Why is laparoscopy prescribed? Laparoscopic surgery. What is the adhesive process? How is it related to laparoscopy?

Currently, laparoscopic operations are very widespread. Their share in the treatment of various surgical diseases, including gallstones, ranges from 50 to 90%, since laparoscopy is a highly effective, and at the same time relatively safe and low-traumatic method of surgical interventions on the abdominal and pelvic organs. That is why laparoscopy of the gallbladder is currently performed quite often, having become a routine operation recommended for cholelithiasis as the most effective, safe, low-traumatic, fast and with minimal risk of complications. Let’s consider what the concept of “gall bladder laparoscopy” includes, as well as what are the rules for performing this surgical procedure and subsequent rehabilitation of a person.

Laparoscopy of the gallbladder - definition, general characteristics, types of operations

That is, “laparoscopy of the gallbladder” is, first of all, a surgical operation, during which either the complete removal of the entire organ is performed, or the stones present in it are removed. A distinctive feature of the operation is the access through which it is performed. This access is carried out using a special device - laparoscope, and therefore is called laparoscopic. Thus, laparoscopy of the gallbladder is a surgical operation performed using a laparoscope.

In order to clearly understand and imagine what the differences are between conventional and laparoscopic surgery, it is necessary to have a general understanding of the process and essence of both techniques.

So, a usual operation on the abdominal organs, including the gall bladder, is carried out using an incision in the anterior abdominal wall, through which the doctor sees the organs with his eye and can perform various manipulations on them with instruments in his hands. That is, it is quite easy to imagine a regular operation to remove the gallbladder - the doctor cuts the stomach, cuts out the bladder and stitches the wound. After such a conventional operation, a scar always remains on the skin in the form of a scar corresponding to the line of the incision made. This scar will never allow its owner to forget about the operation performed. Since the operation is performed using an incision in the tissue of the anterior abdominal wall, such access to the internal organs is traditionally called laparotomy .

The term "laparotomy" is formed from two words - "lapar-", which translates as belly, and "tomia", meaning to cut. That is, the general translation of the term “laparotomy” sounds like cutting the stomach. Since as a result of cutting the abdomen, the doctor is able to manipulate the gallbladder and other abdominal organs, the process of such cutting of the anterior abdominal wall is called laparotomy access. In this case, access refers to a technique that allows the doctor to perform any actions on internal organs.

Laparoscopic surgery on the abdominal and pelvic organs, including the gallbladder, is performed using special instruments - a laparoscope and trocar manipulators. A laparoscope is a video camera with a lighting device (flashlight), which is inserted into the abdominal cavity through a puncture on the anterior abdominal wall. Then the image from the video camera is shown on a screen on which the doctor sees the internal organs. It is based on this image that he will carry out the operation. That is, during laparoscopy, the doctor sees the organs not through an incision in the abdomen, but through a video camera inserted into the abdominal cavity. The puncture through which the laparoscope is inserted has a length of 1.5 to 2 cm, so a small and almost invisible scar remains in its place.

In addition to the laparoscope, two more special hollow tubes called trocars or manipulators, which are designed to control surgical instruments. Through hollow holes inside the tubes, instruments are delivered into the abdominal cavity to the organ that will be operated on. After this, using special devices on the trocars, they begin to move the instruments and perform the necessary actions, for example, cutting adhesions, applying clamps, cauterizing blood vessels, etc. Controlling instruments using trocars can be roughly compared to driving a car, airplane or other device.

Thus, laparoscopic surgery involves the insertion of three tubes into the abdominal cavity through small punctures 1.5–2 cm long, one of which is intended for obtaining an image, and the other two for performing the actual surgical procedure.

The technique, course and essence of the operations that are performed using laparoscopy and laparotomy are exactly the same. This means that the removal of the gallbladder will be performed according to the same rules and steps both using laparoscopy and during laparotomy.

That is, in addition to the classic laparotomy approach, laparoscopic access can be used to perform the same operations. In this case, the operation is called laparoscopic, or simply laparoscopy. After the words “laparoscopy” and “laparoscopic”, the name of the operation performed is usually added, for example, removal, after which the organ on which the intervention was performed is indicated. For example, the correct name for removing the gallbladder during laparoscopy would be “laparoscopic removal of the gallbladder.” However, in practice, the name of the operation (removal of part or the entire organ, enucleation of stones, etc.) is skipped, as a result of which only an indication of the laparoscopic approach and the name of the organ on which the intervention was performed remains.

Two types of gall bladder interventions can be performed using laparoscopic access:
1. Removal of the gallbladder.
2. Removing stones from the gallbladder.

Currently surgery to remove gallstones is almost never performed for two main reasons. Firstly, if there are a lot of stones, then the entire organ should be removed, which is already too much pathologically changed and therefore will never function normally. In this case, removing only the stones and leaving the gallbladder is unjustified, since the organ will constantly become inflamed and provoke other diseases.

And if there are few stones or they are small, then you can use other methods to remove them (for example, litholytic therapy with ursodeoxycholic acid preparations, such as Ursosan, Ursofalk, etc., or crushing stones with ultrasound, due to which they decrease in size and independently exit the bladder into the intestine, from where they are removed from the body along with food bolus and feces). For small stones, litholytic therapy with medications or ultrasound is also effective and avoids surgery.

In other words, the current situation is that when a person needs surgery for gallstones, it is advisable to remove the entire organ completely, rather than remove the stones. This is why surgeons most often resort to laparoscopic removal of the gallbladder, rather than stones from it.

Laparoscopy of the ovaries (removal of a cyst, fallopian tube or the entire ovary, etc.) - advantages, description of types of laparoscopy, indications and contraindications, preparation and progress of the operation, recovery and diet, reviews, price of the procedure

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Ovarian laparoscopy is a common name, convenient for everyday use, for a number of operations on a woman’s ovaries, performed using laparoscopy techniques. Doctors usually call these therapeutic or diagnostic procedures laparoscopic operations. Moreover, the organ on which the surgical intervention is performed is most often not indicated, since this is clear from the context.

