Why is laparoscopy done? Laparoscopy - what kind of surgery method is it?

Laparoscopy- this is one of the types of modern surgical operations when, without an incision, using optical instruments (gastroscope or laparoscope), the doctor can examine organs from the inside. Laparoscopy, literally translated, examination of organs abdominal cavity.

There are diagnostic and operative laparoscopy.

Diagnostic laparoscopy is operative technique a study in which the doctor examines the abdominal organs with his own eye without making large incisions on abdominal wall. During laparoscopy, you can directly see the woman’s internal genital organs with the eye and, thanks to this, obtain comprehensive information about their condition. During diagnostic laparoscopy, after examining the abdominal organs, the doctor confirms or rejects any diagnosis, or checks, for example, the patency of the fallopian tubes.

During surgical laparoscopy, the doctor eliminates the detected pathological changes.

Laparoscopic gynecology - new opportunity effective treatment gynecological diseases, which allows you to minimize recovery time and does not leave cosmetic defects

What operations can be done with laparoscopy?

Using laparoscopic access, you can perform almost all operations that are performed open method, i.e. using a cut. These include: removal of various ovarian cysts, separation of adhesions and restoration of patency of the fallopian tubes, removal of nodes (with preservation of the uterus), removal of the uterine body and uterine appendages, as well as operations on the fallopian tubes with ectopic pregnancy.

Solving some surgical problems, such as eliminating genital endometriosis, is generally impossible without the use of laparoscopy. This technology has opened a new era in diagnostics and has made it possible to achieve significant improvements in results. Timely detection and removal of ovarian cysts using laparoscopic access has significantly reduced the incidence of ovarian cancer. We can safely say that the degree of development and implementation of endoscopic technology is the key to the quality of the services provided. medical services. This must be taken into account when choosing a gynecological hospital.

How is laparoscopic surgery performed?

The surgeon makes 3 small punctures of the anterior abdominal wall, 5 and 10 millimeters in diameter (as thick as a ballpoint pen). Unlike the traditional (laparotomy) incision of the anterior abdominal wall, 15 to 20 centimeters long, these punctures do not injure muscle tissue Therefore, patients experience much less pain after surgery and can usually return to normal life within one week. A puncture of the abdominal wall is carried out with a thin special tube - a trocar. Through it, a small amount of gas is introduced into the abdominal cavity (to create volume), a telescope tube, to which a special small video camera and a light source are connected. This allows you to view the image of the abdominal organs and the surgeon’s manipulations during the operation on the screen of a special TV with high magnification and record the progress of the operation on a video recorder. Through two other trocars, special instruments (manipulators) necessary to perform the operation are introduced into the abdominal cavity.

Diagnostic laparoscopy is usually performed under local anesthesia, the operating one is under anesthesia, and both last no longer than a regular operation. Painful sensations in the puncture area disappear, as a rule, after 1-2 days, after which the patient does not experience the discomfort characteristic of postoperative period traditional surgical operations. The patient is discharged home 2-3 days after surgery, and returns to full life succeeds within 5-6 days. However, medical supervision is necessary throughout the entire recovery period to avoid complications.

What are the advantages of laparoscopic operations in gynecology?

Advantage endoscopic operations lies in their low morbidity, short stay of patients in the hospital (2-3 days), rapid restoration of health and ability to work after interventions. Carrying out the operation under multiple magnification makes it possible to carry out any surgical intervention more accurately and less traumaticly. Minimal trauma to the anterior abdominal wall contributes to rapid recovery functions of all organs and systems: breathing, activity of the cardiovascular system, motor-evacuation function of the intestines and bladder. There are no wounds during the healing period painful sensations, which eliminates the need to prescribe potent painkillers. In addition, there are no postoperative scars, which is observed in conventional incision operations.

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Contraindications to laparoscopy

Both diagnostic and operative laparoscopy may not be performed in all patients. The main contraindication to laparoscopy is a massive adhesive process in the abdominal cavity associated with major abdominal surgeries that the patient has undergone in the past due to, for example, peritonitis, intestinal obstruction etc. In this case, there is a high risk of life-threatening intestinal damage during laparoscopy with serious consequences for the patient.

