Laparoscopy - Causes, symptoms and treatment. MF.
Laparoscopy ( from Greek λαπάρα - groin, womb and Greek σκοπέο - see) - a modern method of surgery in which operations on internal organs are carried out through small( usually 0.5-1.5 centimeters) apertures, whileIn traditional surgery, large incisions are required. Laparoscopy is usually performed on the organs of the abdominal or pelvic cavities.
The main instrument in laparoscopic surgery is a laparoscope: a telescopic tube containing a lens system and usually attached to the camera. The tube is also connected to an optical cable illuminated by a "cold" light source( halogen or xenon lamp).The abdominal cavity is usually filled with carbon dioxide to create an operative space. In fact, the belly is inflated like a balloon, the wall of the abdominal cavity rises above the internal organs like a dome.
Laparoscopy
Laparoscopy is usually performed under general anesthesia. To purge potential space in the abdominal cavity and displacement of the intestine, a harmless gas is used. Then the endoscope is inserted through a small incision and various instruments are inserted through it.
• The tissues can be sprayed with a laser or cut without bleeding with the help of a wire mesh cuffing prowess.
• Sections of the damaged tissue can be destroyed by means of a cauterization device in the form of a wire loop or laser.
• From any organ, you can take tissue on a biopsy using biopsy forceps that pinch off a tiny piece of organ tissue.
It may seem to the patient that the gas pressure causes discomfort for 1-2 days, but the gas will soon be absorbed by the body.
With vidiolaparoscopy, a video camera is attached to the laparoscope, and the interior of the abdominal cavity is displayed on a video monitor. This allows the surgeon to perform the operation, looking at the screen, - a much more comfortable way than to look through a small eyepiece for a long time. This method also allows you to record on video. General indications for the use of laparoscopy.
With the planned treatment of
1. Infertility.
2. Suspicion for the presence of a tumor of the uterus or uterine appendages.
3. Chronic pelvic pain in the absence of the effect of treatment.
Laparoscopy in extreme situations
1. Suspicion of tubal pregnancy.
2. Suspicion of ovarian apoplexy.
3. Suspicion of perforation of the uterus.
4. Suspicion of the torsion of the ovarian tumor.
5. Suspicion of rupture of ovarian or pioalpinx cyst.
6. Acute inflammation of the uterine appendages in the absence of the effect of complex conservative therapy for 12-48 hours.
7. Loss of the IUD.
Contraindications for diagnostic and therapeutic laparoscopy.
Laparoscopy is contraindicated in diseases that can aggravate the general condition of a patient at any stage of the study and be life-threatening:
- diseases of the cardiovascular and respiratory systems in the stage of decompensation;
- hemophilia and severe hemorrhagic diathesis;
- acute and chronic hepatic-renal failure.
These contraindications are common contraindications for carrying out laparoscopy.
In the clinic of female infertility, patients who could meet such contraindications, as a rule, do not occur, since patients suffering from severe chronic extragenital diseases are advised not to continue examination and treatment of infertility already at the first, out-patient stage.
In connection with specific problems solved by endoscopy, contraindications to laparoscopy are:
1. Inadequate examination and treatment of a married couple by the time of the supposed endoscopic examination( see indications for laparoscopy).
2. Acute and chronic infectious and catarrhal diseases present or transferred less than 6 weeks ago.
3. Subacute or chronic inflammation of the uterine appendages( a contraindication for the operative stage of laparoscopy).
4. Deviations in the indicators of clinical, biochemical and special research methods( clinical analysis of blood, urine, biochemical blood test, hemostasiogram, ECG).
5. III-IV degree of purity of the vagina.
6. Obesity.
Pros and cons of laparoscopy
In modern gynecology, laparoscopy is perhaps the most advanced method of diagnosis and treatment of a number of diseases. Among its positive aspects is the absence of postoperative scars and postoperative pain, which is largely due to the small size of the incision. Also, the patient usually does not need to comply with strict bed rest, and the normal state of health and working capacity is restored very quickly. The hospitalization period after laparoscopy does not exceed 2 to 3 days.
During this operation, there is very little blood loss, extremely traumatized body tissues. In this case, the tissues do not contact the surgeon's gloves, gauze napkins and other means that are unavoidable in a number of other operations. As a result, the possibility of forming a so-called adhesive process, which can cause various complications, is reduced as much as possible. In addition, the undoubted advantage of laparoscopy is the ability to simultaneously diagnose and eliminate certain pathologies. In this case, as mentioned above, organs such as the uterus, fallopian tubes, and ovaries, despite the surgical intervention, remain in their normal state and function in the same way as before the operation.
