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 unable 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 the rehabilitation period after the operation will take.
IN Lately This method is popular among surgeons. The main advantage of the method is that it is quite fast recovery patient and return to 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;
- at 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 diagnosis and treatment gynecological diseases, laparoscopic surgery is performed on the following internal organs:
- gallbladder;
- intestines;
- stomach and others.
Indications for the procedure for pathologies 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 the abdominal cavity, the surgeon sees everything that is happening 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 cardiovascular and respiratory system;
- 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 surgical intervention and possible negative complications after surgery.
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.
At emergency surgery Be sure to check the blood for coagulability and group and measure the pressure.
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 an artificial respiration device.
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.
Following all doctor's advice, postoperative period will be short-lived and painless. And don’t be afraid, because laparoscopy is the least traumatic operation.
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In the hierarchy modern medicine laparoscopy as a method for diagnosing and treating organ diseases abdominal cavity not only occupies one of the leading places, but also represents its most progressive link: most scientific and technical achievements in the field of medicine are associated with the use of this particular method.
In modern gynecology, laparoscopy is successfully used not only to diagnose diseases of the uterus and its appendages, but also their surgical correction, including hysterectomy with lymphadenectomy. However, there is a fairly well-founded point of view according to which laparoscopy should not be used if a malignant process is suspected, given high risk dissemination cancer cells against the background of pneumoperitoneum. Therefore, it is advisable to consider operative laparoscopy from the standpoint of reproductive surgery. In the structure of the latter, laparoscopy is used for the treatment of tubo-peritoneal infertility, acute inflammation of the uterine appendages, peritoneal endometriosis, ectopic pregnancy, tumors and tumor-like formations of the ovaries.
Indications To operative laparoscopy are:
1) during planned treatment:
- tumors and tumor-like formations of the ovaries;
- tubo-peritoneal infertility;
- peritoneal endometriosis;
- uterine fibroids;
- voluntary surgical sterilization;
2) in case of emergency treatment:
- ectopic pregnancy;
- ovarian apoplexy;
- rupture of an ovarian cyst;
- torsion of the “leg” of subperitoneal uterine fibroids, tumors (or cysts) of the ovary;
- perforation of the uterus;
- purulent inflammatory diseases uterine appendages.
Contraindications to laparoscopy are divided into absolute and relative.
Absolute:
- diseases of the cardiovascular and respiratory systems in the stage of decompensation;
- shock and comatose states;
- cachexia;
- blood clotting disorder;
- acute and chronic renal failure;
- acute and chronic liver failure;
- anterior hernia abdominal wall and/or diaphragm (since the pressure of pneumoperitoneum during a hernia of the anterior abdominal wall can provoke its strangulation, and with diaphragmatic hernia- displacement and compression of the heart and lungs with fatal);
- severe bloating;
- complications during the application of pneumoperitoneum or during the insertion of a trocar - extensive emphysema, damage to the hollow organs of the abdominal cavity, great vessels;
- pronounced adhesive process in the abdominal cavity after laparotomy, complicated by injury to the intestine and/or large vessels.
Relative(conditions that do not meet the requirements for the conditions for preparing patients for planned surgical intervention):
- inadequate preoperative examination;
- acute and chronic infectious diseases suffered less than 1 month before surgery;
- subacute or chronic inflammation of the uterus and its appendages in the stage of reverse development (especially for reconstructive plastic surgery);
- deviations in clinical laboratory test results;
- III-IV degree of purity of vaginal contents.
Laparoscopy technique
The operation begins with the application of pneumoperitoneum - one of the most important stages of laparoscopy. Firstly, it is at this stage that complications most often arise, such as injuries to the intestines, omentum, great vessels, subcutaneous emphysema, and, secondly, the safety of inserting the first (“blind”) trocar, the most important one, depends on the accuracy of this manipulation. moment in laparoscopy technique.
Carbon dioxide and nitrous oxide are used to create pneumoperitoneum. These chemical compounds are easily and quickly resorbed, unlike oxygen and air, they do not cause pain or discomfort in patients (on the contrary, nitrous oxide has an analgesic effect) and do not form emboli (for example, carbon dioxide, having penetrated the bloodstream, actively combines with hemoglobin). Optimal place for gas insufflation into the abdominal cavity is a point located in the area of intersection of the midline of the abdomen with the lower edge of the umbilical ring (when choosing a point for gas insufflation, the location of the epigastric vessels, aorta, and inferior vena cava is taken into account; in this regard, the area surrounding the umbilical ring in radius 2 cm). Gas is injected into the abdominal cavity using a Veress needle.