In other cases, in surgery the essence of this medical manipulation is more precisely formulated, indicating not only the use of the laparoscopy technique, but also the type of operation performed and the organ undergoing intervention. An example of such detailed names is the following - laparoscopic removal of ovarian cysts. In this example, the word “laparoscopic” means that the operation is performed using laparoscopy. The phrase “removal of a cyst” means that a cystic formation was removed. And “ovary” means that doctors removed a cyst from this particular organ.

In addition to enucleating the cyst, during laparoscopy foci of endometriosis or inflamed areas of ovarian tissue, etc. can be removed. The entire complex of these operations can be performed laparoscopically. Therefore, for a complete and correct name of the intervention, it is necessary to add the type of operation to the word “laparoscopic”, for example, removal of a cyst, foci of endometriosis, etc.

However, such long names of interventions at the everyday level are often replaced by the simple phrase “ovarian laparoscopy,” when uttered, a person implies that some kind of laparoscopic operation was performed on the woman’s ovaries.

Laparoscopy of the ovaries - definition and general characteristics of the operation

So, a typical operation on the ovaries is performed as follows: the surgeon cuts the skin and muscles, moves them apart and sees the organ with the eye through the hole made. Then, through this incision, the surgeon removes the affected ovarian tissue in various ways, for example, enucleates the cyst, cauterizes foci of endometriosis with electrodes, removes part of the ovary along with the tumor, etc. After completing the removal of the affected tissue, the doctor sanitizes (treats) the pelvic cavity with special solutions (for example, Dioxidine, Chlorhexidine, etc.) and sutures the wound. All operations performed using such a traditional incision in the abdomen are called laparotomies, or laparotomies. The word "laparotomy" is formed from two morphemes - lapar (stomach) and tomia (incision), respectively, its literal meaning is "cutting the abdomen."

Laparoscopic surgery on the ovaries, unlike laparotomy, is performed not through an abdominal incision, but through three small holes with a diameter of 0.5 to 1 cm, which are made on the anterior abdominal wall. The surgeon inserts three manipulators into these holes, one of which is equipped with a camera and a flashlight, and the other two are designed to hold instruments and remove excised tissue from the abdominal cavity. Next, focusing on the image obtained from the video camera, the doctor, using two other manipulators, performs the necessary operation, for example, enucleates a cyst, removes a tumor, cauterizes foci of endometriosis or polycystic disease, etc. After the operation is completed, the doctor removes the manipulators from the abdominal cavity and sutures or seals three holes on the surface of the anterior abdominal wall.

Thus, the entire course, essence and set of operations on the ovaries are absolutely the same both with laparoscopy and with laparotomy. Therefore, the difference between laparoscopy and conventional surgery lies only in the method of access to the abdominal organs. With laparoscopy, access to the ovaries is made using three small holes, and with laparoscopy - through an incision in the abdomen 10 - 15 cm long. However, since laparoscopy is much less traumatic compared to laparotomy, there are currently a huge number of gynecological operations on various organs, including including the ovaries, is produced precisely by this method.

This means that the indications for laparoscopy (as well as for laparotomy) are any diseases of the ovaries that cannot be treated conservatively. However, due to its low morbidity, laparoscopy is used not only for surgical treatment of the ovaries, but also for diagnosing various diseases that are difficult to recognize using other modern examination methods (ultrasound, hysteroscopy, hysterosalpingography, etc.), since the doctor can examine the organ from the inside and, if necessary, take tissue samples for subsequent histological examination (biopsy).

Advantages of laparoscopy over laparotomy

• Less tissue trauma, since the incisions during laparoscopy are much smaller than during laparotomy;
• Less risk of developing adhesions, since during laparoscopy internal organs are not touched and compressed as much as during laparotomy surgery;
• Postoperative rehabilitation after laparoscopy occurs several times faster and easier than after laparotomy;
• Low risk of infectious and inflammatory process after surgery;
• Almost complete absence of risk of seam divergence;
• No large scar.

This is the most effective method of treating various diseases of the female genital organs. Before the discovery of this method, no doctor would have even thought of prescribing surgery for a pregnant woman (unless the question was about life and death). This would most likely threaten termination of pregnancy. Nowadays, women not only successfully become pregnant after operations on the ovaries and uterus, such operations can be performed directly during pregnancy. Read our article to the end, and you will find out how long after such a procedure you can plan a pregnancy, how much time the body needs to restore reproductive function after this treatment method, and much more useful information.

The patient remains in the clinic for 24 hours after the operation. During this time, he recovers from anesthesia, and doctors can monitor his adaptation. When performing more complex interventions on vital organs, the patient remains under the supervision of doctors for up to three days. But, as a rule, after a day the reclining position is allowed, and after another day you can move around.
If the operation was performed on the genitals or liver, then a special diet is not required. Liquid intake is prohibited for some time after surgery. In other cases, the patient is allowed a special diet. Usually you can eat dietary foods, boiled or baked, broths, cereals, and fermented milk products. You should eat at least five times a day, in small portions. Drink about one and a half liters of various diet drinks.
If the intervention was directly on the digestive organ, you can only drink for a day or a day and a half. The first meal is possible after three days and solid food is prohibited. Over time, other foods are introduced into the diet. The patient must adhere to a strict diet for a month.
However, regardless of which organ was operated on, you should completely abstain from heavy food and alcohol for at least 30 days. Thanks to this, it is easier for the body to cope with the adaptation period.
It is forbidden to take a bath for fifteen days, and after taking water procedures, it is mandatory to lubricate the seams with a disinfectant. If it is necessary to remove sutures, this is done a week after the operation.
Twenty days after laparoscopic interventions, a person can lead a normal lifestyle.

