Laparoscopy - what is this type of surgery. When is Diagnostic and Surgical Laparoscopy Performed?

Laparoscopy is a low-traumatic operation performed for therapeutic and diagnostic purposes. Its essence lies in the fact that the doctor can perform an operation on the internal organs of the abdominal cavity through small punctures, avoiding abdominal incisions. Special tubes are inserted into the peritoneum through small holes, and with the help of them the doctor controls the instruments, lights and cameras. In gynecology, laparoscopy (endoscopy in gynecology) has importance, because it can be used both for the purpose of diagnosing pathologies and for the purpose of treatment. How is laparoscopy performed?

Laparoscopic surgery is performed under general anesthesia.

A small passage is pierced in the wall of the patient's abdomen, through which air is pumped into the peritoneum. This manipulation helps doctors avoid injuries to organs located nearby, as the stomach increases in volume.

After that, several small micro-incisions are made for the introduction of the laparoscope. A laparoscope is a special device similar to a tube. On the one hand, it has an eyepiece, and on the other, a video camera with a lens. The second incision is necessary for the insertion of the manipulator. After that, the procedure begins. How long does the operation take? Its duration may be different, it depends more on the severity of the disease and the purpose of the procedure. If the task of laparoscopy is diagnostics, then no more than 60 minutes. Treatment can last up to several hours.

When is the choice: laparoscopy or abdominal surgery? Compared with conventional abdominal surgery, laparoscopy is able to provide better visual control with the help of optical magnification several times of the examined organs, the abdominal cavity, and the retroperitoneal space.

During the course of the operation, doctors monitor their own movements and what happens to the patient's organs on a special screen. The surgeon performs the necessary actions, focusing on him.

A video inspection of the area where the operation was performed is mandatory after the procedure is completed. The surgeon must make sure that there is no bleeding, remove the blood or fluid that has accumulated during the operation. Then gas or oxygen is removed. Only after that the instruments are removed, and the cuts in skin stitches are applied.

Drainage at the end of the operation is required without fail. It is placed after laparoscopy in order to remove blood residues, the contents of wounds and abscesses from the peritoneum to the outside. This helps prevent the possibility of peritonitis.

Types of laparoscopy

In gynecology, a distinction is made between elective and emergency laparoscopy. And also diagnostic laparoscopy or therapeutic is carried out. When prescribing an operation in a planned manner, the surgeon must carefully study the results of the tests, read the information about chronic diseases, if any. Important age and indications for laparoscopy, preparation.

Currently, diagnostic laparoscopy (in other words, endoscopic surgery in gynecology - diagnosis through natural holes or 0.5 cm punctures) is often used by surgeons. One of the main advantages of this method is considered to be low tissue trauma, a minimum of complications and a rather quick return of the patient to the normal rhythm of life.

Diagnostic laparoscopy allows the doctor, with the help of a tube with a video camera inserted into the abdominal cavity, to have a good opportunity to examine in detail the organs of the patient's abdominal cavity. This allows you to assess the situation and understand the cause of the disease, ways to eliminate it. Or make sure the woman is healthy.

It often happens when diagnostic laparoscopy, according to the indications that emerged during the procedure, is reclassified as a medical one. This happens if the surgeon during the operation sees that there is an opportunity to help the patient right now. At the same time, laparoscopy, now aimed at treatment, leads to recovery, complete or partial.

As a rule, interventions by this method are done according to the prescription of the attending gynecologist. Before a laparoscopy is performed, tests are preliminarily given and an examination is performed.

Emergency execution is assigned in certain cases. Laparoscopy, indications for urgent conduction:

Rupture of the ovary (apoplexy);
, ovary;
flowing in acute form infectious and purulent diseases;
With a ruptured cyst;
Necrosis of the myomatous node;
If the pregnancy is ectopic and progresses;
Puncture of the uterine wall during a medical abortion;
If diagnostics is necessary for acute pain syndrome in the lower abdomen with an unclear etiology.

Emergency laparoscopy in gynecology is necessary in a situation where surgical intervention needs to be performed urgently. Its purpose can be both therapeutic and diagnostic.

Indications for laparoscopy

Gynecological diseases lead to the need for an operation.

Indications for laparoscopy:

Infertility
Obstruction of the fallopian tubes (for example, when diagnosing infertility - if it was not possible to find out by other methods), excision of adhesions in the small pelvis
Endometriosis (If combined with other ailments of unclear etiology)
Ovarian cyst (laparoscopic cystectomy)
Myoma node
Violations menstrual cycle
Inflammatory processes in the pelvic area
Suspicion of ectopic pregnancy
Tumor in the ovarian region of unknown nature
Polycystic
To clarify the development and nature of anomalies of the internal genital organs of a woman
To control the treatment, aimed at suppressing inflammation in the pelvis.
To clarify the stages of development of a pathological and malignant nature (when there is a question about surgical treatment and its volume)
To control the integrity of the uterine wall during hysteroresectoscopy

Quite often, diagnostic laparoscopy during surgery is retrained as a medical one.

Statistics show that the number of complications associated with infertility due to obstruction of the fallopian tubes is approaching 40% relative to all others. Therefore, laparoscopy of the fallopian tubes is a fairly common procedure in the gynecological profile. Obstruction can be caused by inflammatory processes, the consequences of past interventions, when adhesions form, infections.

Laparoscopy of the fallopian tubes can be performed both with diagnostic and with therapeutic purpose. At the same time, diagnostics during the operation can become a stage of therapeutic intervention in the process, for example, laparoscopy of adhesions.

It turns out that laparoscopy of the fallopian tubes becomes an excellent alternative to conventional abdominal surgery: it is less traumatic, the rehabilitation period is short, and it allows the doctor to perform all the necessary manipulations.

Despite the fact that surgical intervention using laparoscopy is less traumatic, there are several contraindications to its implementation.

They are divided into absolute and relative.