A design feature of the Veress needle is the presence of a blunt spring mandrel that protrudes beyond the needle in the absence of external resistance. This design protects the abdominal organs from damage from the needle tip. Needle traction is performed with constant effort without interruption until you feel the effect of “sinking” and the appearance of a click from the spring mechanism. Gas is pumped into the abdominal cavity using a laparoflator, which provides control of the pressure and gas flow rate.
The use of a laparoflator allows you to solve two problems simultaneously:
1) when operating in automatic mode, the device automatically turns off the gas supply when the resistance exceeds 12 mm Hg. Art.;
2) with unhindered penetration of the needle into the abdominal cavity, the pressure of the insufflated gas decreases relative to the initial one (the so-called negative pressure recorded on the gas pressure indicator).
The introduction of the first (“blind”) trocar is the most critical stage in the laparoscopy technique, since its complications can include extensive injuries to parenchymal organs, intestines, and large vessels. Therefore, performing this stage requires special care and a thorough approach to its implementation. The current level of development of laparoscopic technology involves the use of two types of trocars that ensure the safety of “blind” insertion:
1) trocars with defense mechanism- resemble the design of a Veress needle - in the absence of external resistance, the tip of the trocar is blocked by a blunt fuse;
2) “visual” trocars - the advancement of the trocar through all layers of the anterior abdominal wall is controlled by a telescope.
The introduction of additional trocars is carried out strictly under visual control. To stop bleeding in endosurgery, three main methods are currently used:
1) ligation (or clipping) of blood vessels;
2) high-energy thermal effects on biological tissues - electrosurgery, laser radiation, thermal effects;
3) drug hemostasis.
High-frequency electrosurgery is considered the main method of endosurgical hemostasis. Depending on the scheme of influence on the patient, three main technologies of HF electrosurgery are distinguished: monopolar, bipolar and monoterminal - monopolar without the use of a passive electrode (monothermal type due to increased danger for the patient and medical personnel not used in endoscopy).
When working using monopolar technology, various instruments that have an insulated metal rod (clamp, dissector, scissors, etc.) are used as an active electrode, the open surface of which is used to perform surgical action (coagulation or tissue dissection). The passive electrode (the second output of the HF generator) is connected to the patient. This technology supports both cutting and coagulation modes.
Tissue dissection is ensured by a high density of RF power in the contact zone, as a result of which the interstitial fluid, sharply increasing in volume, instantly turns into steam. The process of vaporization destroys the structure of the tissue, which leads to its separation (the crossed vessels do not coagulate). Coagulation is achieved by using HF currents with a significantly lower density, under the influence of which dehydration and drying of biological tissue occurs, coagulation of cellular protein and blood, accompanied by thrombus formation and hemostasis.
Bipolar type of HF electrosurgery involves simultaneous connection to the site surgical intervention both active and passive terminals of the generator (therefore, instruments for bipolar technology have two electrodes isolated relative to each other). The essence of bipolar technology is to limit the impact of electric current on biological tissue within a short distance between the electrodes (2-3 mm) and, thereby, minimize the area of thermal damage to the tissue. Thus, bipolar technology provides a point coagulation effect, which is indispensable in reconstructive plastic surgeries.
The bipolar module is the preferred method of electrosurgical hemostasis, as it has two irreplaceable qualities:
1) bipolar technology provides “soft” and, at the same time, reliable coagulation;
2) the bipolar type is considered the safest high-frequency technology (the so-called controlled RF energy).
Drug (local) hemostasis is used as an addition to the main method of stopping bleeding. As medicinal substances To ensure drug hemostasis, vasopressin (antidiuretic hormone), terlipressin, aminocaproic, aminomethylbenzoic, tranexamic acid, etamsylate are used.
