. In case of danger of infection and bacterial complications, antibiotics are prescribed wide range actions.
Before any laparoscopic surgery, the last meal and water intake is allowed no later than 6-7 pm the day before. The patient takes a shower, changes clothes, and in case of severe anxiety, the doctor recommends a sedative or sleeping pill.
Laparoscopic technique
General principles of laparoscopy include insertion of the laparoscope and trocars, application of pneumoperitoneum, manipulation inside the body cavity, removal of instruments and suturing of skin punctures. Before the operation begins, to prevent the reflux of gastric contents into Airways a probe is inserted into the stomach, and a catheter is placed into the bladder to drain urine. The person being operated on usually lies on his back.
Before manipulations in the cavities, carbon dioxide or other inert gas (helium, nitrous oxide) is injected there with a special needle or through a trocar. The gas raises the abdominal wall into a dome, which makes it possible to improve visibility and facilitate the movement of instruments inside the body. Experts do not recommend introducing cold gas, which predisposes to injuries to the serous tissue and a decrease in microcirculation in the tissues.
access points for laparoscopy
Before inserting instruments, the skin is treated with antiseptic solutions. The first hole in abdominal pathology is most often made in the umbilical region. A trocar with a video camera is placed in it. Inspection of the contents of the abdominal or pelvic cavity occurs through a laparoscope equipped with a lens system, or through a monitor screen. Manipulators with instruments are inserted through additional punctures (usually 3-4) in the hypochondrium, iliac regions, and epigastrium (depending on the area of the surgical field).
Based on the image from the video camera, the surgeon carries out the intended operation - excision of the tumor, removal of the diseased organ, destruction of adhesions. As the intervention progresses, the bleeding vessels are “sealed” with a coagulator, and before removing the instruments, the surgeon once again makes sure that there is no bleeding. Laparoscopically, it is possible to apply thread sutures, install titanium clips on the vessels, or coagulate them with electric current.
After the operation is completed, the body cavity is inspected, it is washed with warm saline solution, then the instruments are removed, and sutures are applied to the skin puncture sites. Depending on the specifics of the pathology, drainage can be installed in the cavity or it can be sutured tightly.
Laparoscopy makes it possible to remove large tumors or entire organs (uterine fibroids, gallbladder, cancer of the head of the pancreas, etc.). To make their removal possible and safe, special devices are used - morcellators, equipped with sharp knives that chop the excised tissue, which is placed in special containers for removal.
Hollow organs, for example, the gallbladder, are closed in advance in special containers, and only then opened to reduce their volume in order to prevent the contents from entering the free abdominal cavity.
Postoperative period and possible complications
Recovery after laparoscopy is quite fast and much easier than with classical open operations- this is one of the main advantages of the method. By the evening after the operation, the patient can get out of bed, and early activation is very welcome, as it helps faster recovery bowel function and prevention of thromboembolic complications.
Immediately after laparoscopy, the operated patient may feel pain at the sites where the instruments were inserted, and therefore analgesics may be prescribed to him. As the gas dissolves, the discomfort in the abdominal area goes away and intestinal function is restored. At risk infectious complications antibiotics are indicated.
For the first day after surgery on the abdominal organs, it is better to refrain from eating and limit yourself to drinking. The next day, it is already possible to take liquid and light foods, soups, and fermented milk products. The diet is gradually expanded, and after a week the patient can safely switch to a general diet, if there are no contraindications to this due to a specific disease (previous cholecystitis or pancreatitis, for example).
Sutures after laparoscopy are removed on days 7-10,but you can go home earlier - 3-4 days. It is worth remembering that the healing of internal scars occurs somewhat more slowly, so for the first month you should not engage in sports or heavy physical labor, or lift heavy objects at all, and for the next six months - no more than 5 kg.
Rehabilitation after laparoscopy is quite easy due to less surgical trauma. 1-2 weeks after treatment, depending on the characteristics of the pathology, the patient can return to normal life and labor activity. WITH water procedures- bathhouse, sauna, swimming pool - you will have to wait a while, and if the work involves physical effort, then a temporary transfer to easier work is advisable.
Nutrition after laparoscopy has some features only in the early postoperative period, when there is a risk, albeit minimal, of intestinal paresis and constipation. In addition, diet may be indicated for pathology digestive system, and then its features will be prescribed in the recommendations by the attending physician.
