Modern surgical methods of treatment exclude the need to perform large incisions, which is achieved thanks to a special device - an endoscope, and called such endoscopic interventions. Laparoscopy is one of the most common types of endoscopy. Let's consider, what is it - a laparoscopy, in what cases can be applied.
Laparoscopy - what is it?
Operations on the internal organs, conducted by the open method, require more than one incision to reach the pathological focus. Endoscopic operations are performed differently: for access to the body it is required to make small punctures or completely do without injuring tissues, introducing the endoscope through natural paths. The medical endoscope is a long tube, at the end of which a light source is attached and a micro-camera that displays the image on the monitor. In addition to it, the instruments necessary for the operation are brought to the organ through thin tubes.
Endoscopic surgery provides a wide range of operations in any field of medicine. Laparoscopy is a technique that is applicable to abdominal and pelvic organs. The endoscope in this case is called a laparoscope. There are several varieties of laparoscopy: medical, diagnostic and control. Therapeutic - minimally invasive manipulation, which can be conservative (medication administration) or surgical. Diagnostic and control techniques are used to visualize the condition of internal organs.
Diagnostic laparoscopy
The use of a laparoscope for diagnosis is the final stage in the detection of pathological conditions and their causes in cases where conventional clinical studies fail to do so. Often, this need arises when conducting a differential diagnosis. Often a study is appointed with:
- tumoral formations in the abdominal cavity, pelvic region;
- persistent pain syndromes of unexplained genesis;
- infertility with unclear causes;
- suspicion of ectopic pregnancy ;
- acute surgical diseases of the abdominal cavity with doubtful symptoms.
In most cases, diagnostic laparoscopy with infertility allows one hundred percent confidence to make a diagnosis, as the doctor manages to see the slightest deviations. Sometimes diagnostic manipulations are combined with surgical treatment of the revealed pathologies (removal of tumors, adhesions, excision of the overgrown endometrium and so on).
Surgical Laparoscopy
Laparoscopic operations are carried out, as if under a microscope, and provide greater visibility, because the used equipment creates a forty-fold increase, and thanks to the optics, the operated organ is inspected at different angles. Laparoscopy, like the traditional technique, can be performed in a planned manner (for example, with the removal of bile ) or be an emergency (laparoscopy of appendicitis).
It should be noted that laparoscopy is an intervention that is performed with minimal blood loss and weak pain. Thanks to the smallest incisions, postoperative scars are almost invisible, which is especially important for young women. Unlike cavitary operations, laparoscopy does not require long hospitalization and compliance with bed rest.
Laparoscopy - indications
The operation of laparoscopy is performed in the following common cases:
- inflammation of the gallbladder, the presence of concrements in it;
- ovarian cysts;
- inflammation of the appendix;
- inguinal hernia;
- umbilical hernia;
- hernia of the esophageal opening of the diaphragm;
- cyst of the liver;
- obstruction of the fallopian tubes ;
- uterine myoma;
- endometriosis ;
- omission of the uterus, vagina;
- adrenal gland tumors;
- adhesive process;
- urinary incontinence;
- the initial stages of cancer;
- pancreatic necrosis;
- obesity.
Laparoscopy - contraindications for carrying out
Laparoscopy contraindications has the following:
- purulent peritonitis;
- acute renal or hepatic insufficiency;
- acute disturbance of cerebral circulation;
- serious deviations in the activity of the cardiac or respiratory system;
- intestinal obstruction;
- transferred recently opened operations;
- late gestation;
- hemorrhagic shock;
- significant adhesive process of the pelvis;
- bronchial asthma with frequent exacerbations;
- allergy to anesthesia.
Laparoscopy - how to prepare for surgery?
If a patient is prescribed laparoscopy, how to prepare for it, explains the attending physician. Before the operation, various diagnostic manipulations (blood and urine analysis, electrocardiogram, X-ray examination, ultrasound, etc.) are often performed, a patient is questioned about the transferred diseases, operations, allergic reactions. Preparation for intervention may include the following:
- a few days before laparoscopy - compliance with a slag-free diet, which excludes the consumption of fatty, roasted, sweets, carbonated and alcoholic beverages;
- refusal to eat and drink 12 hours before surgery;
- purification of the intestines by means of an enema (before bedtime or the morning before the operation);
- on the appointed day - taking a shower and depilation zone, which will be operated.