The first group includes:

Respiratory ailments (decompensation diseases, exacerbation of asthma);
Cardiovascular diseases, including cerebral vessels, diaphragmatic hernia or infirmity of the esophageal opening, that is, those ailments that can prevent a woman from giving the correct body position on the operating table for the work of surgeons;
Poor blood clotting;
severe exhaustion;
Shock of any kind and coma. state of shock may occur if there is a rupture of the fallopian tube or cyst. Then laparoscopic operations are replaced by abdominal ones;
Hypertension in severe degree;
Acute viral infections;
Acute renal or hepatic failure.

The second group includes (relative):

Cancers of the ovaries, cervix or any other localization;
Obesity (3, 4 degree);
Pathological formations in the small pelvis of a significant volume;
Adhesions in the abdominal cavity that have arisen after previous operations;
Hemorrhage in the peritoneum;
Inflammation of the peritoneum (peritonitis);
Allergy;
Pregnancy more than 16 weeks;
Fibroids larger than 12 weeks.

Contraindications to laparoscopy will also be situations if the patient has a lot of adhesions in the small pelvis, if tuberculosis is detected in the organs reproductive system, with endometriosis in advanced severe form, as well as if the hydrosalpinx is large.

Since there are indications and contraindications for laparoscopy in gynecology, it is necessary to undergo an examination before the procedure.

The doctor determines whether it is possible to carry out laparoscopy of the abdominal cavity in each individual case after examining all the tests, getting acquainted with the results of the ultrasound. It happens that the positive effect of laparoscopy treatment is quite difficult, then a laparotomy is prescribed (surgery with an incision abdominal wall).

How to prepare for laparoscopy should be explained in detail by the attending physician. In addition to the gynecologist-surgeon and the anesthetist, the patient must undergo consultations of related specialists. All comorbidities are identified. Since the operation is performed under general anesthesia, the preparation of the patient for laparoscopy should take place at a serious level. Before the operation, a woman should visit:

therapist
Neurologist
Nephrologist
Dentist and other doctors, to detect possible chronic foci of infection.

It is mandatory to pass tests:

Blood and urine on general analysis;
Biochemistry of blood;
On the level of glucose and sugar;
Blood type;
For syphilis and HIV;
For hepatitis;
Coagulogram (blood clotting test);
Smear on flora.

Before the operation, the patient also receives referrals for fluorography, cardiograms, ultrasound of the pelvic organs.

If a laparoscopy of the uterus or other organ is performed urgently, then the number of studies and analyzes is limited to general ones, because in this situation not only the woman's health, but also her life can be in danger.

The minimum is blood type and Rh, general blood and urine tests, coagulation, cardiogram, pressure is measured. The rest are performed when absolutely necessary.

Before an emergency operation, food and water intake is prohibited for two hours. They put a cleansing enema, wash the stomach in order to prevent vomiting and the release of stomach contents into Airways under the influence of anesthesia.

During the planned preparation for the operation, a strict diet is prescribed before laparoscopy: do not eat anything in the evening, and do not drink anything in the morning either. A cleansing enema is prescribed both in the evening and in the morning.

On what day of the cycle do laparoscopy? Usually this is the date of the planned operation is appointed after the fifth - seventh day from the onset of menstruation. During the period of menstruation, they try not to carry out laparoscopy, since the bleeding of tissues increases. However, this is not a contraindication, but is taken into account by the operating surgeon and anesthesiologist.

Is laparoscopy a danger or a benefit?

Many patients are afraid of laparoscopy, removal of cysts and fibroids. Are their fears justified? How dangerous is this procedure? How is the rehabilitation going?

There are risks, of course. After all, laparoscopy is a full-fledged operation and it is performed under general anesthesia. However, such a surgical intervention is considered much less dangerous compared to, for example, abdominal surgery. This information is correct based on the fact that when it is carried out, the risk of complications is reduced to a minimum. The main rule is to obey the doctor and follow all the recommendations during preparation and after.

Advantages and disadvantages of the laparoscopy procedure

This method of operation has both advantages and disadvantages. Let's take a look at them.

The advantages include:

Small incisions on the abdominal wall instead of a wide one;
After the operation, there is practically no pain;
Scars do not remain due to the lack of an incision;
The need for hospitalization is minimal;
Pretty soon after the operation, you can get up and walk;
Sometimes you can go home on the same day in a maximum of 2-3 days. With abdominal operations, this period will be 14–21 days;
The rehabilitation period passes quickly and you can return to normal life;
Postoperative hernias - a rare event. So, after simple operations, this complication is common;
The surgeon gets a more convenient view of the organs due to the multiple magnification of the optics;
Blood loss is much lower;
Tissues are less injured;
It is possible to clarify the diagnosis, and hence the change in treatment tactics;
It is possible to identify comorbidities;
It is permissible to perform two operations without unnecessary skin incisions and the introduction of additional instruments into the abdominal region. For example, ovarian resection and simultaneous plastic surgery;
The adhesive process, which can lead to infertility, and other serious pathological ailments, is minimal, since during laparoscopy there is no need to use gloves with talc, gauze wipes, and there are fewer manipulations with the intestines;
There are practically no divergences of seams;
The use of laparoscopy for diagnosis allowed physicians to negate exploratory operations (cavitary diagnostic operations used when it is impossible to make a diagnosis);
With the use of this sparing method, even laparoscopic hysterectomy (amputation of the uterus) is easier for the body to tolerate.

In the treatment of women's diseases, the use of laparoscopic technology is especially important, since there are many operations that require only a ten-minute intervention to heal an organ. And at the same time, making a large incision of 15 centimeters is impractical.

How much does laparoscopy cost depends on the clinic.

However, we can say that usually free insurance is enough to cover the cost of the operation.

The disadvantages of this method of diagnosis and treatment include:

The high cost of equipment, the rapid deterioration of instruments, disposable consumables, the uniqueness of the laparoscopy method requires special training - hence the high cost of the procedure;
General anesthesia;
Some laparoscopic operations take longer than usual, because the control of the equipment reduces the freedom of manipulation;
There are a number postoperative complications associated with laparoscopy. They are rare, yet they exist. About 1% of patients suffer from subcutaneous emphysema (accumulation of air in tissues), malfunction of the cardiac and respiratory systems due to gas in the abdominal cavity, burns of trocar wounds during coagulation.