The current development of laparoscopy makes it possible to solve almost any problem that arises with the female genital organs. Moreover, if a woman cannot have children and only surgical methods can help, then this study solves the problem accurately and humanely. More than half of the cases are associated with obstruction or deformation of the fallopian tubes. Such problems are easily detected and solved using a laparoscope. Many infectious diseases, including sexually transmitted ones, leave their traces in the body in the form of adhesions. Chlamydia and ureaplasmosis are very common today. These diseases often cause unwanted processes in the tubes, into which the infection rises from the external genitalia. Sometimes the infection penetrates through the flow of physiological fluids. More often, both tubes become diseased at once and in advanced cases, the result, as a rule, is the inability to have children. Moreover, blockage of the tubes often provokes ectopic pregnancies, and this is already a threat to the patient’s life.

Using a laparoscope, you can cope with adhesions in the female genital organs. This effect causes minimal damage to nearby organs and is quite effective. Then the patient is prescribed restorative procedures, as well as exposure to antimicrobial drugs.

The results of this study are verified using x-rays and ultrasound.
In addition to adhesions, laparoscopy can be used to get rid of endometriosis, a fairly common disease. With endometriosis, the inner surface of the uterus grows and interferes with the normal functioning of the organ.

Laparoscopy is a form of treatment when, without harming the patient’s skin, an intervention is performed and problems of a surgical nature are solved or diagnostics are carried out in doubtful cases.
In order for the patient to be allowed to undergo surgery, many laboratory tests must be done. This is a common checklist that is requested in any hospital before any operation. It consists of a large number of points and based on the results of these studies, one can judge the patient’s health status.

The reason for a temporary ban on laparoscopy is menstruation. In addition, the procedure is postponed if the patient is in the midst of ARVI, influenza and similar conditions. If a woman wants to conduct such a study to identify the reasons for the inability to have children, then it is better to do this from the fifteenth to the twenty-fifth day of the cycle.

On the day of laparoscopic examination or surgery, you should not eat food. If the patient takes any medications, this must be told to the doctor, since there are drugs that are prohibited to take some time before the study. In addition, some drugs can interact with anesthesia and produce unpredictable consequences.
Seven days before the procedure, it is advisable not to eat gas-forming foods. The menu should be easily digestible and not heavy.

Five days in advance, drink absorbents and enzyme preparations.
The night before laparoscopy, perform procedures to empty the intestines.
During the day, exclusively dietary food, and in the evening, liquid food.
It is recommended to drink herbal-based sedatives a week in advance.

If we literally translate the term “laparoscopy”, it means “looking into the stomach.” There are other methods to look into the internal organs of a person, but the fundamental difference is that to conduct this study, a hole is made in the abdominal wall and all the necessary instruments are inserted into it to carry out an examination or perform an operation. The examination is carried out under local anesthesia, and surgical interventions are performed under general anesthesia.
Sometimes, after doing many tests and examinations, doctors are not sure what is really going on with the patient. In many cases, laparoscopy can be helpful.

Doctors recommend such a study to confirm the disease in cases where: the patient has discomfort in the stomach or nearby organs; if a tumor is detected in the same area. Sometimes the discovery is made by the patient himself, sometimes by a physician. Laparoscopy helps to clearly examine the tumor and take a puncture for analysis. If there is fluid in the epigastric region, this study will clearly show what is happening. Laparoscopy is indicated for liver problems. Only this examination makes it possible to take a liver puncture and do tests.

This method is good because usually after surgery, patients recover quickly and do not suffer from any undesirable consequences. Problems sometimes occur due to damage to blood vessels and nearby organs. Perhaps microorganisms entered the wound. But similar cases also occur with conventional surgery, and the failure rate is much higher.

After laparoscopy, there may be problems that are common for surgical interventions, and specific ones that are characteristic of this type of treatment. More often this happens due to the use of special tools.
Instruments used to make a hole in the abdominal wall are inserted without visual control. To prevent errors, there is a special technique, checks are carried out during work, and there are also devices to help avoid injuries. Some models are equipped with a laparoscope to see the direction of the instrument. However, the possibility of injury to nearby organs cannot be completely denied. If the injury is detected in time, everything can be corrected quickly.

After laparoscopy, the formation of blood clots is sometimes activated. This complication is typical for people who are overweight, have problems with the cardiovascular system, varicose veins, and elderly patients. To avoid the formation of blood clots, special procedures are carried out, the patient is given drugs that prevent excessive blood clotting.
Injecting CO into the body can lead to deterioration in the functioning of some organs, such as the lungs. To reduce the risk of this complication, closely monitor CO pressure; it should be minimal.

Often CO accumulates under the patient’s skin, but this is not dangerous to life or health and goes away on its own after some time.
Sometimes during the intervention, tissues are burned. This is probably due to a hardware malfunction. If the burn is not detected, tissue death may begin.
Infection of the puncture site occurs due to weak body resistance, or may be a consequence of surgical manipulations.

In different medical institutions, the technique of laparoscopic operations may differ slightly.
Preoperative measures are no different from those carried out before classical surgery. In addition, under certain circumstances it is sometimes necessary to complete such an operation in the classical way.

Such an operation is impossible without preliminary injection of CO into the abdominal cavity. Gas injection is necessary so that all areas to be operated on are visible and can be reached with special tools. The body is wiped with disinfectants, covering an area slightly larger than necessary, so that if necessary, an incision can be made. When the patient is fully anesthetized, a puncture is made in the center of the abdomen and a special Veress mechanism is inserted into it. This mechanism is designed for laparoscopic operations and acts as carefully as possible in relation to the human body. There are special tests by which the doctor determines that the mechanism has reached the desired point and gas is pumped through it under the peritoneum. When the gas injection is completed, the Veress mechanism is pulled out and the next instrument is inserted into this hole, which makes a hole in the right place; now the laparoscope and the mechanisms with which the operation will be performed are inserted into it.

A laparoscope is a device consisting of a microcamera and a light bulb for illuminating the abdominal cavity. The camera sends a video signal to the monitor, through which the surgical intervention is carried out.

