Diagnostic laparoscopy. Diagnostic laparoscopy Diagnostic laparoscopy indications

Today, approximately ten percent of all women of reproductive age face the problem infertility.

Note: Infertility is called the condition, which is caused by the inability to conceive a child within one year with the existing regular sexual life.


There are the following types of infertility:

• primary infertility- this infertility can only be in those women who have never been pregnant before;
• secondary infertility- this type of infertility can be observed only in those women who have previously had a pregnancy.

Uterine pathologies can be:

• congenital (e.g. bicornuate uterus, intrauterine septum, duplication of the uterus);
• acquired (e.g. postoperative scarring, endometrial hyperplasia, uterine fibroids).

What is laparoscopy?

Laparoscopy is a therapeutic and diagnostic operation in which the surgeon makes three punctures in the anterior abdominal wall of the abdomen ( about five millimeters) for introducing special instruments and a video camera inside.

Laparoscopy has the following advantages:

• The operation is painless, as during the surgery the patient arrives under general anesthesia.
• Has a short postoperative period. Often, patients are discharged the day after surgery.
• The physiological functions of the body are restored in a short period of time ( usually up to two days).
• It has a good cosmetic effect. Compared to other types of surgery, laparoscopy leaves behind only three barely visible traces of holes.
• Significantly reduces the risk of postoperative hernia.
• During the operation, minimal blood loss is observed.
• Allows you to save organs in various pathological conditions ( for example, the uterus in the presence of myomatous nodes).

Anatomy of the uterus

The uterus is divided into the following parts:

• body of uterus
• isthmus of the uterus;
• Cervix.

In the body of the uterus, the following components are distinguished:

• The bottom of the uterus. It is located above the fallopian tubes and is a convex part of the body of the uterus.
• The cavity of the uterus. It has a triangular shape, wider at the top and gradually tapering at the bottom. It is in the uterine cavity that the implantation and maturation of a fertilized egg takes place. In the upper two corners, the uterine cavity communicates with the fallopian tubes, which go to the sides. In the lower corner, it passes into the isthmus ( narrowing that leads into the cavity of the cervical canal).

The walls of the uterus consist of the following layers:

• endometrium ( mucous membrane);
• myometrium ( muscular coat);
• perimetry ( serosa).

The mucous membrane of the uterus tends to exfoliate physiologically. This process occurs monthly and is called menstruation. Due to the fact that the uterus has a good blood supply, menstruation is characterized by the release of blood. A significant delay in menstruation indicates a possible pregnancy or any pathological disorders.

Laparoscope and preparation for laparoscopy

There are the following types of laparoscopy:

• diagnostic laparoscopy;
• operative laparoscopy;
• control laparoscopy.

Laparoscopy is the latest and high-tech method of surgical intervention. To perform this kind of operations, surgeons must be additionally trained.

Laparoscopy uses:

• laparoscopic instruments;
• endoscopic equipment.

• stylets for tissue dissection;
• trocars - special tubes that can maintain tightness during surgery;
• Veress needle - gives carbon dioxide into the abdominal cavity;
• scissors - for cutting tissues;
• electrodes - for coagulation ( moxibustion) tissues;
• clamps - for clamping blood vessels;
• retractors - for dilution of tissues;
• clip-on tool;
• clips - to stop bleeding;
• needle holder - guides the needle through the tissue when suturing;
• needles - for connecting fabrics.

A set of endoscopic equipment includes:

• endovideo camera;
• Light source;
• monitor;
• aspirator-irrigator - delivers physiological saline into the abdominal cavity for the purpose of washing;
• insufflator - automatically supplies carbon dioxide.

During laparoscopy, the abdominal cavity is inflated with carbon dioxide for the duration of the operation.

Gas is injected into the abdominal cavity for the following purposes:

• increase the abdominal space;
• improve visualization of organs;
• enable more free manipulation of tools.

• First cut is made in the navel, where a Veress needle is subsequently inserted, through which gas can be injected into the abdominal cavity.
• Second cut is made with a diameter of ten millimeters for the introduction of a trocar with a video camera.
• Third and, if necessary, fourth incisions five millimeters in diameter are made in the suprapubic region and are necessary for the introduction of instruments such as a laser ( for electrocoagulation), scissors, clamps, tongs and others. The diameter of the introduced instruments does not exceed five millimeters.