One more serious contraindication to laparoscopy is a pronounced disturbance of cardiac activity, because This operation is performed with the patient upside down and the abdominal cavity filled with gas, which can cause cardiac decompensation.

What complications can occur after laparoscopy?

Complications after laparoscopy are rare, among them there is bleeding as a result of injury to the vessels of the abdominal wall and abdominal organs (with laparoscopy, as with any other operation, there is always a risk of damage internal organs), organ perforation, and infection.

Tests before laparoscopy. Shelf life of tests for laparoscopy surgery

An approximate list of tests required for hospitalization:(if necessary, the scope of the examination can be expanded by your attending physician)

*		Validity period of tests from the date of delivery to surgery
	1. General analysis blood	2 weeks
	2. General urine test
	3. Clotting time
	4. Platelet count
	5. Prothrombin content
	6. Fibrinogen content
	7. Bilirubin content
	8. Contents total protein blood
	9. Blood glucose level
	10. Urea content
	11. Blood type and Rh factor (the stamp in the passport is not enough)
	12. Wasserman reaction, blood for HIV, HBs Ag, HB C Ag.	3 months
	13. Vaginal smear for flora and degree of purity	2 weeks
	14. Smear for oncocytology	1 year
	15. Fluorography data	11 months
	16. ECG (with interpretation)	1 month
	17. Feces on helminth eggs	1 year
	18. Consultation with a therapist

On what day of the cycle is laparoscopy performed?

Laparoscopy surgery is not performed during menstruation and 1-3 days before menstruation. It is also impossible to perform surgery against the background of acute inflammatory processes (acute respiratory infections, herpes, etc.). The most optimal time to perform a laparoscopic examination for infertility is after ovulation (with a 28-day cycle - from the 15th to 25th day of the cycle), and for some operations - the first phase of the cycle (immediately after menstruation).

Preparation for laparoscopy

You don't need much to prepare for laparoscopy. Depending on your age, gender and health status, the doctor will prescribe a set of tests for you, including a blood test, ECG, X-ray studies, ultrasound, etc. Before the procedure, you must refrain from eating for 8 hours. It is necessary to inform your doctor about what medications you are taking, since it is recommended to stop taking some medications several days before laparoscopy (for example, aspirin, ibuprofen, etc.)

Preparation of the gastrointestinal tract before laparoscopy:

1. During the week before surgery, exclude from the diet foods that cause the formation of gases in the intestines - legumes, brown bread, potatoes, vegetables, fruits, unleavened milk. You can eat fish, lean meat, chicken, cottage cheese, kefir, porridge, broth.
2. Start taking it 5 days before surgery activated carbon 2 tablets after meals 3 times a day (you can use Mezim-Forte, Festal, Pancreatin, Panzinorm).
3. Several cleansing enemas the evening before surgery and one in the morning on the day of surgery.
4. On the eve of the operation, for lunch - only liquid food (first and third courses), for dinner - only drink. On the day of surgery, you should not drink or eat.

Preparing the surgical area before laparoscopy

On the morning of the operation, you need to take a shower and shave the hair in the navel, lower abdomen and perineum.

Psycho-emotional preparation before laparoscopy

A few days before surgery, it is advisable to start taking herbal sedatives(valerian, motherwort, persen).

Contraception before laparoscopy

In the cycle in which the operation is performed, it is necessary to protect against pregnancy by non-hormonal means (condom).

After laparoscopy

Compared with normal operation laparoscopy is less traumatic (muscles and other tissues are less damaged). For this reason, to your physical activity There are fewer restrictions than you might expect. Walking is allowed and even encouraged within a few hours after surgery. Start with short walks, gradually increasing the distance and duration. There is no need to follow a strict diet. Painkillers should be taken as directed by your doctor.

This is an opportunity to conduct medical manipulations inside human body using a laparoscope - a modern device with an optical system that allows doctors to look even into remote corners without requiring large incisions.