The food consumed after surgery should not be rough, too spicy, fatty or fried. It is important not to put excessive stress on the intestines while the sutures are healing. Legumes, cabbage, and confectionery products that cause bloating and delayed bowel movements are excluded from the menu. To prevent constipation, you need to eat fermented milk products, prunes, cereal porridge with dried fruits, bananas are healthy, and it is better to temporarily avoid apples and pears.
Quite often situations arise when a person needs surgical intervention. A few decades ago, doctors used laparotomy. During its implementation, the patient is introduced into deepest sleep using general anesthesia, after which the abdominal wall, muscles and tissues are dissected. Next, the necessary manipulations are performed and the tissue is sutured in layers. This method of intervention has many disadvantages and consequences. That is why the development of medicine does not stand still.
Lately, in almost every medical institution There are all conditions for a more gentle surgical intervention.
Laparoscopy
This is a method of performing surgical intervention or diagnostics, after which a person can quickly return to the usual rhythm of life and receive a minimum of complications from the manipulation.
Laparoscopy in gynecology
The use of this manipulation has become quite popular. If the doctor is unable to make an accurate diagnosis of the patient, then this type procedures will help with this. Laparoscopy in gynecology is used to treat or remove tumors and to treat infertility in women. This method will also help to eliminate and remove foci of endometriosis as accurately as possible.
Other Applications
In addition to the diagnosis and treatment of gynecological pathologies, examinations of the intestines, stomach and other organs can be performed. Quite often, this method is used to remove one or another organ or part of it.
Indications for intervention
Laparoscopy is a correction method that has indications for carrying out, like any other surgical intervention:
- Severe internal bleeding.
- Rupture of any organ.
- Female infertility without an established cause.
- Tumors of the ovaries, uterus or other abdominal organs.
- The need for ligation or removal of the fallopian tubes.
- The presence of an adhesive process that brings severe discomfort to a person.
- Treatment of ectopic pregnancy.
- With the development of endometriosis or other organ diseases.
In some cases, laparoscopy is not the most the best option treatment and laparotomy is necessary.
Contraindications for intervention
Laparoscopy is never performed in the following cases:
- In the presence of a severe stage of vascular or heart disease.
- While a person is in a coma.
- With poor blood clotting.
- At colds or poor tests (exceptions are emergency cases that cannot be delayed).
Before surgery
The patient is recommended to undergo a short examination before undergoing surgery. All tests prescribed to a person must comply with the standards that the hospital has. Planned laparoscopy before the procedure involves the following examination:
- General and biochemical blood test.
- Determination of blood clotting.
- Analysis of urine.
- Conducting fluorography and cardiogram examination.
If carried out emergency surgery, then the doctor is limited to a minimum list of tests, which include:
- Blood test for group and coagulability.
- Pressure measurement.
Patient preparation
Elective surgeries are usually scheduled before lunch. The day before the procedure, the patient is advised to limit food intake in the evening. The patient is also given an enema, which is repeated in the morning before surgery.
On the day on which the manipulation is scheduled, the patient is prohibited from drinking or eating.
Since laparoscopy is the most gentle method of surgical intervention, during its implementation microinstruments are used, and small incisions are made in the abdominal cavity.
To begin with, the patient is put into a sleep state. The anesthesiologist calculates required dose medicinal product, taking into account the gender, weight, height and age of the patient. When the anesthesia has taken effect, the person is connected to an artificial respiration apparatus. This is necessary so that no unforeseen situations arise during the operation, since the abdominal organs are subject to intervention.
Continue to the patient using a special gas. This will help the doctor move the instruments freely in the abdominal cavity and not catch the upper wall.
Progress of the operation
After the patient's preparation is completed, the doctor makes several incisions in the abdominal cavity. If laparoscopy of the cyst is performed, then incisions are made in the lower abdomen. If surgical intervention in the intestines, gallbladder or stomach is necessary, then incisions are made at the target location.
In addition to small holes for instruments, the surgeon makes one incision that has several big sizes. It is necessary to insert a video camera. This incision is usually made above or below the belly button.
After all the instruments are inserted into the abdominal wall and the video camera is connected correctly, the doctor sees a several times enlarged image on the large screen. Focusing on it, they perform the necessary manipulations in the human body.
The time period for laparoscopy can vary from 10 minutes to one hour.