Diagnostic and operative laparoscopy can be performed at any period of the menstrual cycle, with the exception of the period of menstruation itself.

Recently, in medicine, there has been an introduction to the use of the most progressive robot in the world today, the Da Vinci. This system contains a control unit, a unit consisting of three robotic arms, and another arm with a camera, which are controlled by the surgeon. Mechanical arms are inserted into the patient's body using standard laparoscopic techniques. During the operation, the surgeon is located at the control unit, controlling the robot and observing what is happening in the abdominal cavity in a three-dimensional HD quality image ( high image quality).

The Da Vinci robotic system has several advantages:

• the surgeon is provided with a comfortable working environment;
• the three-dimensional image allows you to see a high-quality picture of the surgical site;
• the robot's cameras show the image at 10x magnification;
• the robot arms have seven degrees of freedom robotic wrist movements that accurately mimic human wrist movements and also suppress hand tremors;
• During the operation, only minor blood loss is observed.

Preparing the patient for laparoscopy

• prehospital training;
• preoperative examination;
• preoperative preparation;
• preparation for the operation.

After the patient has received all the answers to her questions, she needs ( in case of consent) sign a voluntary consent to this surgical intervention. The proposed written form also contains information that the patient was explained the full meaning of the surgical intervention, and also provided information about other methods of treatment in parallel.

During pre-hospital preparation, the doctor psychologically sets up the patient in such a way that she develops a calm, balanced attitude towards the upcoming operation.

Preoperative examination
At this stage, certain analyzes are taken, as well as additional studies are carried out. Preoperative examinations make it possible to identify possible disorders on the part of other organs and systems, which, for one reason or another, may be a contraindication to laparoscopy.

The obtained results of the conducted studies allow us to develop tactics for managing the patient in her subsequent preparation for surgery.

Before laparoscopy, a woman will need to undergo the following laboratory and instrumental studies:

• blood for determining the blood type and Rh factor;
• blood test for HIV AIDS virus), syphilis, viral hepatitis B, C;
• coagulogram ( for blood coagulation testing);
• urogenital smear ( to determine the microflora of the urethra, vagina and cervix);
• ECG ( electrocardiogram).

Preoperative preparation
At this stage, it is necessary to prepare your body as much as possible for the upcoming laparoscopy.

• Before laparoscopy, it is recommended to perform simple gymnastic exercises.
• Activated charcoal is recommended five days before laparoscopy to reduce bloating ( two tablets orally three times a day).
• On the eve of the operation, a woman needs to take a bath, as well as remove pubic and abdominal hair ( navel and lower abdomen).
• Psycho-emotional preparation is recommended, in which herbal sedatives are taken a few days before the operation ( sedatives) drugs ( e.g. motherwort, valerian).
• The patient needs to follow a certain diet. Three to four days before the operation, gas-producing foods, as well as carbonated drinks, should be excluded from the diet. The day before laparoscopy, the last meal should take place no later than seven o'clock in the evening.

• legumes ( e.g. peas, beans);
• cabbage;
• eggs;
• plums;
• apples;
• fatty meats;
• fresh milk;
• black bread;
• potato.

• lean meats ( e.g. chicken);
• fish;
• cottage cheese;
• kefir;
• cereals;
• broths.

• Before laparoscopy, bowel cleansing is performed. To do this, before going to bed on the eve of the operation, a woman is given an enema. An additional cleansing enema is given on the morning of the operation.
• For ease of administration of medications during surgery, a venous catheter is installed for the patient.
• Immediately before transport to the operating room, the patient should go to the toilet and empty the bladder.
• To prepare the body for surgery and general anesthesia, premedication is usually necessary. Its implementation will depend on the general condition of the woman, the presence of concomitant diseases, as well as the choice of type of anesthesia.

Premedication is carried out:

• to reduce the level of anxiety and excitement before surgery;
• to reduce the secretion of glands;
• to increase the effect of anesthetic drugs.