Laparoscopy as a branch of surgery has been known for almost a century. But in the twenty-first century it received a new development. Studies of this method have made it possible to better understand the processes taking place, assess the preoperative and postoperative condition of patients, and, among other things, revise the list of diagnoses for which this study is undesirable. Scientists have not entirely reached consensus on this issue; discussions are still ongoing. But we will provide the reader with a list of contraindications that do not cause controversy in scientific circles.

Contraindications to laparoscopic operations can be categorical and those that can be neglected in certain circumstances. In addition, they may relate to specific organs, or they may relate to the state of the body as a whole. This classification is not academic in nature and varies depending on the individual case. For example, if a woman is carrying a child and is in the second trimester, then she will be prohibited from laparoscopic surgery to remove a hernia, but surgery on the gall bladder will be allowed without problems.

Categorical contraindications include the patient being in a coma, disturbances in the functioning of the cardiovascular and respiratory systems in the developmental phase, extensive inflammatory and abscess processes, any complications of the patient’s health in which laparoscopy is dangerous. In addition, it is undesirable to perform surgery if the patient has a very increased body weight, a tendency to form blood clots, is pregnant in the last trimester, or if the patient is sick with a contagious disease.

There was a joke among European doctors that said: “a big master makes big stitches.” Many generations of doctors were raised on a similar theory. There were periods in surgery when doctors competed in cutting and sewing skills. Attempts to connect various parts of the human body with the help of surgical instruments, various amputations were the main directions of medicine. It is remarkable that “surgery” in the ancient language is “handicraft”.

The development of medicine has gone through stages in which little attention was paid to the holistic functioning of the human body as a single system. Doctors did not think about the fact that the operation itself was a blow to health. Therefore, when working, surgeons primarily cared about their own comfort; the length of the suture did not matter, the main thing was the quality of suturing.

The idea of ​​performing operations with minimal disruption of the skin arose at the end of the twentieth century, and was met with hostility among professionals. But the denial was quite short. Surgical innovators began to promote laparoscopy because a more gentle method of surgical intervention had not yet been invented.

Patients who have undergone laparoscopy have many times fewer side effects, and adaptation after the intervention occurs much faster.

A special conversation about patients who are overweight. During classic surgery, a huge number of fat cells are cut. This greatly worsens the body’s condition and complicates adaptation after the intervention. These tissues are an excellent breeding ground for pathogenic microflora. The suture heals worse, abscesses are possible.

It turns out that there are categories of citizens who are positively influenced by computer games. That is, not on themselves, but on their professional skills. A study was conducted in Israel among doctors working in endoscopic surgery. It turns out that those specialists who like to play computer games are more likely to perform laparoscopic operations. At the same time, such specialists’ manipulation of devices is more complex and targeted.

Laparoscopy differs fundamentally from classical surgical technologies. The fact is that all manipulations are carried out not with a scalpel, but with microinstruments, which are introduced into the patient’s body through several punctures in the abdominal cavity. All instruments fit into tubes with a diameter of half a centimeter. Therefore, microscopic precision is required to control such equipment. The doctor sees the entire progress of the operation on a computer monitor. “Friendship” with electronic equipment also helps here.

Israeli scientists underwent special tests, based on the results of which they were given points. It turned out that the more skillfully a surgeon plays electronic games, the more skillfully he performs laparoscopic operations. Those doctors who played more than three hours every seven days had almost forty percent fewer inaccuracies in operations than their non-gaming colleagues.

Such data allow us to speak with confidence about the positive impact of computer games on the eye, reaction speed, and fine motor skills. At the same time, a person is better oriented in nearby space. If you are a fan of playing, do not forget to support your vision with special exercises, as well as dietary supplements (dietary supplements).

Today, pancreatitis is a serious medical problem, as the number of patients is growing every year. Pancreatitis is difficult to treat and also difficult to recognize. At the same time, the number of cases with sad endings reaches half! The high level of alcoholism in society contributes to the development of this disease. In addition, a blow can provoke pancreatitis.

Laparoscopy greatly facilitates the recognition and complete relief of pancreatitis.
It is performed under local anesthesia. Before this, classical drug therapy is carried out. General anesthesia is given only in special cases, for example, if the patient is weak or very old.

Through the hole, the laparoscope is inserted into the patient's abdomen. Before this, the stomach is pumped with gas. In some cases it is air, and in some cases it is CO.
During the operation, pathologically deformed parts of the organ are cut off and the fluid is pumped out. After this, the organ is cleaned using disinfectants. Special therapy is carried out for tissues, especially those damaged by the disease. In addition, medications, including antimicrobial ones, are poured into the cavity.

According to practical medicine, the effectiveness of this study in identifying and treating pancreatitis is almost one hundred percent. This method makes it possible to identify the disease quickly and urgently begin the process of its treatment. In addition, the further use of a laparoscope to monitor the course of the disease makes it possible to find the most effective methods of therapy. If conservative methods are not enough, laparoscopy helps determine the optimal time for surgery.

This is a young branch of surgery; one might even say that laparoscopy is taking its first confident steps in the history of medicine.
The starting point in the development of such operations can be considered the publication of a work on this topic by the doctor and inventor Kurt Semm. This happened in the seventies of the twentieth century. Since Semm was a specialist in the treatment of specific female diseases, the first laparoscopic interventions were on the genitourinary system. A whole team of like-minded people worked with him. Many of the devices used today in such operations were developed by these enthusiasts.

By the end of the eighties, the number of such interventions numbered in the tens of thousands. There were less than half a percent of side effects after surgery. These data served as convincing evidence of the feasibility of such operations.
The introduction of laparoscopy spurred the largest medical equipment manufacturers to create more advanced devices for this type of medicine.
The end of the seventies was marked by the introduction of laser technology into the process. From that moment on, lasers began to be improved by manufacturers.

The most important role in the operation is played by the microcamera and lenses. At the beginning of the twentieth century, the first endoscopic images were performed. The first images were very imperfect. Even by the mid-twentieth century they were still too small. In the early sixties, the photolaparoscope was invented.
The advent of electronic equipment made it possible to construct small cameras that produce color images.