What you need to know about complications

After such a type of surgical intervention as laparoscopy, complications in gynecology are extremely rare, provided that the preparation for laparoscopy has been completed correctly. The laparoscopic operation itself in gynecology is more easily tolerated by the body, therefore, severe consequences occur in exceptional cases.

If an experienced surgeon operates, then there should be no complications.

After laparoscopic intervention, the following consequences may occur:

Complications of laparoscopy - this is when, during the implementation of surgical procedures, the internal organs were accidentally damaged. The reason may be poor visualization of the progress of the operation;
Bleeding in the abdomen;
Violation of the integrity of one or more vessels when piercing the abdominal wall;
Gas embolism (blockage of the vessel with air bubbles) as a result of gas entering the damaged vessel;
subcutaneous emphysema;
Damage to the outer lining of the intestine.

How is the postoperative period

Upon completion of the laparoscopy, the operated woman wakes up immediately after anesthesia, on the operating table. Doctors have to make sure that her condition is normal and that her reflexes are working properly. The patient is then transferred to the recovery room.

It is recommended to start moving lying down after an hour. And literally after 5 hours (according to well-being), a woman begins to get out of bed in order to activate blood circulation, to prevent intestinal paresis (lack of peristalsis). Recommend independent trips to the toilet, food. You need to move carefully, smoothly and slowly, avoiding sudden movements. You can’t eat on the first day, only drink non-carbonated water.

The seams are looked after with the help of antiseptics. There are small scars on the abdomen from punctures. The stitches will be removed about a week after the operation. And the discharge will be carried out depending on how large the volume of intervention was - in 2-5-7 days. After laparoscopic extirpation of the uterus, sometimes a little later.

Pain in the abdomen and lower back after surgery is relative. It disappears approximately 3 days after the intervention. Often you can do without painkillers. But if necessary, you need to tell your doctor about it. In the evening or in the morning of the next day, discharge with ichor is possible, and then without it. The temperature can rise up to 37 o. Allocations can last up to 1.5–2 weeks.

At the beginning of the recovery period after the laparoscopy, discomfort and heaviness in the lower abdomen, as well as nausea, are possible. These symptoms are the result of carbon dioxide introduced into the abdominal cavity. As soon as the gas is completely released, all unpleasant feelings will stop.

Most women undergoing laparoscopy leave positive reviews about the procedure. Quick recovery and good health are always joy and satisfaction. Some managed to completely get rid of the disease, which had long tormented and disturbed, others partially.

If you strictly follow all the recommendations of the doctor, then the operation will be successful and recovery period will be short - laparoscopy is the least traumatic operation.

The surgical method of treatment is characterized by the fact that its use is always accompanied by tissue damage. human body. Sometimes the surgical trauma received when accessing the affected organ is more significant than the incisions 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. For the first time this expression was used by medical researchers more than a hundred years ago. Laparoscopy is a minimally invasive surgical procedure performed through small incisions in the front wall of the abdominal cavity. In the medical literature containing 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 the organs located in the abdominal cavity and the pelvic area. This technique is used to diagnose, treat diseases of various profiles, and provide 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 that is 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 the abdominal cavity with gas;
Maintaining a certain level of pressure;
Periodic gas renewal.

Carbon dioxide is supplied from a cylinder or through a main 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 penetration of the trocar into the abdominal cavity, the stylet is removed, and the tube is used as a working channel through which instruments are inserted and cut off 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 re-intervention. They are made from inert titanium alloys. Dynamic laparoscopy is used in cases where continuous monitoring of the state of the affected organ is required.

Scientific and technical achievements in the field of electronics, optics, materials science contribute to the continuous improvement of equipment. This allows expanding the scope of the method, for example, using laparoscopy in pediatric surgery. In order to elevate 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, as increased abdominal pressure negatively affects the child's heart, brain, and respiratory system. The use of ultra-precise devices, 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 district 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 the diagnosis of diseases. The term itself, translated from Greek, means examination of the abdominal cavity. Currently, there are many modern methods of research human body that do not traumatize tissues: MRI, radiography, ultrasound, endoscopy and others. However, laparoscopy is often used for diagnostic purposes. Newest optical instruments are able to repeatedly increase the investigated surface and detect very minor pathologies. The accuracy of diagnosis in such studies is close to 100%.

The unique method makes it possible to examine not only the organs of the abdominal cavity and small pelvis, but also the retroperitoneal region. Features of the procedure make it possible to urgently perform the necessary surgical procedures in emergency situations by introducing additional trocars for instruments. Of all medical directions laparoscopy is most often used by gynecological surgeons to determine the exact 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 allow you to painlessly take an analysis of pathological material for research, determine the type of tumor, the stage of the disease, and choose the tactics of treatment. If shown surgery laparoscopy is used if indicated. Its use reduces the risk of unwanted complications and contributes to the rapid recovery of the patient.

Indications

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

Internal trauma, injury and bleeding;
Acute forms of diseases of the stomach, intestines, pancreas, as well as the liver and bile ducts;
The formation of various tumors;
Suspicion of postoperative or acute peritonitis;
Penetrating wounds in the abdomen;
Accumulation of fluid in the peritoneum.

Indications for laparoscopy are situations when clinical picture testifies to acute pathology: pain, fever, irritation of the peritoneum, and less traumatic research methods did not allow the 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;
Hernia of the abdomen;
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 according to the following indications:

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

Laparoscopic surgery can be emergency or elective. Despite the fact that they are better tolerated by patients than interventions accompanied by a cavity incision, the likelihood of complications exists. It is necessary to prescribe such an operation taking into account all available data on the patient's condition.

Contraindications

Like any surgical intervention, the operation performed by the laparoscopic method 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 bleeding disorders, serious illnesses cardiovascular and respiratory system.