Gynecology is one of the areas of medicine where laparoscopy has taken pride of place and helped solve more than one problem women's health– in diagnosis, if, despite the high professionalism and experience of the doctor, it is difficult to make a diagnosis, and in treatment, significantly reducing surgical trauma to tissues.

Table of contents:

The essence of gynecological laparoscopy

Both diagnostic and therapeutic laparoscopy are operational methods gynecology - in order to insert the laparoscope into the pelvis, it is necessary to make incisions in the anterior abdominal wall. This is also tissue trauma, but not comparable to trauma during incisions performed using the open method of surgical treatment - the diameter of the laparoscopic approach is about 0.5 cm, in contrast to laparotomy incisions with a length of 8-10 cm or more.

In order for the laparoscope to be inserted into the pelvis, 2 incisions are most often made in the anterior abdominal wall:

• through one of them, a laparoscope is inserted - a thin tube that has an objective (lens system) at one end, and an eyepiece at the other for observation by a doctor. Or, at the end of the device, which is immersed in the patient’s cavity, a video camera is attached, which transmits the image to a monitor or screen;
• through another incision, the functional part of the laparoscopic system is introduced - the one that will carry out the actual manipulation (clamps, devices for electrocoagulation, and so on).

All elements of the laparoscope, which are inserted into the patient’s pelvic cavity during the use of this method, are made of durable hypoallergenic materials.

To ensure that the internal organs do not interfere with the operating gynecologist’s ability to target one or another organ, during laparoscopy a portion of gas is injected into the small pelvis, which is why the organs do not come into contact with each other and with the abdominal wall. Thanks to this technical solution using optical system can be inspected internal structures from all sides - the field of view of the operating doctor increases.

Diagnosis of gynecological diseases using laparoscopy

The main indications for the use of diagnostic laparoscopy in gynecology are:

• acute gynecological pathology;
• chronic diseases of the female reproductive organs;
• signs of acute surgical pathology that needs to be treated differential diagnosis women's diseases.

Laparoscopy makes it possible to identify following reasons infertility:

• obstruction of the fallopian tubes, which causes infertility in approximately 30% of cases;
• benign neoplasms of the uterus;
• incorrectly performed artificial termination of pregnancy (abortion or induced birth)

and others.

Acute gynecological pathology, for the diagnosis of which the laparoscopic method is used, is:

• torsion of a pedunculated cyst;
• cyst rupture;
• internal bleeding

The most common chronic gynecological diseases for the diagnosis of which laparoscopy is successfully used are the following:

In some cases, due to the characteristics female body signs of acute gynecological pathology may be unclear or absent in their classic manifestation. Previously in such complex diagnostic cases Diagnostic laparotomy was used - open access to the pelvis. The “disadvantage” of the open method was the unnecessary trauma to tissues - the diagnosis could not be confirmed, which meant that the anterior abdominal wall was subjected to trauma in vain. The laparoscopic method avoids inappropriate penetration into the pelvis.

note

Very often, acute surgical diseases are masked under acute gynecological pathology. For example, due to the pelvic location of the inflamed appendix clinical picture will be perverted, and this will affect the correctness of treatment - in particular, the wrong surgical approach will be chosen. In the clinic, cases are observed that are exactly the opposite - when, based on symptoms, an incorrect diagnosis is made acute illness abdominal organs, although in fact the gynecological area suffers. With the help of laparoscopy, such errors can be avoided in both cases.

Treatment of gynecological diseases using laparoscopy

If the diagnosis of a particular gynecological disease is confirmed, very often surgeons immediately move on to eliminating the causes of the disease: diagnostic laparoscopy becomes a therapeutic procedure - in particular, this applies to acute gynecological diseases that require emergency surgical intervention(internal bleeding, cyst rupture, etc.).