Laparoscopy is gaining popularity every year, and this method is preferred by doctors from different fields of medicine. To perform it, you need modern equipment that allows you to make precise incisions and visually monitor the process in order to avoid erroneous actions by the surgeon.

This technique becomes safe only in the hands of professionals. They should not only know what laparoscopy is, but also have extensive experience in operating in this way. Learning this technique requires a long time and dedication. Laparoscopy is most often used by gynecologists, but it has also found wide application in other areas of medicine.

Areas of use

Laparoscopy is a minimally invasive method of diagnosis and surgical treatment. During its implementation, all surgical procedures are performed through a small (about 10–15 mm) hole in the abdominal cavity using special instruments. A laparoscope, which is equipped with a video system, allows you to visualize what is happening during the procedure.

Most often, laparoscopy is used when performing the following operations:

• removal of the gallbladder or stones in it;
• ovarian cystectomy;
• myectomy;
• operations on the small and large intestines;
• appendectomy;
• gastric resection;
• removal of umbilical and inguinal hernia;
• liver cystectomy;
• pancreatectomy;
• adrenalectomy;
• elimination of obstruction of the fallopian tubes;
• elimination of varicose veins of the spermatic cord;
• surgical methods for treating obesity.

Using the laparoscopic method, it is possible to perform all traditional operations and at the same time maintain the integrity of the tissues of the abdominal wall. In addition, laparoscopy is also used for diagnostic purposes in the following cases: serious damage to the abdominal organs with irritation of the peritoneum, pathologies of the hepatobiliary system, pathologies of internal organs caused by injuries.

The list continues with effusion of blood into the body cavity, ascites of the abdominal cavity, purulent inflammation of the peritoneum, and neoplasms in the internal organs. Laparoscopy is performed both routinely and in emergency cases. Hydrosalpinx is a pathology of the fallopian tubes caused by the accumulation of transudate in their lumen.

Laparoscopy is an operation, so the risk of serious complications is inevitable

Gynecological practice

In gynecology, a combination of hysteroscopy and laparoscopy often occurs, when it is necessary to make an accurate diagnosis and immediately carry out a series of therapeutic actions. Thus, hysteroscopy allows for diagnostics, sampling of material for histological analysis, or immediate elimination of minor defects in the uterus (septums or polyps). And laparoscopy, unlike the first procedure, allows even tumors to be removed. It can completely replace abdominal surgery.

These diagnostic procedures cannot be avoided when a woman is examined for infertility. If, during hysterosalpinography, obstruction of the fallopian tubes was confirmed, then, according to indications, hydrosalpinx laparoscopy is performed under general anesthesia. After its removal, the chances of successfully getting pregnant increase to 40–70%. If it is necessary to remove the tube, then the woman can resort to IVF.

Contraindications

With all its advantages, laparoscopy has a number of absolute and relative contraindications. It is strictly forbidden to perform this procedure in the following cases:

• acute blood loss;
• proliferation of connective tissue cords in the peritoneum;
• purulent cavities on the walls of the peritoneum;
• abdominal pain and severe flatulence;
• postoperative hernia at the site of the scar;
• severe cardiovascular pathologies;
• brain damage;
• liver and kidney failure;
• severe pathologies of the respiratory system;
• malignant formations of the appendages.

In addition, there are a number of other restrictions:

• carrying a child for up to 16 weeks;
• benign tumor of large muscle tissue;
• suspicion of oncopathology of the pelvic organs;
• acute respiratory infection in the acute stage;
• allergic reaction to anesthetics or other drugs.

In such cases, laparoscopy is not completely ruled out, but optimal options are sought for each individual patient.

Preparing for surgery

If emergency laparoscopy is recommended, preparation is limited to cleansing the gastrointestinal tract with an enema and emptying the bladder. The most necessary tests are taken - a clinical blood and urine test, RW, the heart is checked on an electrocardiogram and blood clotting is assessed on a coagulogram.

Preparation for the planned diagnosis is carried out in more detail and for a long time. The patient is carefully examined within 3–4 weeks. It all starts with collecting an anamnesis, since the success of the operation largely depends on it. The doctor must find out the following nuances: the presence of injuries, damage or previous operations, chronic diseases and medications taken on an ongoing basis, allergic reactions to medications.

Then a consultation with specialized specialists (cardiologist, gynecologist, gastroenterologist) is recommended. In addition, all necessary laboratory tests and, if necessary, additional diagnostic procedures (ultrasound, MRI) are carried out.

Successful operation depends on compliance with the following rules:

• 3–5 days before surgery it is forbidden to drink alcohol;
• take medications that reduce gas formation for 5 days;
• immediately before surgery, cleanse the intestines using enemas;
• on the day of laparoscopy, take a shower and shave your hair in the necessary places;
• no later than 8 hours before surgery you should refrain from eating;
• empty your bladder 60 minutes before laparoscopy.

If there is a need to perform emergency laparoscopy, then menstruation is not a contraindication for this. If the operation is planned, then it can be performed starting from the 6th day of the cycle.

As a rule, laparoscopy takes from 30 minutes to 1.5 hours

Performing laparoscopy

In connection with the planned operation, patients are often concerned about how laparoscopy is performed, under what anesthesia and how long it takes for the sutures to heal. Performing laparoscopy includes the following steps. Application of pneumoperitoneum - a Veress needle is used for these purposes. The manipulation involves injecting carbon dioxide into the abdominal cavity to improve visualization and movement of instruments.

Insertion of tubes: when the required amount of gas is injected into the peritoneum, the Veress needle is removed, and hollow tubes (tubes) are inserted into the existing puncture sites. Trocar insertion: As a rule, during therapeutic laparoscopy, 4 trocars are inserted, the first one being blindly inserted. They are necessary for the further introduction of special instruments (preparing probes, spatulas, clamps, aspirators-irrigators).