Advanced age. During this period of life, patients usually have a number of chronic diseases, violations in activity of cardio-vascular system. The disadvantages of laparoscopy, like any surgical intervention, are the use of general anesthesia. It can cause myocardial infarction in the very elderly, ischemic disease heart, arrhythmia
Extreme obesity. Excess overweight and related health problems are contraindications for surgery in any way. During laparoscopy in obese patients, the introduction of the laparoscope and trocars is difficult, and piercing of 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.
Possibility of formation of adhesions. This factor is relevant for those who, shortly before laparoscopy, underwent a conventional abdominal operation.
Diseases of the cardiovascular or respiratory system. They can 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 the operation

If the doctor has prescribed a laparoscopic examination or surgery, serious preparation is necessary. The patient must undergo a series of examinations:

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

Mandatory laboratory tests:

General urine analysis;
General and biochemical analysis blood;
Blood clotting test;
Determination or confirmation of blood type and Rh factor;
Testing for syphilis, hepatitis and HIV infection.

The task of the patient is to follow all the recommendations for preparing for laparoscopy. In addition to referral for blood and urine tests, as well as other examinations, the doctor usually prescribes a diet that should be followed 6-7 days before the operation. 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 the operation.

When is the best time for laparoscopy?

The date of the minimally invasive surgery for women is directly related to the course of the menstrual cycle. Planned laparoscopy is not prescribed on the days of menstruation. During this period, the likelihood of bleeding and infection increases. Due to the normal physiological changes that occur in female body, it is more difficult for the patient these days to cope with the loads 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, the optimal conditions for surgery for ovarian cysts and infertility diagnosis. In any case, the choice of the date of surgical intervention 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 surgical, gynecological and urological doctors. At present, a large experience of such interventions has been accumulated, and optimal methods for their implementation have been developed.

How is the preliminary stage of laparoscopy

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 an increase in the acidity of the contents of the stomach. Reducing the level of anxiety and secretion of the glands is the main goal of the ongoing premedication.

In the operating room, the patient is connected to a device that controls 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 dripped to help relax the muscles. Then an endotracheal tube is inserted, connected to a ventilator.

How is the operation itself carried out

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

After the necessary pressure is 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 the introduction of a laparoscope. The next step is to introduce trocars for additional surgical instruments. If during the operation damaged tissues or organs are excised, neoplasms are removed, the extraction is performed in special container bags through trocar tubes. For grinding large organs directly in the cavity and their subsequent removal, a special device is used - a morcellator. This is done in surgeries such as hysterectomy.

Vessels and aorta are clamped during laparoscopy with titanium clips. For their imposition, a special device is introduced into the abdominal cavity - an endoscopic clip applicator. Surgical needles and absorbable suture material are used for internal sutures.

The final stage of the operation is the final examination and sanitation of the cavity, the removal of instruments. Then the tubes are removed and small skin punctures are sutured at the places of their installation. Be sure to put a drain to remove blood residue and pus to avoid peritonitis.

Should I do laparoscopy - advantages and disadvantages

The use of the laparoscopy method allows the patient to recover as soon as possible. Average duration 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.

The 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 work of the surgeon;
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 there is no way to use the hands;
When observing the internal cavity on the monitor, the perception of the third dimension - depth can be distorted.

All of these shortcomings are currently being eliminated. First, due to the spread and popularity of laparoscopic surgery, in 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, advances in various areas knowledge. In the future, it is planned to use robots controlled by surgeons for laparoscopic operations.

Often, indecision occurs in a patient to whom laparoscopy is prescribed as a diagnosis. Assessing the pros and cons of laparoscopic examination, it must be remembered that today this method allows you to establish a diagnosis with maximum accuracy. In addition, having detected a pathology, the surgeon can simultaneously treat.

Possible Complications

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

bloat subcutaneous tissue not only on the peritoneum, but also in other areas. This is called subcutaneous emphysema, is due to the action of carbon dioxide, does not need treatment, and disappears after a few days.
Damage to an organ or vessel as a result of incorrect actions of 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 the infected excised organ is inaccurately removed through the 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 surgical interventions.

Postoperative period

After the operation by laparoscopy, the patient wakes up already on the operating table. The doctor evaluates his condition, the work of reflexes. The patient placed in the ward after five hours is allowed to get up with outside help. It is recommended to walk, but slowly, carefully, avoiding sudden movements. On the first day, no food is allowed. It is only allowed to drink non-carbonated water.

Seams should be treated with an antiseptic. They are removed a week after the operation. Pain weak in abdomen and back. If they bother the patient, the doctor will allow pain medication. 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 is out of the body.
Discharge from the hospital is made at the discretion of the doctor.

Hospitalization can last 2-5 days, depending on the complexity of the operation and the patient's well-being. For 4 weeks, a sparing diet is prescribed with the exception of foods that are difficult to digest: fatty meat, milk, eggs. Allowed fruits and vegetables that stimulate metabolism and promote the removal of residual gas.

Heavy physical work and intense sports activities are prohibited for a month. Most of those who underwent laparoscopic intervention note a quick recovery, a return to normal life.

Laparoscopy (from the Greek. "I look at the womb") came to replace the usual abdominal surgery. Apply it on the organs of the small pelvis and abdominal cavity. Now, for a detailed diagnosis, surgery or treatment, just a few tiny incisions are enough. So low-impact and safe method surgery quickly won the trust of both patients and doctors themselves. It allows you to accurately establish a complex diagnosis, quickly perform surgical procedures, restore functions internal organs. In this case, patients are often discharged a couple of hours after the procedure.

What it is

Laparoscopy refers to a progressive technique in modern surgery. It is based on a small surgical intervention. Instead of a scalpel and abdominal incisions, two or three small incisions are made on the anterior wall of the abdomen and special instruments are used - trocar manipulators and a laparoscope. Through one hole in the abdomen, the doctor inserts a small tube with a laparoscope, a video camera and a lighting device are located on it. Everything that the camera shoots, it sees on the monitor. To improve access to the internal organs, the peritoneal cavity is filled with carbon dioxide, followed by removal.

Modern technologies make it possible to equip the microcamera with digital matrices. Thanks to this, the image becomes as clear as possible, diagnostics and other manipulations are facilitated. All other instruments are manipulators, substitutes for conventional surgical devices.

With their help, they move to the affected area, remove and sew up organs, get rid of tumors, cysts, etc. The operation is performed under general anesthesia. After it, the openings in the abdominal cavity are sutured, as a rule, this requires two or three stitches. The patient can be discharged after a few hours, if the condition allows.