Laparoscopy minuses, as a rule, boil down to the use of general anesthesia, which is inevitable in any surgical operation. The effect of anesthesia on the body is largely individual, but it should be remembered that various contraindications to it are elucidated in the process of preoperative preparation. Based on this, the expert concludes how safe general anesthesia is for the patient. In those cases when there are no other contraindications to laparoscopy, the operation can be performed under local anesthesia.
What tests should I take before laparoscopy?
The doctor may not accept you for laparoscopy without the results of the following tests:
- clinical blood test;
- biochemical blood test;
- coagulogram( blood coagulability);
- blood type + Rh factor;
- analysis for HIV, syphilis, hepatitis B and C;
- general urinalysis;
- general smear;
- electrocardiogram.
In the pathology of the cardiovascular, respiratory system, gastrointestinal tract, endocrine disorders, it is necessary to consult other specialists to develop the tactics of patient management during the pre and postoperative periods, and also to assess the presence of contraindications for laparoscopy.
Remember that all tests are valid for no more than 2 weeks! In some clinics, it is accepted that the patient undergoes a survey where she will be operated, since the standards for different laboratories are different and it is more convenient for the doctor to navigate the results of his laboratory.
What day of the cycle should I do laparoscopy?
As a rule, laparoscopy can be performed on any day of the cycle, only not during menstruation. This is due to the increased bleeding during menstruation and the risk of increased blood loss during surgery.
Is obesity and diabetes mellitus contraindicated to laparoscopy?
Obesity is a relative contraindication to laparoscopy.
With sufficient skill of the surgeon for obesity of 2-3 degrees, laparoscopy may well be technically feasible.
In patients with diabetes, laparoscopy is the operation of choice, the healing of the cutaneous wound in diabetic patients is much longer, and the probability of purulent complications is significantly higher. With laparoscopy, however, trauma is minimal and the wound is much less than in other operations.
How to anesthetize with laparoscopy?
Laparoscopy is performed under general anesthesia, the patient is asleep, does not feel anything. With laparoscopy, only endotracheal anesthesia is used: during surgery, the lungs of the patient breathe through the special breathing apparatus.
The use of other types of anesthesia with laparoscopy is impossible, because during the operation a gas is injected into the abdominal cavity, which "presses" on the diaphragm from below, which leads to the fact that the lungs can not breathe independently. As soon as the operation ends, the tube is removed, the patient is "awakened" by the anesthesiologist, the anesthesia is finished.
How long does laparoscopy last?
This depends on the pathology, because of which the operation and qualifications of the doctor are performed. If this separation of adhesions or coagulation of foci of endometriosis is of an average degree of complexity, then laparoscopy lasts an average of 40 minutes.
If the patient has multiple uterine fibroids, and all myomatous nodes need to be removed, the duration of the operation may be 1.5-2 hours.
When can I get out of bed and eat after laparoscopy?
As a rule, after laparoscopy, you can get up already in the evening on the day of the operation.
The next day, an active lifestyle is recommended: the patient should move and eat in order to recover faster. Discofort after surgery is mainly due to the fact that a small amount of gas remains in the abdominal cavity and then gradually absorbed. The gas that remains can cause pain in the muscles of the neck, the press, the legs. To accelerate the absorption process, movement and normal bowel movement are necessary.
When are sutures removed after laparoscopy?
Sutures are removed on the 7-9th day after the operation.
When can I start sex after laparoscopy?
Sexual life is resolved one month after laparoscopy. Physical stress should be limited in the first 2-3 weeks after surgery.
When can I start trying to get pregnant after laparoscopy? How quickly you can start trying to get pregnant after laparoscopy:
If laparoscopy is done about the adhesion process in the small pelvis, which was the cause of infertility, then you can start trying to become pregnant within a month after the first menstruation.
If laparoscopy is performed about endometriosis, and in the postoperative period, additional treatment is required, then it is necessary to wait until the end of treatment and only then plan the pregnancy.
After a conservative myomectomy, pregnancy is prohibited for 6-8 months, depending on the size of the myomatous node, which was removed during laparoscopy. For this period of time, the use of contraceptive medications will not be a problem, since pregnancy during this period is very dangerous and threatens to rupture the uterus. Such patients are recommended strict protection from pregnancy after laparoscopy.
When can I go to work after laparoscopy?
According to the standards, a sick leave sheet is given on average 7 days after laparoscopy. As a rule, by this time the patients can already work peacefully, if their work is not connected with heavy physical labor. After a simple operation, the patient is ready to work after 3-4 days.