Visual examination of the abdominal cavity is carried out using a laparoscope. The image is transmitted from the camera to the control unit, and from it the video is displayed on the monitor screen. After examining the insides, specialists decide on further treatment tactics. During the process, biomaterial can be taken for further research. At the end of the operation, the tubes are removed, gas is removed from the peritoneum and the subcutaneous tissue of the canal is sutured.

Diagnostic laparoscopy is performed under local anesthesia, therapeutic laparoscopy is performed under general anesthesia. In many cases, doctors prefer spinal anesthesia, since it does not require putting the patient into medical sleep and does not cause significant harm to the body.

Rehabilitation period

The postoperative period, as a rule, passes quickly and without significant complications. After a few hours you can and even need to move. You can drink and eat in the usual amount only after 24 hours. Discharge from the surgery department occurs the next day. The pain in the lower abdomen, as a rule, only occurs in the first 2–3 hours after manipulation.

Some patients have a slight increase in temperature (37.0–37.5 °C). If the operation was performed on the gynecological part, then bleeding may be observed for 1–2 days. On the first day, patients may experience indigestion, and in subsequent days, bowel problems (diarrhea or constipation).

In the photo you can see post-operative scars

Patients who were examined in this way due to the inability to have children may try to get pregnant just a month after the procedure. If a benign tumor was removed during the process, then you can try to conceive a child only after six months. Sutures are removed after laparoscopy after 7–10 days. This is decided by the attending physician. If the suture does not heal for a long time, then the period may increase to one month, and throughout this time they should be properly cared for.

The surgical method of treatment is characterized by the fact that its use is always accompanied by damage to the tissues of the human body. Sometimes the surgical trauma received during access to the affected organ is more significant than the cuts made during the main stage of the intervention.

The desire to minimize the size of incisions and preserve tissue has led to the emergence of such a direction as laparoscopic surgery. This expression was first used by medical researchers more than a hundred years ago. Laparoscopy is a minimally invasive surgical procedure performed through small punctures in the anterior wall of the abdominal cavity. In the medical literature, which contains all the information about laparoscopy, other names for such an operation are sometimes used: “peritoneoscopy” or “abdominoscopy”.

Using a modern minimally invasive method of intervention, surgeons gain access to organs located in the abdominal cavity and pelvic area. This technique is used for diagnosis, treatment of various diseases, and provision of emergency care.

Laparoscopic surgery is performed using sophisticated medical devices. The main one, the laparoscope, consists of the following components:

• Telescopic special tube, which is a metal tube with two channels;
• A set of lenses that transmit an image from the organ under study to a video camera;
• A video camera that displays the resulting image on an enlarged scale on the screen;
• Illuminator – a source of cold light supplied to the area being examined.

During the operation, the surgeon inserts a laparoscope into the abdominal cavity. Another necessary device is an insufflator. It performs the following functions:

• Filling of the abdominal cavity with gas;
• Maintaining a certain level of pressure;
• Periodic gas renewal.

Carbon dioxide is supplied from a cylinder or through a mains network. Modern insufflators can create different gas flow rates.

Therapeutic laparoscopy is performed using special devices - trocars, which are inserted through additional holes. They are a hollow tube with a stylet inside for puncturing the skin and soft tissues. After the trocar penetrates the abdominal cavity, the stylet is removed, and the tube is used as a working channel through which instruments are inserted and the severed organs or tissues are removed. In order to prevent gas leakage, the device is equipped with a valve mechanism.

There are trocars that remain in the patient’s abdominal wall for a certain time and allow for repeated intervention. They are made from inert titanium alloys. Dynamic laparoscopy is used in cases where continuous monitoring of the condition of the affected organ is required.

Scientific and technical achievements in the field of electronics, optics, and materials science contribute to the constant improvement of equipment. This makes it possible to expand the scope of the method, for example, to use laparoscopy in pediatric surgery. In order to raise the abdominal wall and facilitate the insertion of instruments, carbon dioxide is pumped into adult patients using an insufflator.

Laparoscopy in children should be performed without this procedure, since increased pressure in the abdominal cavity negatively affects the child's heart, brain and respiratory system. The use of ultra-precise instruments, as well as special devices that protect organs from accidental damage, allows surgeons to perform minimally invasive operations on children.

Currently, complex, expensive equipment is available not only to large medical centers, but also to regional hospitals. This is especially important for emergency laparoscopy, when the patient's condition requires urgent intervention.

The role of diagnostic laparoscopy

The first developers of the laparoscopy method used it primarily in diagnosing diseases. The term itself, translated from Greek, means examination of the abdominal cavity. Currently, there are many modern ways to study the human body that do not injure tissue: MRI, radiography, ultrasound, endoscopy and others. However, laparoscopy is often used for diagnostic purposes. The latest optical devices are capable of greatly magnifying the surface under study and detecting very minor pathologies. The diagnostic accuracy of such studies approaches 100%.

A unique method makes it possible to examine not only the abdominal and pelvic organs, but also the retroperitoneal region. The peculiarities of the procedure make it possible to urgently carry out the necessary surgical procedures in emergency situations by introducing additional trocars for instruments. Of all medical specialties, laparoscopy is most often used by gynecological surgeons to determine an accurate diagnosis and as the main method of treatment. It makes it possible to visually assess the condition of the internal female genital organs. According to experts, up to 95% of gynecological operations can be performed laparoscopically.

In oncology, minimally invasive methods make it possible to painlessly analyze pathological material for research, determine the type of tumor, stage of the disease, and choose treatment tactics. If surgery is indicated, laparoscopy is used if indicated. Its use reduces the risk of unwanted complications and promotes rapid recovery of the patient.

Indications

The laparoscopic method is used for diagnosis in the presence of the following symptoms:

• Internal injuries, damage and bleeding;
• Acute forms of diseases of the stomach, intestines, pancreas, as well as the liver and bile ducts;
• Formation of various tumors;
• Suspicion of postoperative or acute peritonitis;
• Penetrating wounds in the abdominal area;
• Accumulation of fluid in the peritoneum.