When she's needed

Laparoscopy is needed in two cases: for diagnosis and operations. Diagnostic is used to examine organs in the pelvis and peritoneum, confirming a complex diagnosis. Therapeutic is needed for surgical interventions: removal of adhesions, cysts, tumors, foci of endometriosis, etc. Therapeutic laparoscopy can be planned or emergency. For the patient himself, these types differ only in the method of anesthesia: local anesthesia is more often used for diagnosis, and general anesthesia for operations.

For diagnostics

For examination, this method is rarely used. In most cases, diagnoses are made on the basis of anamnesis, clinic, and test results. But there are cases when the treatment does not give the desired result or it is impossible to establish a diagnosis using other methods. In such a situation, laparoscopy is used.

The indication for such a procedure is:

Defects of the internal genital organs. Invasion allows you to establish the nature of the disease, methods of treatment, to refute the fact of defects.
Suspicion of an ectopic pregnancy. Such an examination is possible until the 16th week of pregnancy and only if other methods are helpless.
For infertility, if long-term treatment gives no results.
Diagnosis of malignant and benign tumors.
With persistent pain in the abdomen and pelvis with an unexplained cause.
The likelihood of fibroids, ruptured ovarian cysts, endometriosis, ovarian apoplexy.
To determine the patency of the fallopian tubes.

This method of research can be used for any suspicion of pathology of the abdominal organs, if non-invasive methods are ineffective. Also, with the help of manipulators and a laparoscope, the doctor can take part of the biomaterial from inaccessible places for analysis, which other diagnostic methods do not allow.

In oncology

Laparoscopy is effective for removing tumors located in the pelvis and peritoneum. It is used in oncology for both operations and diagnostics. This method is applicable even if the tumor is located inside the organ; for this, several technologies are combined at once. To view the structure of tissues in detail and determine the place of formation, angiography (examination of blood vessels) is used and computed tomography. The resulting images are displayed on the screen as a 3D model. The surgeon then uses manipulators to remove the tumor, part of the organ, or the entire organ.

In gynecology

This technology has found the greatest application in the gynecological industry. Today, most of all surgical interventions on the internal genital organs are performed by laparoscopy. This allows you to eliminate many causes of infertility, restore the functioning of the genitourinary system, and clarify the diagnosis. The tangible advantage is the fast rehabilitation period female patients.

Laparoscopy can be prescribed to a woman in such cases:

with infertility with an unexplained cause;
with polycystic;
to eliminate foci of endometriosis;
with myoma;
anomalies in the structure of the pelvic organs;
removal of the uterus or part of it;
removal of the ovary for tumors;
elimination of adhesions in the reproductive system.

In most cases, surgery is necessary due to infertility. This method of surgery identifies and eliminates almost any cause of this problem. Also, by laparoscopy, a woman can be temporarily or permanently sterilized, for this, protective clamps are applied to the fallopian tubes or they are completely removed.

In emergency situations, this method of operating is also applicable. For example, when a cyst is ruptured, the surgeon quickly removes the consequences of the rupture and applies internal sutures. An ectopic pregnancy is removed without serious consequences with the establishment of its cause and the possibility of a second normal pregnancy.

In other areas

This innovative method is gradually replacing open surgery, so they are trying to expand its scope. It is effective not only in the treatment of gynecological problems, men also often need such manipulations. They can prescribe therapeutic laparoscopy for the treatment of the intestines, stomach, kidneys, and removal of the gallbladder. In addition, a minimally invasive method helps to establish a diagnosis in diseases of the pancreas and liver, remove the appendix. A separate niche is occupied by the treatment of the spine by punctures of the abdominal cavity. Laparoscopic operations on the spine are performed for such diseases of the lumbosacral region as hernias, injuries, osteochondrosis, and tumors.

Who and where performs this operation

All manipulations are carried out by an experienced surgeon, he is assisted by the rest of the medical staff. The procedure is carried out only in the operating room, in a hospital setting. Since the technique is already quite popular, it is used in many clinics. For this medical institution must be properly equipped. As a rule, these are private clinics. In major cities state institutions may also have expensive equipment, but this is rare.

How to prepare

For a planned invasion or diagnosis, the attending physician prescribes a series of tests. A preliminary examination is carried out no earlier than 14 days before the scheduled procedure. Among such studies, the patient must pass:

blood and urine tests;
cardiogram;
fluorography;
blood test for clotting.

For a week before the planned operation, you need to give up products that provoke gas formation: cabbage, carbonated drinks, dairy products, cereals (except). The doctor may prescribe enzyme preparations to prepare the abdominal organs. For a few days it is forbidden to take drugs that reduce blood clotting (Aspirin, Coumadin, Warfarin, Heparin). All medications taken should be reported to the doctor.

12 hours before the invasion, you can not drink and eat, with a strong thirst, you can slightly moisten your lips and mouth with warm water. In the evening and in the morning, a cleansing enema is done, it can be replaced with medicines to cleanse the intestines. Before the operation, you need to take a shower with antibacterial soap, remove hair from the abdomen. Also, lenses, all jewelry, and dentures are removed before the operating table.

How is the procedure

Regardless of the reason for laparoscopic intervention (treatment or examination), such an operation always looks the same. The difference is only the processes inside the abdominal cavity, which are carried out by the surgeon. First, the patient is injected with drugs that enhance the effect of the painkiller. In the operating room, the anesthesiologist puts anesthesia, throughout the procedure, the specialist will monitor the patient's pulse, pressure, and the amount of oxygen in the blood. All data is output to a computer.

The surgeon applies an antiseptic and makes 2-3 incisions: one under the navel for the laparoscope, others on the sides for manipulators. Instruments are inserted into these holes, and nitrous oxide (N2O) or warm humidified carbon dioxide (CO2) is injected into the abdominal cavity. The wall of the abdomen rises and gives easy access to the internal organs. This part of the procedure is absolutely safe, gases do not irritate blood vessels and tissues, and are not toxic. Moreover, CO2 has a beneficial effect on the respiratory system, and N2O has an additional analgesic effect.