In the endosurgical treatment of diseases of the uterus and its appendages, the following types of operations are performed:
uterine fibroids
- organ-sparing myomectomy;
peritoneal endometriosis
- coagulation (vaporization) of pathological implants (produced for the purpose of destruction of foci of endometriosis);
- excision of heterotopias followed by their coagulation (performed for the purpose of biopsy and subsequent destruction of endometrioid heterotopias);
- resection of the ovary (indications - ovarian endometriosis, endometrioid ovarian cysts);
benign tumors and non-infectious tumor-like formations of the ovaries
- ovarian resection;
- removal of the ovaries (performed in premenopausal patients);
- removal of the uterine appendages (indications - torsion of an ovarian tumor (cyst) with the formation of a surgical “leg”);
purulent inflammatory diseases of the uterine appendages
- evacuation of pathological effusion, sanitation of the abdominal cavity with antiseptic solutions (furacillin, chlorhexidine) or isotonic sodium chloride solution containing antibiotics or drugs of the metronidazole group;
- dissection of adhesions between the fallopian tubes, ovaries, and surrounding tissues;
- opening of purulent tubo-ovarian formations, evacuation of pus, sanitation of the cavity of pathological formations;
tubal pregnancy
- salpingectomy (indications: patients’ disinterest in preserving reproductive function and/or lack of conditions for conservative surgery);
- salpingotomy (the goal is to preserve the organ) (Fig. 1);
- segment resection (performed in patients with a single tube if it is impossible to perform salpingotomy; it is fair to note that with the improvement of the artificial insemination program, the feasibility of resection of a tube segment raises some doubts);
tuboperitoneal infertility
- salpingo-ovariolysis (indications - the presence of adhesions and adhesions that fix the fallopian tube and ovary, isolate the ovary from the tube (peritoneal infertility) and/or disrupt the anatomical and topographic relationships between the pelvic organs);
- fimbryolysis (indications - fusion of fimbriae);
- salpingostomy (the purpose of salpingostomy is to restore the patency of the fallopian tube when it is occluded in distal section ampoules);
- salpingoneostomy (in terms of technique and methodology, the operation of salpingoneostomy is identical to salpingostomy, but unlike the latter, it is performed in an atypical place in the ampulla of the fallopian tube).
Rice. 1. Main stages of laparoscopic salpingotomy
Selected lectures on obstetrics and gynecology
Ed. A.N. Strizhakova, A.I. Davydova, L.D. Belotserkovtseva
Surgeons like to repeat: “The belly is not a suitcase; it cannot just be opened and closed.”. Indeed, 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 looks at 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 procedures. 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, during radiography, ultrasound examination 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.
Laparoscopy is low-traumatic surgery which is carried out to examine organs and treat diseases. Features a short light rehabilitation period. The method is used more often in gynecology ().
Description of laparoscopy, its features
What is laparoscopy? This is an examination or surgery that eliminates large incisions in the peritoneum. The operation is performed using a modern medical device - a laparoscope. The devices are inserted into the abdominal cavity through small punctures. This eliminates stitches and the appearance of keloid scars, which are characteristic of traditional method surgical intervention.
The method reduces the risk of side effects and complications. Unlike traditional surgery, it has a short recovery period. Surgical instruments are equipped with illuminated micro-cameras, so the desired organ is clearly visible. To increase the information content, the peritoneum is inflated with pneumoperitonium air. Little preparation is required before the operation.
Types of laparoscopy
Laparoscopy can be planned, with gradual preparation, or emergency, when treatment is required urgently. The method is divided into three main types. They differ in purpose of use:
- During diagnostic laparoscopy The peritoneum and its internal organs are examined from the inside. This is done with the help of a manipulator. Diagnosis is required when the exact cause of the disease has not been identified by other methods.
- Operative laparoscopy is a low-traumatic surgical operation. In the process, the pathology is removed or a correction is made (pelvic adhesions are eliminated). Laparoscopy in gynecology is used most often.
- Control diagnostics are aimed at monitoring the patient’s condition after previous operations. During the procedure, the effectiveness of the surgical intervention is assessed, and a prognosis for future conception can be made.
Transvaginal hydrolaparoscopy
Transvaginal hydrolaparoscopy is used to examine the pelvic organs and its immediate area. At the same time, the patency of the fallopian tubes is checked using a contrast agent. During hydrolaparoscopy, internal anesthesia is performed.
The operation has a drawback - the method is strictly diagnostic and is not suitable for treatment. The benefits include checking the patency of the fallopian tubes. Other methods do not provide such accurate information.