Condition after surgery
Upon completion of the manipulations, the doctor removes the instruments and manipulators from and partially releases the air with which the abdominal wall was raised. After this, the patient is brought back to his senses and the control devices are turned off.
The doctor checks the state of the person’s reflexes and reactions, and then transfers the patient to the postoperative department. All movements of the patient are carried out strictly on a special gurney with the help of medical personnel.
After just a few hours, it is recommended to lift top part body and try to sit up. You will be able to get up no earlier than five hours after the end of the operation. It is recommended to take the first steps after the intervention with outside help, as there is a high risk of losing consciousness.
The patient is discharged within five days or a week after the operation, provided wellness and positive dynamics. Sutures from the incisions are removed on average two weeks after the intervention.
Recovery after surgery
If the tumor was treated, then after laparoscopy the cyst or its fragment is sent for histological examination. Only after receiving the results can the patient be prescribed subsequent treatment.
When or part of another organ is carried out if it is necessary to clarify the diagnosis.
If surgery was performed on the female organs, the ovaries should “rest” for some time after laparoscopy. For this, the doctor prescribes the necessary hormonal drugs. The patient is also advised to take anti-inflammatory and antibacterial medications.
Choosing a clinic
Before preference is given to an institution where laparoscopy will be performed, the cost of work and hospital stay must be taken into account and agreed upon with the attending physician. Analyze the work and cost of service in several places and make your choice.
If the surgery is an emergency, then most likely no one will ask about your preferences and you will receive care at a public health facility. In this case, laparoscopy has no cost. All manipulations are carried out free of charge if you have an insurance policy.
Consequences and complications of surgery
In most cases, laparoscopy has a positive effect on human health. However, sometimes complications can arise both during and after the manipulation.
Perhaps the main complication is the formation of adhesions. This is an inevitable consequence of all surgical interventions. It is worth saying that during laparotomy, the development of the adhesive process occurs faster and is more pronounced.
Another complication that may arise during the operation is injury to neighboring organs by the inserted manipulators. As a result, it can begin. That is why at the end of the manipulation the doctor examines the abdominal cavity and organs for damage.
After surgery, the patient may feel pain in the collarbone area. This is completely normal and does not last more than one week. This discomfort is explained by the fact that the gas “walking” through the body seeks a way out and affects nerve receptors and tissues.
Never be afraid of your upcoming laparoscopy. This is the most gentle method of surgical treatment. Don't get sick and be healthy!
Surgeons like to repeat: “The belly is not a suitcase; it cannot just be opened and closed.”. And it's true surgical operations on the abdominal organs are traumatic, full of risks and negative consequences. Therefore, when bright minds came up with a laparoscopic method for treating surgical diseases, doctors and patients breathed a sigh of relief.
What is laparoscopy
Laparoscopy is an introduction into the abdominal cavity through small (slightly more than one centimeter in diameter) holes, when a laparoscope comes out with the hands and eyes of the surgeon, which is inserted into the cavity through these holes.
The main parts of a laparoscope are:
The tube serves as a kind of pioneer, which is carefully inserted into the abdominal cavity. Through it, the surgeon sees what is happening in the inner kingdom of the abdomen, through another hole he introduces surgical instruments, with the help of which he performs a series of surgical manipulations in the abdominal cavity. A small video camera is attached to the end of the laparoscope tube that is inserted into the abdominal cavity. With its help, an image of the abdominal cavity from the inside is transmitted to the screen.
The word “laparoscopy” reflects the essence of this method: from the ancient Greek “laparo” means “stomach, belly”, “skopia” means “examination”. It would be more correct to call an operation using a laparoscope laparotomy (from the ancient Greek “tomia” - section, excision), but the term “laparoscopy” has taken root and is used to this day.
Let's say right away that Laparoscopy is not only surgery “through a tube”, but also the detection of diseases of the abdominal organs. After all, a picture of the abdominal cavity with all its insides, which can be seen directly with the eye (even if through optical system), more informative than “encrypted” images obtained, for example, from radiography, ultrasound or computed tomography– they still need to be interpreted.
Scheme of laparoscopic treatment
With laparoscopy, the manipulation algorithm is significantly simplified. There is no need to perform complex access to the abdominal cavity, as with the open method of surgery (with traditional surgical intervention, it is often delayed due to the need to stop bleeding from damaged vessels, due to the presence of scars, adhesions, and so on). There is also no need to waste time on layer-by-layer suturing of the postoperative wound.