• Sedative drugs. This group of drugs has a sedative effect, reduces activity and emotional stress ( e.g. valerian, validol, valocordin).
• Sleeping drugs. These drugs are used for the purpose of obtaining a hypnotic effect ( e.g. seduxen, midazolam, diazepam).
• Antihistamines ( antiallergic) drugs. These drugs block the activity of histamine receptors, as a result of which allergic reactions are reduced ( e.g. tavegil, suprastin).
• Analgesics ( painkillers). This group of drugs is designed to reduce pain ( e.g. baralgin, analgin, paracetamol).
• Anticholinergic drugs. The action of these drugs is that they block the transmission of nerve impulses in various parts of the nervous system ( e.g. atropine, platifillin, metacin).

Research methodology

Indications for diagnostic laparoscopy of the uterus in infertility

• adenomyosis of the uterus;
• uterine fibroids;
• anomalies in the development of the uterus.

Contraindications to diagnostic laparoscopy of the uterus in infertility

There are the following absolute contraindications:

• severe cardiovascular disease ( e.g. acute myocardial infarction);
• poor blood clotting;
• acute period of liver failure or renal failure;
• shock states ( hemorrhagic shock);
• state of coma;
• cachexia ( pronounced depletion of the body);
• hernia of the white line of the abdomen, as well as with diaphragmatic hernia;
• ovarian cancer or cervical cancer.

• acute respiratory viral infections ( influenza, parainfluenza, adenovirus infection), colds, herpetic eruptions;
• arterial hypertension ( high blood pressure);
• period of menstruation;
• obesity ( third or fourth degree).

Choosing the type of anesthesia

Also, before the anesthesiologist determines the optimal method and type of anesthesia used, the patient will need to undergo certain examinations. This is required for the timely detection and subsequent treatment of concomitant diseases of vital organs and systems.

In most cases, laparoscopy uses general anesthesia, which is carried out in two ways:

• intravenous anesthesia;
• inhalation anesthesia.

Intravenous anesthesia
This type of anesthesia is carried out by intravenous administration of narcotic drugs ( e.g. hexenal, sodium thiopental, fentanyl) bypassing the respiratory tract.

The advantages of this type of anesthesia are the following indicators:

• ease of use;
• the speed of onset of the narcotic effect after the administration of the drug.

Inhalation anesthesia can be carried out in the following ways:

• endotracheal method;
• mask method.

There are the following advantages of endotracheal anesthesia:

• the possibility of using artificial ventilation of the lungs;
• significant reduction in the risk of aspiration ( entry of stomach contents into the respiratory tract);
• accurate control of the incoming dose of the narcotic substance;
• ensuring free patency of the upper respiratory tract.

Mask method
The mask method for inhalation anesthesia is used less frequently and in the following cases:

• with simple and short operations;
• if the patient has anatomical features or diseases of the pharynx, larynx, and trachea, which do not allow endotracheal anesthesia;
• during operations that do not require muscle relaxation ( decreased muscle tone), as well as artificial lung ventilation.

Rehabilitation after diagnosis

In connection with anesthesia, a woman may experience the following symptoms:

• sore throat ( due to insertion of an endotracheal tube);
• weakness, drowsiness;
• hallucinations, delusions.

However, it should be noted that since during laparoscopy the abdominal cavity is filled with gas, after the procedure is completed, a small amount of it remains inside. This can cause discomfort, a feeling of bloating, and pain in the chest area ( used gas is evacuated from the body through the lungs). In order for the process of absorption of the gas inside to be accelerated, it is necessary to create favorable conditions for the effective functioning of the lungs and intestines. Therefore, the very next day after the operation, a woman is recommended to start moving more, as well as eat properly and fractionally ( five to six times a day) to speed up the healing process.

General principles of diet after diagnostic laparoscopy:

• in the first twelve hours after the procedure, it is necessary to drink a sufficient amount of water ( without gases);
• food is recommended to be taken stewed, baked or boiled ( avoid fried and fatty foods);
• the food taken should be in a mushy form;
• in the first days after laparoscopy, the number of meals should be five to six times a day;
• food should include the intake of proteins, carbohydrates ( especially fiber).

• salted, pickled, as well as peppered products;
• gas producing vegetables ( e.g. cabbage, beets, corn);
• astringent fruit varieties ( e.g. persimmon, quince);
• fatty meats ( e.g. pork), lard and smoked meats;
• confectionery
• alcohol, strong coffee, cocoa, carbonated drinks.