Indications for laparoscopy are situations where the clinical picture indicates an acute pathology: pain, fever, irritation of the peritoneum, and less traumatic research methods did not allow establishing a diagnosis. With the help of laparoscopy, it is possible, having determined the cause of the ailment, to immediately stop the bleeding, perform tissue excision, and remove the neoplasm.
Laparoscopy is also used in the treatment of many diseases:

• Acute or chronic appendicitis;
• Cholelithiasis;
• Abdominal hernia;
• Malignant neoplasms in the pancreas, rectum, stomach area;
• Ulcers, adhesions, intestinal obstruction;
• Other diseases of the abdominal organs.

In the field of gynecology, laparoscopy is performed for the following indications:

• Infertility of unknown origin;
• Sclerocystosis, cysts and ovarian tumors;
• Endometriosis of the uterine appendages, ovaries;
• Adhesive disease;
• Ectopic pregnancy;
• Myomatous lesions of the uterus;
• Ovarian apoplexy, accompanied by internal bleeding;
• Other gynecological diseases.

Laparoscopic surgeries can be emergency or planned. Despite the fact that they are tolerated by patients better than interventions accompanied by a cavity incision, the likelihood of complications exists. Such an operation must be prescribed taking into account all available data on the patient’s condition.

Contraindications

Like any surgical intervention, surgery performed laparoscopically has certain limitations. Doctors divide contraindications to laparoscopy into absolute and relative. The first category includes very serious manifestations: coma, clinical death, blood poisoning, purulent peritonitis, intestinal obstruction, uncorrectable blood clotting disorders, severe diseases of the cardiovascular and respiratory systems.

1. Advanced age. During this period of life, patients usually have a number of chronic diseases and disorders of the cardiovascular system. The disadvantages of laparoscopy, like any surgical intervention, are the use of general anesthesia. It can cause myocardial infarction, coronary heart disease, and arrhythmia in very elderly people.
2. Extreme obesity. Excess excess weight and accompanying health problems are contraindications for surgery by any method. During laparoscopy in obese patients, insertion of the laparoscope and trocars is difficult; puncturing the skin and soft tissues often causes bleeding. Due to the fact that the abdominal cavity contains a lot of fat deposits, the surgeon does not have enough free space for manipulation. If the operation is planned, such patients are usually given time to start losing weight.
3. Possibility of formation of adhesions. This factor is relevant for those who, shortly before laparoscopy, underwent conventional abdominal surgery.
4. Diseases of the cardiovascular or respiratory system. They may worsen during the administration of anesthesia.

All contraindications apply to planned surgical interventions. In emergency cases, when not only the health but also the life of the patient is at risk, the operation can be performed after appropriate preparation.

Preparing for surgery

If the doctor has ordered a laparoscopic examination or surgery, serious preparation is required. The patient must undergo a number of examinations:

1. Fluorography;
2. X-ray and ultrasound of the affected organ;
3. Fibrogastroduodenoscopy (if the intervention is related to the digestive system).

Mandatory laboratory tests:

1. General urine analysis;
2. General and biochemical blood test;
3. Blood clotting test;
4. Determination or confirmation of blood group and Rh factor;
5. Check for syphilis, hepatitis and HIV infection.

The patient’s task is to follow all recommendations for preparing for laparoscopy. In addition to directing blood and urine tests, as well as other examinations, the doctor usually prescribes a diet that should be followed 6-7 days before surgery. Foods that promote increased gas formation should be excluded from the diet. These are peas, beans, lentils, white cabbage, rye bread and others. The last meal is allowed no later than six o'clock in the evening on the eve of surgery. A little later, a cleansing enema is prescribed. This procedure must be repeated the next morning before surgery.

When is it better to do laparoscopy for women?

The date of minimally invasive surgery for women is directly related to the course of the menstrual cycle. Elective laparoscopy is not prescribed on menstruation days. During this period, the likelihood of bleeding and infection increases. Due to normal physiological changes occurring in the female body, these days it is more difficult for the patient to cope with the stress associated with surgical intervention.

Most gynecological operations are performed on any non-critical days of the cycle. In the middle of it, just before ovulation, there are optimal conditions for operations for ovarian cysts and diagnosing infertility. In any case, choosing the date of surgery is the prerogative of the doctor.

How is laparoscopy done?

Minimally invasive operations without layer-by-layer dissection of the soft tissues of the abdominal cavity are performed by general surgeons, gynecologists and urologists. Currently, extensive experience in such interventions has been accumulated, and optimal methods for their implementation have been developed.

How is the preliminary stage of laparoscopy performed?

In the process of preoperative preparation, the anesthesiologist develops a premedication and anesthesia plan that matches the individual characteristics of the patient. The patient’s natural anxiety about surgical intervention can cause cardiac arrhythmia, hypertension, and increased acidity of the stomach contents. Reducing the level of anxiety and gland secretion is the main goal of the premedication.

In the operating room, the patient is connected to a machine that monitors cardiac activity. Anesthesia during the procedure can only be administered intravenously, but most often a combination of this method with endotracheal is used. In addition to anesthesia, relaxants are instilled to help relax the muscles. Then an endotracheal tube is inserted and connected to a ventilator.

How the operation itself is performed

The small internal space of the abdominal cavity makes it difficult to examine organs and manipulate surgical instruments. Therefore, the technique of performing laparoscopic surgery involves preliminary injection of a large volume of gas. To do this, a small incision is made in the navel area through which a Veress needle is inserted. The abdominal cavity is filled using an insufflator; carbon dioxide is considered the optimal filler.

After the required pressure has been established in the patient’s abdomen, the needle is removed and a trocar is inserted into the existing incision. The tube from this device is intended for insertion of a laparoscope. The next step is to insert trocars for additional surgical instruments. If during the operation damaged tissues or organs are excised, neoplasms are removed, the extraction is carried out in special container bags through trocar tubes. To crush large organs directly in the cavity and then remove them, a special device is used - a morcellator. This is done during operations such as hysterectomy.