The laparoscopy scheme is as follows:
The range of diseases that can be treated using laparoscopy is quite wide.:
and many other surgical pathologies.
Benefits of laparoscopy
Since, unlike the open method of surgical intervention, large incisions do not need to be made in the abdomen for examination and manipulation, the “advantages” of laparoscopy are significant:
Disadvantages of laparoscopy
The laparoscopic method has made, without exaggeration, a revolutionary revolution in abdominal surgery. However, it is not 100% perfect and has a number of disadvantages. Not uncommon clinical cases, when, having started laparoscopy, surgeons were not satisfied with it and were forced to switch to the open method of surgical treatment.
The main disadvantages of laparoscopy are as follows::
- due to observation through optics, depth perception is distorted, and significant experience is needed for the surgeon’s brain to correctly calculate the true depth of insertion of the laparoscope;
- the laparoscope tube is not as flexible as the surgeon's fingers, the laparoscope is somewhat clumsy, and this limits the range of manipulations;
- due to the lack of tactile sensation, it is impossible to calculate the force of pressure of the device on tissue (for example, gripping tissue with a clamp);
- it is impossible to determine some characteristics of internal organs - for example, the consistency and density of tissues in a tumor disease, which can only be assessed by palpating with fingers;
- a spotty picture is observed - at some specific moment the surgeon sees in the laparoscope only a specific area of the abdominal cavity and cannot visualize it as a whole, as with the open method.
Possible complications during laparoscopic treatment
There are significantly fewer of them than with the open method of surgical intervention. However, you need to be aware of the risks.
The most common complications during laparoscopy are:
Achievements of laparoscopy
The laparoscopic method is not only considered the most progressive in abdominal surgery - it is constantly evolving. Thus, the developers have created a smart robot equipped with micro-instruments that are significantly smaller in size than standard laparoscopic instruments. The surgeon sees a 3D image of the abdominal cavity on the screen, gives commands using joysticks, the robot analyzes them and instantly turns them into jewelry movements of micro-instruments inserted into the abdominal cavity. In this way, the accuracy of manipulations increases significantly - as if a real living surgeon, but of reduced size, climbed through a small hole into the abdominal cavity and performed all the necessary manipulations with reduced hands.
Laparoscopic surgery– examination of the pelvic organs, which allows for diagnosis and treatment gynecological disease using special endoscopic instruments.
Types of laparoscopy
Laparoscopy can be divided into two types:
- Diagnostic– the operation is performed to detect a disease or pathology, confirm or refute the diagnosis;
- Operational– intended only for the treatment of the disease, removal of foci of inflammation.
Quite often there are cases when, during the diagnostic laparoscopy Doctors decide to perform an emergency operation. This is due to the detection of serious pathologies, protracted illness or acute rapidly developing inflammation. It also happens that surgical laparoscopic treatment, on the contrary, is canceled due to severe disease of the pelvic organs, in which it is necessary to make a large incision on the anterior abdominal wall.
Advantages of the operation
Unlike others surgical interventions, performing the operation using laparoscopy of the pelvic organs has a number of advantages. The main advantage of this operation is the ability to accurately determine the presence of infection, inflammation and pathology in general. Through laparoscopy, the actual shape and size of the organs can be seen. Blood loss during this procedure is minimal.
The postoperative period is not long and requires the patient to stay in the hospital for only a couple of days. After laparoscopy, the woman feels virtually no pain. Unfortunately, cosmetic defects remain. The seams are small, invisible and do not cause discomfort. In most cases, adhesions do not occur after surgery.
If the laparoscopy was successful and the woman is healthy, you can start planning a child in the near future.
Indications
If you suspect serious illness or serious infection in reproductive organs For women, the doctor most often prescribes laparoscopy, both for diagnosing the pelvic organs and for treatment purposes.
Routine diagnostics through the abdominal wall is indicated in the following cases:
- . Carrying out a biopsy;
- A pathological form of pregnancy when the development of the embryo occurs outside the uterine cavity;
- The formation of tumors of unknown origin in the ovarian area;
- Pathologies of the development of the uterus and its structure of a congenital nature;
- Anomalies in the development of the internal genital organs of women;
- Obstruction of the fallopian tubes;
- Infertility. Establishing its causes;
- Prolapse of the genital organs;
- Chronic painful sensations lower abdomen and other pain of unknown etiology;
- Malignant processes in the pelvic organs, determining their stages of development and making decisions about surgical intervention to eliminate them;
- ECO. Preparation for the procedure;
- Inflammatory processes, monitoring the effectiveness of their treatment.