In some cases, surgical laparoscopic intervention requires preparation of the patient, as well as a more thorough examination - for example, studying a biopsy (a piece of tissue) in order to find out whether the diagnosed tumor is benign or malignant. After a certain period of time, gynecological surgeons perform a repeat laparoscopy, but for therapeutic purposes.

note

Not all chronic pathologies require preparation to perform the operation - for example, if obstruction of the fallopian tubes was established as the cause of infertility, operating team can immediately begin to eliminate it.

Using the laparoscopic method, almost all gynecological diseases can be treated, which were discussed above from a diagnostic perspective. Thus, excellent results are obtained with laparoscopic treatment of almost all known and common:

The treatment method we are considering is more than justified. Thanks to the mobility of the laparoscope, it is possible to identify and remove endometrial cells with an atypical location in almost any localization of the process in the pelvis, while sparing the tissue. During an open operation with a classic incision of the anterior abdominal wall, the operating doctor discovers the exact localization of the endometrium only during the operation and is often forced to expand the surgical approach - in other words, make the abdominal incision longer. In this case, the degree of tissue trauma increases, and in the future the aesthetics of the anterior abdominal wall will suffer due to the postoperative scar (even if a so-called atraumatic suture was applied).

Laparoscopic treatment is a godsend for gynecologists: the method turned out to be effective in severe forms this disease, not amenable conservative treatment. It was noted that after laparoscopic treatment, improvement occurred in 80% of women who were unsuccessfully treated for secondary dysmenorrhea by other methods.

Preparation for laparoscopy

Laparoscopy in gynecology is a surgical procedure, so it should be performed after standard preoperative preparation of the patient, which includes research methods and direct preparation of the female body for laparoscopy.

Before gynecological laparoscopy, the following research methods are performed:

• blood test for coagulation;
• determination of blood group and Rh factor;
• chest organs;
• consultation with a therapist - he must give a conclusion that the patient has no contraindications to laparoscopy.

Preparation before surgery consists of the following:

• if necessary – adjustment of blood parameters, circulating blood volume;
• abstaining from food at least 8 hours before the start of laparoscopy, liquids - 3 hours;
• administering a cleansing enema (preoperative bowel cleansing should be performed by medical staff, and not by the patient herself);
• half an hour before transporting the patient to the operating room - premedication. It consists of introducing medicines, which will strengthen the subsequent one.

How does laparoscopy work?

Laparoscopy is performed in a specially equipped operating room(in particular, the presence of monitors is necessary). It is performed under anesthesia– intravenous, mask or, if there is a need to “turn off” the anterior abdominal wall from the act of breathing, endotracheal (in this case, the device “breathes” for the patient artificial ventilation lungs).

During the introduction of the patient into a state of medicinal sleep (also known as narcotic sleep, also known as anesthesia), the anterior abdominal wall is treated with antiseptics. Treatment is carried out widely - in the hope that after diagnosing the disease, the operating team can move on to eliminating it.

A puncture of the anterior abdominal wall is performed. To lift it and better access Carbon dioxide is injected into the abdominal cavity to the internal organs. It is pumped until the gas pressure in the abdominal cavity reaches a certain level, after which the operating doctor inserts a laparoscope into the abdomen and begins the examination. The duration of diagnostic procedures varies - from 30 minutes or more. The time for diagnostic laparoscopy may increase as there may be a need for:

• overcoming technical difficulties (for example, removing adhesions with a pronounced adhesive process that does not allow viewing internal organs);
• consultation of doctors (including related specialties);
• waiting for the result of a biopsy study (a piece of removed tissue)

The duration of therapeutic laparoscopy depends on the volume of necessary manipulations.

Regimen after laparoscopy of the ovaries, fallopian tubes and uterus

If laparoscopy was performed for diagnostic purposes, the patient is recommended to stay in the clinic for a day to monitor the postoperative condition. The length of stay in the hospital after the patient has been operated on using the laparoscopic method is determined by the operating doctor - in any case, it is significantly less than the length of stay in the hospital after surgery using the open method. At the request of the patient and in agreement with the doctor, the period of hospital stay can last 3-4 days, but such a need for medical reasons practically does not arise due to the small size of postoperative wounds - because:

• the patient experiences virtually no pain, there is no need to prescribe potent narcotic painkillers that require monitoring;
• the possibility of complications from postoperative wounds is minimized, so there is no need for daily long-term dressings and medical supervision.