Indications
Emergency diagnostic surgery is prescribed if there is a suspicion of purulent-inflammatory processes, rupture of a cyst or torsion of the ovarian pedicle, requiring urgent surgical intervention. Inspection is carried out when severe pain lower abdomen, ectopic pregnancy.
Usually a routine diagnosis or surgery is prescribed. Laparoscopy is most often used in gynecology. Indications:
- obstruction of pipes;
- endometriosis;
- loss of spiral;
- infertility for unknown reasons;
- complete or partial removal of the uterus;
- urinary incontinence due to stress;
- removal of adhesions in the pelvic area;
- supravaginal excision of the uterus;
- correction for prolapse of the genital organs;
- diagnosis of polycystic ovary syndrome and its treatment;
- excision benign neoplasms with partial or complete removal uterus;
- fibroids that are not amenable to conventional treatment;
- preparation for IVF;
- full or partial sterilization with tube clamps;
- first degree of uterine cancer;
- deviations in the structure of the pelvic organs.
Diagnostics helps determine the reason for a woman’s inability to become pregnant. In other areas, laparoscopy is prescribed to remove the appendix, hernias, and gallbladder. Such operations are performed on the stomach, intestines, and other abdominal organs. Treatment of the kidneys and bladder is carried out. The method is used to stop internal bleeding.
Contraindications
Contraindications to laparoscopy vary depending on the type of prohibitions. The absolute ones include:
- improper cerebral circulation;
- chronic diseases of the respiratory and cardiovascular systems;
- ovarian and tubal cancer (with the exception of mandatory monitoring during chemotherapy or radiation therapy);
- liver failure;
- myocardial infarction;
- hemophilia;
- 2nd half of pregnancy;
- coma;
- asthma in the acute stage;
- stroke;
- severe hypertension;
- cachexia;
- some respiratory diseases;
- poor blood clotting;
- acute renal failure.
It is impossible to give the patient a Trendelburg position, when the operating table is tilted so that the head is lower than the legs. This is prohibited in case of diseases associated with blood vessels, brain injuries, sliding hernia of the esophagus or diaphragm.
Relative contraindications:
- carrying a child after 16 weeks;
- diffuse peritonitis;
- suspicion of adnexal cancer;
- sixteen weeks (and older) uterine fibroids;
- polyvalent allergy;
- strong adhesions in the pelvic area resulting from post-surgical operations, inflammation;
- ovarian tumor with a minimum diameter of 14 centimeters.
Laparoscopy may not be performed for people with obesity of 3-4 degrees, with a large accumulation of blood in the peritoneum (over two liters) or with a significant increase in the size of internal organs. Surgery is not prescribed for tuberculosis in the pelvic area or severe endometriosis.
Preparation for laparoscopy
If emergency surgery is necessary, it is measured arterial pressure and blood is drawn urgent analysis, Rh factor. Before planned laparoscopy the following is done:
- cardiogram;
- fluorography;
- a general urine test is taken;
- blood is checked for clotting;
- biochemistry;
- a smear is taken from the uterine walls;
- blood type is established.
If necessary, an ultrasound of all organs in the pelvic area is performed. General analysis blood is needed to determine:
- bilirubin;
- syphilis;
- glucose level;
- hepatitis;
- AIDS;
- venereal diseases.
General blood and urine tests, biochemistry, and clotting tests are stored for only 10 days. Test results for all hepatitis, HIV, syphilis - 3 months. Vaginal smear tests are stored for 10 days, cardiogram - 1 month, fluorography - six months.
After the results are obtained, the doctor determines the possibility of laparoscopy and schedules a day for surgery. Most often it is carried out in the morning. Before laparoscopy, it is determined whether the patient is allergic to any drugs or anesthesia. A person must inform the doctor about treatment (if it is carried out during this period), chronic illnesses, and medications used.
If necessary, the patient is prescribed blood thinners. If the operation is performed urgently, then a couple of hours before the operation, the intake of liquids and food is stopped. The intestines are washed and a cleansing enema is administered.
Diet
A week before laparoscopy you need to start following a diet. 7 days before surgery, foods that cause flatulence (milk, legumes, cabbage, carbonated drinks) are excluded from the menu. The diet should include lean meat and fish, cereals, and hard-boiled eggs.