Urgent laparoscopy is prescribed for the following indications:
- Perforation of the uterine wall after curettage (abortion);
- Progressive ectopic pregnancy or its disruption such as tubal abortion;
- Ovarian tumor, torsion of the cyst stalk;
- Rupture of ovarian tissue, open bleeding into the abdominal cavity;
- Necrosis of myomatous node;
- An increase in painful symptoms within 12 hours or the absence of effective dynamics for two days in the treatment of acute inflammatory processes in the uterine appendages.
Contraindications
Despite all the advantages and effectiveness of treatment, laparoscopy has its contraindications. Under no circumstances should surgery be performed using this method if a woman has the following diseases and disorders:
- Hemorrhagic diathesis with severe bleeding;
- Blood clotting disorders. Poor coagulation;
- Purulent peritonitis;
- Obesity;
- Diseases of the cardiovascular system;
- Hernia of the anterior abdominal wall;
- Pregnancy;
This is important to know! The operation is permitted only in the first and early second trimester of pregnancy; in the third trimester it is strictly prohibited!
- Liver and kidney failure;
- Malignant cysts, tumors of the uterus, appendages;
- Coma, state of shock;
- Multiple adhesions in an advanced state;
- Abdominal surgery of the pelvic organs, which was performed quite recently - abdominal myomectomy, laparotomy and others.
Preparation for the operation
Before starting surgery using this method, a woman must pass necessary tests and undergo all the examinations that the gynecologist prescribed for her. Most often this is:
- vaginal smear;
- general blood and urine analysis;
- fluorography;
- cardiogram;
- biochemical blood test and coagulability test;
- ultrasound examination of the pelvic organs;
- blood test for sexually transmitted infections;
- consultation with a therapist and his conclusion about the general health of the patient.
However, preparation for laparoscopy lies not only in taking tests, but also in the behavior of the woman herself. So, a few days before the scheduled date of the operation, the patient should eliminate all negative situations and not be subjected to stress and nervousness. It is not recommended to eat foods that cause bloating and severe flatulence - beans, cabbage, peas, corn and others. At least a week before surgery, completely avoid alcohol, soda, and drinks containing large amounts of caffeine.
Laparoscopy is performed on an empty stomach, so eating and drinking before surgery is prohibited. The woman is also prescribed a cleansing enema.
Upon arrival at the hospital, the patient begins to prepare for the upcoming operation. While still in the ward, medications are administered that improve the introduction of anesthesia and its course.
In the operating room, the woman is fitted with a drip and monitor electrodes, through which blood saturation with hemoglobin and cardiac activity are constantly monitored. Next, intravenous anesthesia and the introduction of relaxants are carried out, which completely relax all the muscles. This total relaxation makes it possible to insert an endotracheal tube into the trachea, through which the view of the abdominal cavity improves. The tube is then connected to the anesthesia machine and the operation itself begins.
Carrying out laparoscopy
The operation is performed using a laparoscope - a thin tube at the end of which there is a small light bulb and a video camera. Thanks to the video camera, everything that happens in the abdominal cavity is reflected on the monitor screen at six times magnification.
Initially, the doctor makes three small incisions in the abdominal wall. One of them is located under the navel, the others are in the groin. Based on the diagnosis, the location of the incisions may change. Next, for better visibility of the internal organs and to create volume, a special gas is injected into the abdominal cavity.
A laparoscope is inserted into one of the holes, and manipulation instruments are inserted into the others, with which the doctor will perform the operation. At the end of the procedure, the manipulators are removed and the gas is released. The skin at the incision site is sutured.
Postoperative period
Based on the woman’s general well-being, she is discharged from the hospital after 4-6 days. You are allowed to return to your previous life, including sexual life, after at least two weeks. However, you need to remember to regularly monitor your doctor to prevent possible complications:
- internal blood loss;
- violation of the integrity of organs and their vessels;
- blood clot formation;
- gas residue in subcutaneous fat;
- disorders of the cardiovascular system.
The operation, which is performed using laparoscopy, helps to identify malignant neoplasms on early stage development. It has minimal recovery time and leaves virtually no cosmetic defects.