Fiber is found in large quantities in the following foods:

• vegetables ( carrots, broccoli, pumpkin, potatoes);
• fruit ( apples, pear, banana);
• porridge ( oatmeal, buckwheat, rice);
• bread with bran or whole grain;
• nuts ( peanuts, almonds, walnuts).

• vegetable or chicken broths;
• mineral water without gases;
• weakly brewed tea;
• fruit or vegetable juices;
• jelly;
• fruit compotes.

At discharge, the attending physician will conduct an explanatory conversation regarding the following aspects:

• How will the recovery process proceed?
• how to care for postoperative wounds;
• what kind of diet and what diet should be followed.

On the seventh to tenth day after the laparoscopy, the woman will need to come to the hospital to remove postoperative sutures.

During the recovery period, the following recommendations should be observed:

• it is recommended to resume sexual life three to four weeks after the operation;
• physical activity should be limited for about three weeks;
• if the work is not related to physical labor, then you can go to it a week after laparoscopy.

Laparoscopy is a fairly safe type of surgical intervention, however, in 0.7 - 7 percent of cases, the following complications may occur after it:

• inaccurate introduction of the trocar into the abdominal cavity may damage the internal organs ( bladder, intestines);
• during the injection of gas into the abdominal cavity, subcutaneous emphysema may develop ( air entry into the tissues of the anterior abdominal wall);
• with incomplete coagulation of the damaged vessel, internal bleeding may develop;
• due to improper preoperative preparation, the risk of thrombosis may increase, therefore, for the purpose of prevention, before surgery, a woman's legs are bandaged with an elastic bandage, and blood thinners are also administered ( anticoagulants).

• hyperemia ( redness) and swelling of the wound and surrounding tissues;
• bleeding from the operated wound;
• increase in local or general body temperature;
• severe pain in the abdomen;
• hoarseness of voice, which progresses over time.

Lecture #6

“Characteristics of endoscopic research methods. Punctures»

Endoscopy (Greek endō inside + skopeō examine, examine) is a method of visual examination of hollow organs and cavities of the body using optical instruments (endoscopes) equipped with a lighting device. If necessary, endoscopy is combined with targeted biopsy and subsequent morphological examination of the material obtained, as well as with x-ray and ultrasound studies. The development of endoscopic methods, the improvement of endoscopic techniques and their widespread introduction into practice are important for improving the early diagnosis of precancerous diseases and tumors of various localization in the early stages of their development.

Modern medical endoscopes are complex optical-mechanical devices. They are equipped with light and image transmission systems; are equipped with instruments for biopsy, extraction of foreign bodies, electrocoagulation, administration of medicinal substances and other manipulations; with the help of additional devices, they provide obtaining objective documentation (photography, filming, video recording).

Depending on the purpose, there are:

viewing;

biopsy;

operating rooms;

special endoscopes;

endoscopes for adults and children.

Depending on the design of the working part, endoscopes are divided:

on rigid ones that retain their shape during the study;

flexible, the working part of which can smoothly bend in the anatomical canal.

The light transmission system in modern endoscopes is made in the form of a light guide consisting of thin fibers that transmit light from a special light source to the distal end of the endoscope into the cavity under study. In rigid endoscopes, the optical system that transmits an image of an object consists of lens elements.

In the optical system of flexible endoscopes (fiberscopes), flexible bundles are used, consisting of regularly laid glass fiber filaments with a diameter of 7-12 microns and transmitting an image of an object to the ocular end of the endoscope. In endoscopes with fiber optics, the image is raster.

The variety of functional purposes of endoscopes determines the difference in their design. For example, duodenoscope with a lateral location of the optical system at the end of the endoscope facilitates examination and manipulation of the major duodenal papilla, esophagogastroduodenoscope with the end position of the optical system allows for examination and therapeutic interventions in the lumen of the esophagus, stomach and duodenum.

In recent years, endoscopes of small (less than 6 mm) diameter have become widespread for examining thin anatomical canals and hard-to-reach organs, for example ureterorenoscopes, different types bronchoscopes with fiber optics.

Promising development video endoscopes, in which instead of an optical channel with a fiber flagellum, a system with a special light-sensitive element - a CCD matrix is ​​used. Due to this, the optical image of the object is converted into electrical signals transmitted through an electrical cable inside the endoscope to special devices that convert these signals into an image on a television screen.