The attending physician will set a date for a follow-up examination after laparoscopy, and will also give recommendations regarding the resumption of sexual activity - these are individual. If there are no complications, after exploratory laparotomy you can have sexual relations after 2 weeks. The doctor will also select and, if necessary, advise whether you need to wait until the child is conceived.

In general, after laparoscopic surgery (both diagnostic and therapeutic), there is no special regimen that must be followed.

Benefits of gynecological laparoscopy

They are as follows:

Disadvantages of the method

Laparoscopy has virtually no disadvantages. The only drawback is the need to use anesthesia with its possible consequences, but this is a “minus” not of gynecological laparoscopy, but of surgical interventions in general.

Contraindications

Laparoscopy is a progressive, proven method. But in some cases its implementation is contraindicated in such cases as:

There are so-called relative contraindications to perform gynecological laparoscopy – those during which there is a risk of an unfavorable outcome, but it is not one hundred percent . These are diseases and conditions such as:

• open abdominal surgeries that have been undergone over the past 4-6 months;
• pronounced (extreme degree);
• late pregnancy;
• complicated chronic diseases;
• general infectious pathology;
• disorders of the blood coagulation system.

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.

IN 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.
• For colds or bad tests (exceptions are emergency cases, not tolerating delay).

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 drug, taking into account the gender, weight, height and age of the patient. When the anesthesia has taken effect, the person is connected to the machine artificial respiration. 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 way surgical treatment. Don't get sick and be healthy!

Gynecology has come a long way since laparoscopic operations became possible in any clinic. This method surgical intervention made it possible to fight many problems and diseases that previously could not be eliminated in the usual way. Laparoscopy in gynecology is so low-traumatic and safe that it has long since moved from the category of surgical interventions to a diagnostic method.

Laparoscopic diagnosis and treatment of problems associated with infertility has the most positive reviews from both patients and surgeons.

Every year, thousands of women get the opportunity to experience the joy of motherhood thanks to the opportunity to study the condition of the reproductive organs and eliminate adhesions, cysts, endometriosis and other problems that interfere with natural conception. If you watch a video of such an operation, you will see that high technology is already being successfully used in treatment. Through tiny incisions, the doctor can remove it from your life in just an hour. terrible diagnosis"infertility".

Laparoscopy in gynecology has incomparably more advantages than disadvantages. First of all, it is minimally traumatic; in videos and photos from medical sites you will see that the scars from this operation are barely noticeable. These three small holes are 0.5–1 cm in size and are arranged in a triangle. The top incision is often made in the belly button, so it won't be visible at all, and the bottom two scars will be hidden by underwear or a swimsuit. Inside the cavity, damage from the operation is also minimal, because through special optics the doctor sees on video exactly where to start working with a scalpel.

Compared to abdominal surgery, where you often have to cut at random, not knowing where exactly to look for the problem, the laparoscope has become simply a magic wand that allows you to get by with little blood - literally and figuratively. Thanks to it, you can avoid large tissue incisions to get to your destination. And this means that not only will there be less pain, but significantly less blood will enter the abdominal cavity during the operation, so the risk of adhesions during the healing process will be much lower.

The second advantage of laparoscopy is the very short rehabilitation period. After a routine exploratory operation or adhesions dissection procedure, you may be discharged from the hospital within 3-4 days. More serious surgeries, such as removal of an ectopic pregnancy, tumors, fibroids, or pelvic organs, may require a longer stay under medical supervision. But all the same, you will be discharged in no more than 6-10 days, and you will begin to get up and walk the next day. But it's not just about deadlines, although they are important in our busy times.

The main thing is that the pain after laparoscopy is several times less than after abdominal surgery. In a few weeks you will already feel completely healthy person, although there are still some restrictions. For example, you should not lift weights or exercise for several months. active sports to avoid seams coming apart. According to reviews from most patients, within a week after discharge they returned to their normal routine.