The image from the laparoscope is transmitted to monitors, the surgeon can examine all organs in detail, detect problem areas. With the help of tools, he performs an operation: removes tumors, cysts, organs or their affected parts. After surgical procedures, the doctor once again examines the area of work. Then the manipulators are removed, stitches and a bandage are applied to the holes. The patient is taken to the recovery room. If diagnostics were carried out, a person can be discharged after 3-4 hours, after operations, observation in the hospital is necessary for another 2-3 days.

Possible Complications

The technique of laparoscopy is extremely complex, and it requires an experienced specialist with well-developed skills. Adverse consequences may be due to improper insertion of trocars. In this case, there may be injuries to internal organs such as the intestines, bladder, ureters, blood vessels. Most of these complications are resolved immediately during surgery, the affected organs are sutured. If the wound of the organs cannot be eliminated by laparoscopy, the doctor is forced to perform a laparotomy - an opening of the anterior wall of the abdomen.

Improper preparation of the patient increases the risk of negative consequences. Thus, a full bladder is very often damaged by the introduction of instruments. At the same time, in addition to the main operation, the patient is urgently put two rows of stitches on the affected organ. If the patient took medication before the procedure and did not warn the doctor about it, the composition of these drugs may unpredictably affect anesthesia. In some cases, the invasion has to be urgently completed. However, such consequences occur with any surgical intervention.

With laparoscopy, the risk of infection, divergence of sutures, and the formation of adhesions is significantly lower.

In the first few hours after the invasion, rest is recommended. The duration of bed rest depends on the degree of complexity of the operation, the presence of complications, the patient's condition. The attending physician will set the time of the rehabilitation period and the date of discharge, and will give recommendations. At home, it is important to fully comply with the doctor's advice. The recommendations may include nutritional rules, if laparoscopy was performed on the gastrointestinal tract, in which case one of the Pevzner diets will have to be followed for 2 weeks. Within a month after the invasion, regardless of its type and purpose, alcohol, too fatty and spicy foods, spicy, canned, are excluded.

Personal hygiene is very important. You can bathe in the shower, take a bath only after 14 days. After each exercise, antiseptic treatment of sutures and dressing or bandage is needed. For the treatment of wounds, it is allowed to use:

hydrogen peroxide 3%;
fucorcin;
alcohol solution of brilliant green.

The stitches are removed on the day set by the doctor, usually after 7-14 days. This should only be done by a paramedic in the dressing room. In the first month after the procedure, you need to limit physical exercise, exclude sports, lifting weights. Slow walks are allowed. You also need to refrain from sex in the first 14-30 days, depending on the disease. After examination by the doctor and with his permission, it will be possible to return to the usual way of life.

If during the rehabilitation period there are frequent pains in the abdomen, consciousness is confused, vomiting occurs, the stool is broken - this should be reported to the doctor. It is also important to monitor the condition of the seams, they should not have swelling, redness, itching, or any discharge.

Additional questions

Swollen belly after laparoscopy. What to do

During the operation, gas is injected into the peritoneal area for precise manipulations. After the invasion, it is pumped out, but there is a chance that some will remain inside. This is not scary, it can be absorbed by tissues, excreted from the body. As a rule, such a symptom disappears on its own after a few days and does not require intervention. To facilitate well-being, the doctor can prescribe sorbents, enzymatic preparations. The main thing is to avoid self-medication.

Delayed menstruation after the procedure

In women, the cycle may shift after such manipulations. Menstruation is delayed up to several weeks. If it does not occur in a month, you need a consultation or a doctor in charge.

Bleeding in women after laparoscopy

If a woman has bloody issues from the vagina, this is an occasion to urgently call an ambulance. While help is coming, you need to apply a cold compress to the lower abdomen and observe bed rest.

When can you get pregnant after surgery

You can plan conception only after the course of medication is over. If surgery took place on the uterus, for example, with fibroids, you will have to wait at least six months with pregnancy. Manipulations on other organs require a time of 1.5-2 months. In any case, examination and permission of doctors will be required. Untimely pregnancy can lead to divergence of internal and external seams, ectopic pregnancy, loss of the child.

Content

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

What is laparoscopy in gynecology

The method that causes the least amount of trauma, damage during diagnosis or operation, with the smallest number of invasive penetrations - this is what laparoscopy of the uterus and ovaries in gynecology is. To get to the female genital organs without making an extensive incision, three or four punctures are made in the abdominal wall, after which special instruments called laparoscopes are inserted into them. These instruments are equipped with sensors and illumination, and the gynecologist "with his own eyes" evaluates the process taking place inside, along with the diagnosis of genital female organs.

Indications

Laparoscopy is widely used, since it is considered in gynecology to be the most convenient way of simultaneous diagnosis and surgical intervention for the treatment of pathological processes of unclear etiology. Gynecologists assess "live" the condition of the female genital organs, if other research methods have not been effective for an accurate diagnosis. Laparoscopy is used for such gynecological pathologies:

if a woman has infertility, the exact cause of which gynecologists cannot identify;
when gynecological therapy with hormonal drugs was ineffective for conceiving a child;
if you need to perform operations on the ovaries;
with endometriosis of the cervix, adhesions;
with constant pain in the lower abdomen;
with suspicion of myoma or fibroma;
for tying the tubes of the uterus;
with ectopic pregnancy, tubal rupture, breakthrough bleeding and other dangerous pathological processes in gynecology, when an emergency intracavitary gynecological operation is necessary;
when twisting the legs of an ovarian cyst;
with severe dysmenorrhea;
with infections of the genital organs, accompanied by the release of pus.

On what day of the cycle do

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

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

Training

In gynecology, laparoscopy can be scheduled or performed urgently. In the latter case, there will be practically no preparation, because gynecologists will strive to save the patient's life, and this situation does not imply a long collection of tests. Immediately before the operation, the patient is taken blood and urine, if possible, and post-factum studies are carried out, after laparoscopy. When carrying out laparoscopy in a planned manner, preparation includes collecting data on the current state of the patient and restricting the diet.