5 days before surgery, the doctor prescribes for recovery digestive system Activated carbon, enzymatic preparations. The day before laparoscopy, it is recommended to eat only light foods - liquid porridge, puree soups. Dinner is cancelled, and a cleansing enema is given in the evening. On the day of surgery, food and drinks are excluded, bladder cannot be filled.
Direct preparation for laparoscopy
Preparation for laparoscopy begins with the administration of anesthesia. This is done intravenously, most often endotracheal is used. Preparation is divided into stages:
- Premedication is given one hour before surgery. The patient is given medications that prevent possible negative reactions after anesthesia and improve its course.
- In the operating room, the patient is given a drip and monitor electrodes to monitor heart function and monitor hemoglobin levels.
- Anesthesia with relaxants that relax the muscles is administered intravenously. This makes it easy to insert the endotracheal tube and improves visibility of the abdominal cavity.
The preparation is completed by connecting the patient to an artificial lung ventilation device and administering anesthetics.
Carrying out laparoscopy
The operation begins by filling the abdominal cavity with carbon dioxide. A small incision of 0.5-1 cm is made in the navel area, not exceeding the diameter of the tube. Top wall the peritoneum is lifted by the skin. Then a medical Veress needle is inserted at a slight angle.
3-4 liters of carbon dioxide are pumped into the peritoneum. In this case, the pressure should not be higher than 12-14 mm R. With. The procedure increases the volume of the abdominal cavity, creating free space, which improves visibility and minimizes the risk of injury to internal organs.
Then the Veress needle is removed, and the main tube with the trocar is inserted into the same hole. It is removed after the punctures are made. A laparoscope with a light guide and a camera is inserted through the tube. An image of the internal area of the peritoneum and organs appears on the monitor.
Small holes are made in 2 more places, separate tubes are inserted into them, and with their help the surgeon manipulates the instruments. First, the entire abdominal cavity is examined, the presence of tumors, adhesions, and purulent contents is detected. The condition of the liver and gastrointestinal tract is checked.
The surgical table is then tilted using the Trendelenburg or Fowler method. This makes the work of doctors easier during surgery. After the inspection, a decision is made to surgical treatment, the need for biopsy and drainage.
If necessary, partial or complete excision of diseased organs, adhesions, and neoplasms is performed. This is done using instruments inserted through tubes. After the diagnosis or surgery is completed, the tubes are removed and the incisions are closed with cosmetic stitches. They may be absorbable or removed after 10 days.
Performing transvaginal laparoscopy
During the operation, a puncture is made with a thin needle back wall vagina. A special liquid is injected through the hole. It promotes tissue straightening and improves visibility. Then a camera is lowered into the puncture, with the help of which the woman’s ovaries and uterus are examined. The patency of the tubes is determined by injecting a contrast agent. It spreads throughout the organs and then exits into the peritoneum.
Complications after laparoscopy
Complications after laparoscopy in gynecology or other areas are very rare. Most often they appear when gas and trocars are introduced into the peritoneum. It may start:
- pneumothorax;
- gas embolism, if gas enters a damaged vessel;
- extensive bleeding due to injury to the aorta and veins;
- damage to the intestinal walls, its perforation.
The consequence of abdominal laparoscopy is the appearance of adhesions. They cause infertility, disrupt intestinal function and interfere with its patency. Complications occur during traumatic manipulations or as a result of individual characteristics body.
Another consequence of laparoscopy can be slow bleeding from small vessels. Their contents gradually fill the stomach. The cause is unresolved or undetected injuries during laparoscopy. After surgery, hematomas, hernias, and purulent inflammation may very rarely appear.
Rehabilitation period
There is practically no rehabilitation period. Immediately after laparoscopy, you need to actively move in bed to avoid complications. You can start walking after 5-7 hours. This prevents the formation of intestinal paresis. Women are discharged from the hospital after 7 hours or the next day.
Slight pain in the abdomen and lower back persists only for a few hours after laparoscopy. Painkillers are not required. After laparoscopy surgery, it is sometimes observed slight increase temperatures in the evening. Discharge in the form of ichor or mucus may continue for another week or two. Then they disappear on their own.
On this moment Laparoscopy is the least traumatic method of performing operations or diagnostics. Women are more often examined and treated. The risk of complications and severe consequences is practically excluded. After the operation there are no scars left, the method is characterized by low blood loss.