Flexible dual-channel operating endoscopes have been widely used. The presence of two instrumental channels makes it possible to simultaneously use various endoscopic instruments (for capturing the formation and its biopsy or coagulation), which greatly facilitates surgical interventions.

After the examination, the endoscope must be thoroughly rinsed and cleaned. The instrumental channel of the endoscope is cleaned with a special brush, after which it is washed and dried with compressed air using special devices.

All valves and auxiliary instrument valves are disassembled, washed and dried thoroughly before reassembly. Store endoscopes in special cabinets or on tables in a position that prevents deformation of the working parts or their accidental damage.

Endoscopes are subjected to sterilization in various means (glutaraldehyde solution, 6% hydrogen peroxide solution, 70% ethyl alcohol) at a temperature not exceeding 50 ° C due to the danger of sticking optical elements.

The most widespread endoscopy received in gastroenterology are used:

esophagoscopy;

gastroscopy;

duodenoscopy;

intestinoscopy;

colonoscopy;

sigmoidoscopy;

choledochoscopy;

laparoscopy;

pancreatocholangioscopy;

fistuloscopy.

In the diagnosis and treatment of diseases of the respiratory system, endoscopic methods are widely used, such as:

laryngoscopy;

bronchoscopy;

thoracoscopy;

mediastinoscopy.

Other endoscopy methods allow informative studies of individual systems, for example urinary(nephroscopy, cystoscopy, ureteroscopy), nervous(ventriculoscopy, myeloscopy), some organs (for example, uterus - hysteroscopy), joints (arthroscopy), vessels(angioscopy), heart cavities (cardioscopy), etc.

Thanks to the increased diagnostic capabilities of endoscopy, it has turned into a leading diagnostic method in a number of areas of clinical medicine from an auxiliary to a leading diagnostic method. The great possibilities of modern endoscopy have significantly expanded the indications and sharply narrowed the contraindications to the clinical use of its methods.

Carrying out a planned endoscopic examination shown :

1. to clarify the nature of the pathological process, suspected or established using other methods of clinical examination of the patient,

2. obtaining material for morphological research.

3. In addition, endoscopy makes it possible to differentiate diseases of an inflammatory and neoplastic nature,

4. as well as reliably exclude the pathological process that was suspected during the general clinical examination.

Emergency endoscopy is used as a means of emergency diagnosis and therapy for acute complications in patients with chronic diseases who are in an extremely serious condition, when it is impossible to conduct a routine examination, and even more so surgery.

Contraindication to endoscopy are:

violations of the anatomical patency of the hollow organs to be examined,

severe disorders of the blood coagulation system (due to the risk of bleeding),

as well as such disorders of the cardiovascular and respiratory systems, in which endoscopy can lead to life-threatening consequences for the patient.

The possibility of endoscopy is also determined by the qualifications of the doctor performing the study, and the technical level of endoscopic equipment that he has.

Training patients for endoscopy depends on the objectives of the study and the patient's condition. Planned endoscopy is performed after a clinical examination and psychological preparation of the patient, in which the task of the study is explained to him and he is introduced to the basic rules of behavior during endoscopy.

With emergency endoscopy, it is possible to carry out only the psychological preparation of the patient, as well as to clarify the main details of the anamnesis of the disease and life, to determine contraindications for research or prescribing drugs.

Medical preparation of the patient is primarily aimed at providing optimal conditions for the implementation of endoscopic examination and consists in relieving the patient's psycho-emotional stress, conducting anesthesia during manipulations, reducing the secretory activity of the mucous membranes, and preventing the occurrence of various pathological reflexes.

Technique endoscopy is determined by the anatomical and topographic features of the organ or cavity being examined, the model of the endoscope used (rigid or flexible), the patient's condition and the objectives of the study.

Endoscopes are usually inserted through natural openings. When conducting such endoscopic studies as thoracoscopy, mediastinoscopy, laparoneoscopy, choledochoscopy, the hole for the introduction of the endoscope is created with special trocars that are inserted through the thickness of the tissues.