Analyzes

Patients are surprised at the extensive list of necessary tests before laparoscopy, however, before any abdominal gynecological surgery, the following studies must be done:

pass the KLA, as well as conduct blood tests for sexually transmitted diseases, syphilis, AIDS, hepatitis, ALT, AST, the presence of bilirubin, glucose, assess the degree of blood clotting, establish the blood type and Rh factor;
pass OAM;
make a general smear from the walls of the cervix;
conduct an ultrasound of the pelvic organs, make a fluorogram;
provide the gynecologist with an extract on the presence of chronic ailments, if any, notify about the constantly taken medications;
make a cardiogram.

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

Diet before laparoscopy in gynecology

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

7 days before laparoscopy, you should refrain from any products that stimulate gas formation in the stomach and intestines - legumes, milk, certain vegetables and fruits. Reception of low-fat meat, boiled eggs, porridge, sour-milk products is shown.
For 5 days, the gynecologist prescribes the intake of enzymatic agents, activated carbon to normalize digestion.
On the eve of the procedure, you can only eat pureed soups or liquid cereals, you can’t have dinner. It is necessary to do a cleansing enema in the evening, if the gynecologist has prescribed it.
Immediately before laparoscopy, you can not eat or drink anything so that the bladder is empty

Does it hurt to do

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

How do they do

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

Recovery after laparoscopy

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

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

Food

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

sexual rest

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

Contraindications

Laparoscopy has few contraindications. These include:

intensive process of dying of the body - agony, coma, state clinical death;
peritonitis and other serious inflammatory processes in the body;
sudden cardiac arrest or respiratory failure;
severe obesity;
hernia;
the last trimester of pregnancy with a threat to the mother and fetus;
hemolytic chronic diseases;
exacerbation of chronic diseases of the gastrointestinal tract;
the course of SARS and colds. You will have to wait for a full recovery.

Effects

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

Complications

As with any penetration into the abdominal cavity, there are complications with laparoscopy. For example, after punctures, when a laparoscope is inserted, blood vessels may burst and a small hemorrhage may begin, and carbon dioxide in the abdominal cavity may enter the tissues and contribute to subcutaneous emphysema. If the vessels are not sufficiently clamped, then blood can enter the abdominal cavity. However, the professionalism of the gynecologist and a thorough revision of the abdominal cavity after the procedure will reduce the likelihood of such complications to zero.

Price

Since laparoscopy is an intervention under general anesthesia, the cost of this gynecological procedure is high. The breakdown of prices in Moscow is shown in the following table:

Video

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

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Discuss

What gynecological diseases are treated with laparoscopy - preparation, operation and recovery

Laparoscopy in gynecology is a minimally invasive, without a layer-by-layer incision of the anterior abdominal wall, an operation performed using special optical equipment for examining the uterus and ovaries. Such diagnostics are carried out for the purpose of visual analysis of the state of the reproductive organs and targeted treatment of pathologies.

Laparoscopy in gynecology is a method that causes the least amount of trauma, damage during diagnosis or surgery, with the smallest number of internal penetrations.

In one laparoscopic session, the doctor:

performs diagnostics of gynecological diseases;
clarifies the diagnosis;
provides the necessary treatment.

The study allows the doctor to examine in detail the internal reproductive organs through a mini camera. In order to perform medical manipulations in a timely manner, special instruments are introduced into the abdominal cavity along with the camera.

In what cases is it carried out and for what?

Laparoscopy in gynecology is used to diagnose and solve problems in the field of female diseases.

This low-traumatic method allows surgeons to:

remove affected areas, adhesions or organs;
perform a tissue biopsy;
perform ligation, resection or plastic tubing;
put stitches on the uterus, etc.

Indications for carrying out

The operation finds its application in the following indications:

severe pain of unclear etiology in the lower abdomen;
suspected ectopic pregnancy;
inefficiency hormone therapy with infertility;
myomatous lesion of the uterus;
clarification of the causes of infertility;
surgical treatment of endometriosis, fibroids, etc.;
preparation for IVF;
biopsy of affected tissue.

Contraindications for laparoscopy

Before the operation, the gynecologist should carefully examine the patient's medical record, as there are a number of contraindications to laparoscopy of the uterus (including the cervix) and appendages.

Absolute contraindications

It is forbidden to do laparoscopy for patients with such a pathology as:

acute infections of the reproductive organs;
diseases of the heart, blood vessels, lungs (severe forms);
blood clotting disorder;
acute disorders of the liver or kidneys;
significant depletion of the body;
bronchial asthma;
hypertension;
hernia of the white line of the abdomen and anterior abdominal wall;
coma;
shock state.

Patients who have had ARVI are allowed a month after recovery.

Relative contraindications

The attending physician analyzes the risks and decides whether it is advisable to perform laparoscopy in patients with these diagnoses:

abdominal operations in a six-month history;
extreme obesity;
pregnancy for a period of 16 weeks;
tumors of the uterus and appendages;
a large number of adhesions in the pelvis.

Operation types

There are two types of laparoscopy in gynecology: planned and emergency. Planned is carried out both for the purpose of research and for the treatment of pathologies. Diagnostic surgery often turns into a therapeutic one. An emergency operation is performed if there is a threat to the patient's life for an unexplained reason.

Planned diagnostic laparoscopy is performed for the following purposes:

clarification of such diagnoses as "obstruction of the fallopian tubes", "endometriosis", "adhesive disease" and other causes of infertility;
determination of the presence of tumor-like neoplasms in the small pelvis to determine the stage and the possibility of treatment;
collection of information about anomalies in the structure of the reproductive organs;
finding out the causes of chronic pelvic pain;
biopsy for polycystic ovary syndrome;
tracking the effectiveness of treatment of inflammatory processes;
control over the integrity of the uterine wall during resectoscopy.

Planned therapeutic laparoscopy is carried out for:

surgery of the pelvic organs in the presence of endometriosis, cysts, tumors, sclerocystosis, fibroids;
performing temporary or complete sterilization (tubal ligation);
treatment of uterine cancer;
removal of adhesions in the pelvis;
resection of the reproductive organs.

Emergency therapeutic laparoscopy is performed when:

interrupted or progressing tubal pregnancy;
apoplexy or rupture of an ovarian cyst;
necrosis of the myomatous node;
acute pain syndrome in the lower abdomen of unclear etiology.