How is laparoscopy performed?
Laparoscopy, the technique of performing which is complex, is carried out only by experienced highly qualified doctors who have undergone special training. This is due, inter alia, to the fact that on the screen all movements have the opposite direction, and also creates a distorted perception of the depth of the treated area. The laparoscopist must perfectly master the cavity technique, because sometimes one has to switch to this technique when complications arise or the technique is brought.
Before the operation, the patient is examined by an anesthesiologist, who selects the type of anesthesia. Often performed endotracheal anesthesia or combined anesthesia. Next, pneumoperitoneum is performed - filling the abdominal cavity with gas supplied by means of a needle under the control of pressure and flow velocity. This is necessary to raise the abdominal wall, so that you can operate, minimally touching other organs.
The next step is the introduction of the first trocar (tube) through the abdominal wall, where the puncture site is selected depending on the location of the organ operated. Through this tube a laparoscope is injected, under the control of which additional trocars are brought-for instruments. After a thorough examination of the internal organs, medical manipulations are carried out, after which the washing of the operating field, the release of gas, sewing of the incisions and so on are carried out.
Laparoscopic cholecystectomy
The operation to remove the gallbladder, made through laparoscopic access, is widely used in cholelithiasis and polyps, being considered preferable to open intervention (the "gold standard"). Depending on the complexity of the situation, laparoscopy of the gallbladder is made through three, four or five punctures in the abdominal wall. In some cases, there is a need for a transition to an open operation:
- obscurity of the anatomy of the operated region;
- strong adhesive adhesion;
- development of complications.
Laparoscopic appendectomy
With an inflammation of the appendix, laparoscopy, the technique of which is perfectly worked out, is performed according to the following indications:
- acute appendicitis in the first day after the onset of the disease;
- chronic appendicitis;
- acute inflammation of the appendix in combination with a high degree of obesity or diabetes mellitus;
- the patient's desire to remove the appendix by a gentle method.
For all manipulations, it is required to make three punctures in the abdominal wall, the points for which are selected depending on the anatomical features. This operation can be performed under local anesthesia. The need to go to an open operation appears in such cases:
- detection of peritonitis;
- atypical location of the appendix;
- abscess, perforation;
- various complications.
Laparoscopy in gynecology
Considering the application in the field of gynecology laparoscopy, it is worth noting that this is a technique that in many cases preserves the reproductive organs: uterus with myomas, ovaries in cysts, fallopian tubes in ectopic pregnancy. Often, only three small punctures are required, so that a high cosmetic effect is achieved.
With certain indications, laparoscopy and hysteroscopy are performed simultaneously. Hysteroscopy - manipulation, which can be diagnostic or operational, is performed to examine the uterine cavity, take a biopsy material, treat pathologies on the part of this organ (for example, removal of polyps). The device for manipulation - a hysteroscope - is inserted through the cervix. The combination of laparoscopy and hysteroscopy expands the possibilities of establishing the causes of pathological conditions and their elimination without the need to apply anesthesia twice.
Complications of laparoscopy
Possible complications after laparoscopy:
- damage by trocar vessels of blood vessels;
- perforation of internal organs;
- hypothermia;
- formation of thrombi;
- malfunctions in the heart and respiratory system;
- bleeding;
- formation of adhesions .
Recovery after laparoscopy
Despite the fact that laparoscopy is a minimally invasive technique, and patients can be discharged after a couple of days, some recommendations are needed to avoid long-term complications. So, after laparoscopy it is necessary:
- Adhere to bed rest (from several hours to several days).
- Minimize physical activity for 6 months.
- Adhere to the correct diet prescribed by the doctor.
- Observe sexual rest for 2-3 weeks.
- Pregnancy should not be planned earlier than 6-8 months later.