Vessels and aortas are clamped during laparoscopy using titanium clips. To apply them, a special device is inserted into the abdominal cavity - an endoscopic clip applicator. Surgical needles and absorbable suture material are used to place internal sutures.

The final stage of the operation is the final examination and sanitation of the cavity, removal of instruments. Then the tubes are removed and small skin punctures at the sites of their installation are sutured. A drainage must be placed to remove blood debris and pus to avoid peritonitis.

Is it worth doing laparoscopy - advantages and disadvantages

The use of laparoscopy allows the patient to recover as quickly as possible. The average length of hospitalization is 2-3 days. Due to the fact that the surgical intervention occurs with virtually no incisions, there is no pain during the healing process. For the same reason, bleeding during laparoscopy is rare.

An undeniable advantage is the absence of postoperative scars.
The disadvantages of laparoscopy are due to the specifics of the operation:

• A small, limited working area creates difficulties in the surgeon's work;
• The doctor uses sharp special instruments, the handling of which requires certain training and experience;
• It is difficult to assess the force with which the instrument acts on the affected organ, because it is not possible to use the hands;
• When observing an internal cavity on a monitor, the perception of the third dimension - depth - may be distorted.

All these shortcomings are currently being eliminated. Firstly, thanks to the spread and popularity of laparoscopic operations, medical centers and hospitals employ surgeons who have performed many minimally invasive interventions, have extensive experience, and have developed skills.

Secondly, the devices, devices and instruments used in laparoscopy are constantly being improved. For this purpose, advances in various fields of knowledge are used. In the future, it is planned to use robots controlled by surgeons for laparoscopic operations.

Hesitation often occurs in a patient for whom laparoscopy is prescribed as a diagnostic procedure. When assessing the pros and cons of laparoscopic examination, you need to remember that today this method allows you to establish a diagnosis with maximum accuracy. In addition, having detected pathology, the surgeon can simultaneously carry out treatment.

Possible complications

Laparoscopy is a serious surgical operation, so the possibility of various negative consequences cannot be ruled out. The main complications that arise as a result of the intervention:

• Swelling of subcutaneous tissue not only in the peritoneum, but also in other areas. This is called subcutaneous emphysema, occurs due to the action of carbon dioxide, does not require treatment, and goes away in a few days.
• Damage to an organ or vessel as a result of incorrect actions by a doctor. In this case, the damaged tissue is immediately sutured and measures are taken to stop internal bleeding.
• Suppuration of surgical wounds occurs when an infected excised organ is inaccurately removed through a wound or due to a decrease in the patient’s immunity.
• Failure of the cardiovascular or respiratory system occurs under the influence of anesthesia and increased pressure in the abdominal cavity due to the intake of carbon dioxide.
• Bleeding from a trocar wound may be the result of a medical error or poor blood clotting of the patient.

To date, complications, including minor ones, occur in 5% of the total number of operations performed. This is much less than with abdominal surgery.

Postoperative period

After laparoscopy surgery, the patient awakens on the operating table. The doctor assesses his condition and the functioning of his reflexes. After five hours, a patient placed in a ward is allowed to get up with outside help. It is recommended to walk around, but slowly, carefully, avoiding sudden movements. On the first day, eating any food is not allowed. You are only allowed to drink still water.

Sutures should be treated with an antiseptic. They are removed one week after surgery. Pain in the abdomen and back is mild. If they bother the patient, the doctor will allow painkillers to be taken. Unpleasant heaviness in the lower abdomen is a consequence of carbon dioxide entering the abdominal cavity. The condition will improve as soon as all the gas leaves the body.
Discharge from the hospital is made according to the doctor's decision.

Hospitalization can last 2–5 days depending on the complexity of the operation and the patient’s well-being. For 4 weeks, a gentle diet is prescribed with the exception of foods that are difficult to digest: fatty meat, milk, eggs. Fruits and vegetables are allowed, they stimulate metabolism and help remove residual gas.

Heavy physical work and intense sports activities are prohibited for a month. The majority of those who have undergone laparoscopic surgery note a rapid recovery and return to normal life.

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 sees what is happening in the inner kingdom of the abdomen, through another hole he introduces surgical instruments, with the help of which he performs a series of surgical manipulations in the abdominal cavity. A small video camera is attached to the end of the laparoscope tube that is inserted into the abdominal cavity. With its help, an image of the abdominal cavity from the inside is transmitted to the screen.

The word “laparoscopy” reflects the essence of this method: from the ancient Greek “laparo” means “stomach, belly”, “skopia” means “examination”. It would be more correct to call an operation using a laparoscope laparotomy (from the ancient Greek “tomia” - section, excision), but the term “laparoscopy” has taken root and is used to this day.

Let's say right away that Laparoscopy is not only surgery “through a tube”, but also the detection of diseases of the abdominal organs. After all, the picture of the abdominal cavity with all its insides, which can be seen directly with the eye (even through an optical system), is more informative than “encrypted” images obtained, for example, from radiography, ultrasound or computed tomography - they still need to be interpreted.

Scheme of laparoscopic treatment

With laparoscopy, the manipulation algorithm is significantly simplified. There is no need to perform complex access to the abdominal cavity, as with the open method of surgery (with traditional surgical intervention, it is often delayed due to the need to stop bleeding from damaged vessels, due to the presence of scars, adhesions, and so on). There is also no need to waste time on layer-by-layer suturing of the postoperative wound.

The laparoscopy scheme is as follows:

The range of diseases that can be treated using laparoscopy is quite wide.:

and many other surgical pathologies.

Benefits of laparoscopy

Since, unlike the open method of surgical intervention, large incisions do not need to be made in the abdomen for examination and manipulation, the “advantages” of laparoscopy are significant:

Disadvantages of laparoscopy

The laparoscopic method has made, without exaggeration, a revolutionary revolution in abdominal surgery. However, it is not 100% perfect and has a number of disadvantages. There are often 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.