Laparoscopy and the menstrual cycle

The menstrual cycle after laparoscopy has a number of features:

The regularity of menstruation after laparoscopy is restored within two to three cycles. Under the condition of successful treatment of endometriosis, uterine fibroids and polycystic ovaries, the disturbed menstrual cycle is leveled and, as a result, the reproductive function is restored.
Normally, menstrual flow should first appear in the next day or two after surgery and last about four days. This is due to a violation of the integrity of the internal organs and is the norm, even if the discharge is quite a lot.
The next cycle may shift, the discharge may become unusually scarce or plentiful for a while.
A delay of up to three weeks is considered acceptable, more than a probable pathology.
If menstruation is accompanied severe pain urgent consultation with a gynecologist is necessary to prevent postoperative complications. Also alert should be brown or green color discharge and an unpleasant odor are signs of inflammation.

How to prepare for surgery

Preparing for gynecological laparoscopy includes several stages. First, a consultation with a therapist is required in order to identify contraindications.

Then research is carried out:

blood (general analysis, coagulogram, biochemistry, HIV, syphilis, hepatitis, Rh factor and blood group);
urine (general);
pelvic organs through ultrasound, taking a smear for flora and cytology;
cardiovascular system (ECG);
respiratory system (fluorography).

Here is how to prepare the patient before the operation:

eat at least 8-10 hours before;
no later than 3 hours, it is allowed to drink a glass of non-carbonated water;
exclude nuts, seeds, legumes from the diet for 2 days;
cleanse the intestines in the evening and in the morning with laxatives or enemas.

In emergency laparoscopy, preparation is limited to:

examination by a surgeon and an anesthesiologist;
urine (general) and blood tests (general, coagulogram, blood type, Rh, HIV, hepatitis, syphilis);
refusal of food and liquid intake for 2 hours;
bowel cleansing.

A planned operation is prescribed after the 7th day of the menstrual cycle, since in the first days there is increased bleeding of the tissues of the reproductive organs. Urgent laparoscopy is performed on any day of the cycle.

Ter-Ovakimyan A. E., Doctor of Medical Sciences, tells in detail about why laparoscopy is done and how to prepare for the procedure on the MedPort. ru".

Execution principle

The execution principle is as follows:

The patient is given anesthesia.
An incision (0.5 - 1 cm) is made in the navel, into which the needle is inserted.
Through the needle, the abdominal cavity is filled with gas, so that the doctor can freely manipulate surgical instruments.
After removing the needle, a laparoscope penetrates into the hole - a mini camera with illumination.
The rest of the instruments are inserted through two more incisions.
The enlarged image from the camera is transferred to the screen.
Diagnostic and surgical manipulations are carried out.
Gas is expelled from the cavity.
Installed drainage tube, through which there is an outflow of postoperative fluid residues from the abdominal cavity, including blood and pus.

Drainage is a mandatory prevention of peritonitis - inflammation of the internal organs after surgery. The drainage is removed within 1-2 days after the operation.

Photo gallery

Photos give an idea of how the operation is carried out.

Entering tools The principle of laparoscopy laparoscopic procedures. Inside view Incisions in the healing stage

Features of transvaginal laparoscopy

Features of transvaginal laparoscopy are that this method more gentle, but it is used only for diagnosing pathologies. Treatment of identified diseases is possible through traditional laparoscopy.

Transvaginal surgery is carried out in several stages:

Anesthesia (local or general) is administered.
The posterior wall of the vagina is punctured.
Through the opening, the pelvic cavity is filled with a sterile liquid.
A backlit camera is placed.
The reproductive organs are being examined.

Hydrolaparoscopy is most often prescribed for patients with infertility of unknown origin.

Postoperative period

After the operation, there are:

pain in the abdomen and lower back (disturb from several hours to several days, depending on the type of operation and the amount of surgical intervention);
discomfort when swallowing;
nausea, heartburn, vomiting;
temperature rise to 37.5°C.

walk 5-7 hours after surgery to restore blood circulation and activate bowel function;
drink water in small sips after at least two hours;
eat food the next day, giving preference to easily digestible foods;
within a week, observe restrictions on fatty, spicy, fried foods;
avoid sunlight for up to three weeks;
2-3 months do not lift heavy objects and limit yourself to charging instead of active sports;
maintain sexual rest for 2-3 weeks;
baths and saunas to be replaced with showers for a period of 2 months;
give up alcohol.

Possible Complications

Laparoscopy in gynecology is associated with some risks and complications.

Possible, but rare:

massive bleeding as a result of injury to the vessel;
gas embolism;
violation of the integrity of the intestinal wall;
pneumothorax;
emphysema - the ingress of gas into the subcutaneous tissue.

Complications arise when the first instrument is inserted (without camera control) and the abdominal cavity is filled with gas.

Postoperative consequences:

suppuration of the sutures due to a decrease in immunity or improper asepsis;
the formation of an adhesive process in the pelvis, which can cause infertility and intestinal obstruction;
the appearance of postoperative hernias.
development of peritonitis.

Complications during surgery and its consequences are rare. Their appearance depends on the quality of the preoperative examination of the patient and the qualifications of the surgeon.

The video was prepared by the MedPort. ru".

Recovery after surgery

After laparoscopic surgery, the patient expects a long recovery, while:

discharge from the hospital occurs 3-5 days after the operation, if there are no complications;
full rehabilitation after diagnosis takes about a month, after treatment - no more than four months, subject to the doctor's recommendations;
conception can be planned 1-2 months after the diagnostic operation and 3-4 months after the surgical one;
scars heal completely after 3 months.

Diagnostic Benefits

The procedure has the following advantages:

less traumatic - instead of a cavity incision, three small punctures are performed;
fast holding - about 30 minutes;
full preservation of fertility;
inconspicuous postoperative scars instead of a long scar.

What is the price?

Prices for laparoscopy vary depending on its type, volume of treatment and region:

Video

The video illustrates the procedure of laparoscopy in the treatment of infertility. Represents the "Drkorennaya" channel.