Another advantage of such a quick recovery and low trauma during laparoscopy is the ability to plan a pregnancy after 1-3 months, while after abdominal surgery it is recommended to use protection for at least 6, and sometimes 12 months. Although here the period of protection may be a little longer, it is determined by your surgeon based on the nature of the operation performed and the condition of your body.

Last but not least on the list is the convenience of the laparoscope for the surgeon. All internal organs are perfectly visualized on video, the doctor can accurately determine the problem and eliminate it as accurately as possible. During the operation they are placed accurate diagnoses, sometimes problems are revealed that no examination has shown. For example, during a planned operation to dissect the surface of polycystic ovaries, the surgeon can detect adhesions and dissect them so that they do not interfere with conception or become a risk factor for ectopic pregnancy.

What are the disadvantages of this operation?

Among the disadvantages of laparoscopy, one can first of all mention the risk of formation of adhesions. Even such a minimally invasive operation is still a surgical intervention. Incisions, small blood leaks, the natural inflammatory process that accompanies surgery, and some other factors lead to the formation of adhesions. To avoid the occurrence of adhesions, you need to follow all the surgeon’s instructions: take anti-inflammatory and absorbable medications, be sure to undergo a course of physical procedures and do not forget about sports, or at least exercise and hiking. This entire set of measures is aimed at preventing the formation of new adhesions.

General anesthesia also does not have a very beneficial effect on the body; it is not for nothing that it is done only in case of emergency and is selected individually. After anesthesia, complications at work are possible:

• gastrointestinal tract;
• cardiovascular;
• nervous systems;
• skin reactions.

There is a risk of complications with any treatment method, even with medication, let alone surgical interventions. All organisms are different, and surgeons are not gods and cannot accurately predict and guarantee the result. There's always a possibility adverse reactions, but you should be reassured by the fact that there are hundreds of thousands of reviews from happy patients about laparoscopy and the statistics of this operation indicate minimal risk unpleasant consequences.

Therefore, the decision about surgery should be made carefully and based on the ratio of expected benefits and possible risk. It is worth consulting with several doctors and comparing their recommendations in your particular case.

Of course, now we are talking about laparoscopy as a diagnosis or to eliminate adhesions and cysts, which can be treated with medication. If you need to remove the fertilized egg during an ectopic pregnancy, remove tumors or organs, then the choice will definitely be in favor of laparoscopy before abdominal surgery.

In cases where surgery is medically necessary and there is a choice between laparoscopy and abdominal surgery, most doctors recommend laparoscopy, and this is not surprising, given all the benefits. If you are going to have an operation, it is better to do it with the least risk to the patient’s health.

But what if laparoscopy is recommended solely for diagnostic purposes? Still, this is a rather serious operation, which has its own risks and consequences. For example, if you just need to check the patency of the fallopian tubes, then you can get by with metrosalpingography.

If we are talking about comprehensive examination, when the presence of adhesions has already been established, there is suspicion of:

• cysts;
• fibroids;
• fibroids;
• endometriosis;

or other diseases that are difficult to detect during external examination, then surgery makes sense.

Laparoscopy is often prescribed as a diagnosis for infertility of unknown origin or mixed problems, for example, adhesions and endometriosis together, as well as in the presence of chronic pelvic pain and serious disorders monthly cycle.

Content

Laparoscopy surgery has relatively recently become widely practiced among gynecologists involved in surgery, so many women are afraid when they are prescribed such a surgical examination, do not understand what it means, fearing pain and severe complications. However, laparoscopy in gynecology is considered one of the most gentle methods of surgical intervention and has a minimum of unpleasant consequences and complications after use.

What is laparoscopy in gynecology

A method that causes the least amount of trauma and damage during diagnosis or surgery, with the smallest number of invasive penetrations - this is what laparoscopy of the uterus and ovaries is in gynecology. To reach the female genital organs without a large incision, three or four punctures are made in the abdominal wall, after which special instruments called laparoscopes are inserted. These instruments are equipped with sensors and lighting, and the gynecologist “with his own eyes” evaluates the process occurring inside, coupled with the diagnosis of genitalia. female organs.

Indications

Laparoscopy is widely used, since it is considered in gynecology the most convenient way to simultaneously carry out diagnostics and surgical intervention for the treatment of pathological processes unknown etiology. Gynecologists evaluate “live” the condition of a woman’s genital organs if other research methods have not proven effective for an accurate diagnosis. Laparoscopy is used for the following gynecological pathologies:

• if a woman is diagnosed with infertility, the exact cause of which gynecologists cannot identify;
• when gynecological therapy hormonal medications turned out to be ineffective for conceiving a child;
• if you need to perform surgery on the ovaries;
• with endometriosis of the cervix, adhesions;
• at constant pain in the lower abdomen;
• if you suspect myoma or fibroma;
• for ligation of uterine tubes;
• for ectopic pregnancy, tubal ruptures, breakthrough bleeding and other dangerous pathological processes in gynecology, when emergency intracavitary gynecological surgery is necessary;
• when the pedicle of an ovarian cyst is twisted;
• with severe dysmenorrhea;
• for infections of the genital organs accompanied by the discharge of pus.

On what day of the cycle is it done?

Many women do not attach importance to what day of the menstrual cycle the operation will be scheduled for, and are surprised by the questions of the gynecologist asking when the last menstruation was. However, preparation for laparoscopy in gynecology begins with clarifying this issue, since the effectiveness of the procedure itself will directly depend on the day of the cycle at the time of the operation. If a woman has her period, there is a high probability of infection in the upper layers of the uterine tissue, in addition, there is a risk of causing internal bleeding.

Gynecologists recommend doing laparoscopy immediately after ovulation, in the middle of the monthly cycle. With a 30-day cycle, this will be the fifteenth day from the start of menstruation, with a shorter one - the tenth or twelfth. Such indications are due to the fact that after ovulation, the gynecologist can look at what reasons prevent the egg from leaving the ovary for fertilization; we are talking about diagnosing infertility.

Preparation

In gynecology, laparoscopy can be prescribed routinely or performed urgently. In the latter case, there will be practically no preparation, because gynecologists will strive to save the patient’s life, and this situation does not involve a long collection of tests. Immediately before the operation, the patient's blood and urine are collected, if possible, and studies are carried out after the fact, after laparoscopy. When performing laparoscopy routinely, preparation includes collecting data on current state sick and dietary restrictions.

Analyzes

Patients are surprised extensive list necessary tests before performing laparoscopy, however, before any abdominal gynecological operation it is necessary to do the following studies:

• take a blood test, as well as conduct blood tests for sexually transmitted diseases, syphilis, AIDS, hepatitis, ALT, AST, the presence of bilirubin, glucose, assess the degree of blood coagulation, establish the blood group and Rh factor;
• pass OAM;
• make a general smear from the walls of the cervix;
• conduct an ultrasound of the pelvic organs, take a fluorogram;
• provide the gynecologist with a statement about the presence of chronic ailments, if any, and notify about the medications you are constantly taking;
• do a cardiogram.

When the gynecologist receives all the research results, he checks the possibility of performing laparoscopy on a predetermined day, specifying the scope of the future gynecological surgery or diagnostic examination. If the gynecologist gives the go-ahead, then the anesthesiologist talks with the patient, finding out if she is allergic to narcotic drugs. medications or contraindications to general anesthesia during the procedure.

Diet before laparoscopy in gynecology

In gynecology, there are the following dietary rules before laparoscopy:

• 7 days before laparoscopy, you should abstain from any foods that stimulate gas formation in the stomach and intestines - legumes, milk, some vegetables and fruits. The intake of lean meat, boiled eggs, porridge, and fermented milk products is indicated.
• For 5 days, the gynecologist prescribes the use of enzymatic agents, activated carbon, to normalize digestion.
• The day before the procedure, you can only eat pureed soups or liquid porridge, you can't have dinner. You need to do a cleansing enema in the evening if the gynecologist prescribed it.
• Immediately before laparoscopy, you should not eat or drink anything to bladder was empty

Does it hurt to do

Women who are afraid of pain often ask gynecologists whether they will feel pain during laparoscopy. However, in gynecology this method is considered the most painless and fastest invasion. Laparoscopy is done under general anesthesia, so you'll just fall asleep and not feel anything. Before the operation, gynecologists prescribe sedatives and painkillers to the most emotional patients and conduct preliminary conversations, telling them what gynecological procedures will be performed.

How they do it

Laparoscopy begins with general intravenous anesthesia. Then gynecologists treat the entire abdomen antiseptic solutions, after which incisions are made in the skin in the navel area and around it, into which trocars are inserted, which serve to pump carbon dioxide into the abdominal cavity. Trocars are equipped with video cameras for visual control, allowing the gynecologist to see the condition of the internal organs on the monitor screen. After the manipulations, gynecologists apply small sutures.

Recovery after laparoscopy

Some gynecologists prefer that the patient regain consciousness after laparoscopy directly on the operating table. So you can check general state patient and prevent complications. However, in most cases, the patient is transferred to a gurney and taken to the ward.

Gynecologists suggest getting out of bed 3-4 hours after laparoscopy so that the woman can walk to stimulate blood circulation. The patient is observed for another 2-3 days, after which she is discharged home for further rehabilitation. You can return to work in about a week, but physical activity should be limited.

Nutrition

Immediately after the operation, the patient is not allowed to eat anything - she can only drink clean water without gas. On the second day, you are allowed to drink low-fat broths and unsweetened tea. And only on the third day is it allowed to take mashed potatoes, porridge, pureed meatballs or cutlets, meat puree, yoghurts. Since the intestines are very close to the genitals, during healing you need the most gentle diet that will not contribute to gas formation or increased peristalsis.

Sexual rest

Depending on the purpose for which the gynecologists performed the intervention, the doctor will determine the period of absolute sexual abstinence. If laparoscopy was performed to remove adhesions to conceive a baby, then gynecologists recommend starting sex life as early as possible to increase the likelihood of getting pregnant, because in just a couple of months the fallopian tubes may become impassable again. In all other cases, gynecologists may prohibit having sex for 2-3 weeks.

Contraindications

Laparoscopy has few contraindications. These include:

• intensive process of dying of the body - agony, coma, state clinical death;
• peritonitis and other serious inflammatory processes in organism;
• sudden cardiac arrest or difficulty breathing;
• severe obesity;
• hernia;
• the last trimester of pregnancy with a threat to the mother and fetus;
• hemolytic chronic diseases;
• exacerbation of chronic gastrointestinal diseases;
• the course of ARVI and colds. We'll have to wait for a full recovery.

Consequences

Considering the low invasiveness of the gynecological procedure, the consequences of laparoscopy, when performed correctly, are small and include the body’s reaction to general anesthesia and the individual’s ability to restore previous functions. The entire system of female genital organs works as before, since penetration into the abdominal cavity is as gentle as possible and does not injure them. The laparoscopy diagram can be seen in the photo.

Complications

As with any penetration into the abdominal cavity, there are complications with laparoscopy. For example, after punctures during the insertion of a laparoscope, the blood vessels and a slight hemorrhage begins, and carbon dioxide in the abdominal cavity can enter the tissues and contribute to subcutaneous emphysema. If the vessels are not sufficiently compressed, blood can enter the abdominal cavity. However, the professionalism of the gynecologist and a thorough examination of the abdominal cavity after the procedure will reduce the likelihood of such complications to zero.

Price

Since laparoscopy is an intervention under general anesthesia, the cost of this gynecological procedure is high. The price breakdown for Moscow is given in the table below:

Video

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only qualified doctor can make a diagnosis and make treatment recommendations based on individual characteristics specific patient.

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