A new direction in endoscopy is the use of flexible endoscopes for the study of internal and external fistulas - fistuloscopy. Indications for fistuloscopy are external intestinal fistulas with a diameter of at least 3 mm; internal intestinal fistulas, located at a distance of up to 20-25 cm from the anus; a high degree of narrowing of the intestinal lumen, when using endoscopes of other designs it is not possible to examine the narrowing itself and the overlying sections of the intestine.

The combination of endoscopy with x-ray methods of research is becoming more common. The combination of laparoneoscopy with puncture cholecystocholangioscopy, cystoscopy with urography, hysteroscopy with hysterosalpingography, bronchoscopy with isolated bronchography of individual lobes and segments of the lung allows you to most fully reveal the nature of the disease and establish the localization and extent of the pathological process, which is extremely important for determining the need for surgical intervention or endoscopic therapeutic measures. .

Research methods are being developed that use a combination of endoscopy with ultrasound methods, which facilitates the diagnosis of cavity formations located next to the organ under study and the detection of stones in the biliary or urinary tract. An ultrasonic probe inserted through the manipulation channel of the endoscope also makes it possible to determine the density of the tissue, the size of the pathological formation, i.e. obtain information that is extremely important for the diagnosis of the tumor process. Since the sensor is located in close proximity to the object under examination with the help of an endoscope, the accuracy of the ultrasound examination is increased and the interference that is possible during the examination in the usual way is eliminated.

Endoscopic diagnosis can be difficult due to local causes (pronounced deformation of the organ under study, the presence of adhesions) or the general severe condition of the patient. Various complications of endoscopy may be associated with the preparation or conduct of the study: they occur in the organ or other body systems under study, depend on the underlying or concomitant diseases, and appear during the study or some time later.

Most often, complications are associated either with anesthesia (individual intolerance to drugs), or with a violation of the technique of endoscopic examination. Failure to comply with the mandatory techniques of endoscopy can lead to injury to the organ up to its perforation. Other complications are less likely: bleeding after a biopsy, trauma to varicose veins, aspiration of gastric contents during an emergency study, etc.

Laparoscopy

Laparoscopy(Greek lapara belly + skopeō observe, examine; synonym: abdominoscopy, ventroscopy, peritoneoscopy, etc.) - endoscopic examination of the abdominal cavity and small pelvis.

It is used in cases where modern clinical, laboratory, radiological and other methods fail to establish the cause and nature of the disease of the abdominal organs.

The high information content, relative technical simplicity and low traumatic nature of laparoscopy have led to its widespread use in clinical practice, especially in children and the elderly.

Not only diagnostic laparoscopy, but also therapeutic laparoscopic techniques are widely used: drainage of the abdominal cavity, cholecysto-, gastro-, jejuno- and colonostomy, dissection of adhesions, some gynecological operations, etc.

Indications for diagnostic laparoscopy are:

diseases of the liver and biliary tract;

abdominal tumors;

suspicion of an acute surgical disease or damage to the abdominal organs, especially if the victim is unconscious;

ascites of unknown origin.

Indications for therapeutic laparoscopy may arise:

with obstructive jaundice;

acute cholecystitis and pancreatitis;

conditions in which the imposition of fistulas on various parts of the gastrointestinal tract is indicated: (obstruction of the esophagus);

maxillofacial trauma;

severe brain damage;

tumor obstruction of the pylorus;

burns of the esophagus and stomach.

Contraindications for laparoscopy are:

blood clotting disorders;

decompensated pulmonary and heart failure;

coma;

suppurative processes on the anterior abdominal wall;

extensive adhesive process of the abdominal cavity;

external and internal hernias;

flatulence;

severe obesity.

For laparoscopy, special instruments are used:

a pneumoperitoneum needle;

trocar with a sleeve for puncturing the abdominal wall;

laparoscope;

puncture needles;

biopsy forceps;

electrodes;

electroknives and other instruments that can be passed either through the manipulation channel of the laparoscope, or through a puncture of the abdominal wall.

Laparoscopes are based on the use of rigid optics, their optical tubes have different viewing directions - straight, side, at different angles. Are being developed fibrolaparoscopes with controlled distal end.

Diagnostic laparoscopy in adults can be performed under local anesthesia; all laparoscopic operations, as well as all laparoscopic manipulations in children, are usually performed under general anesthesia. In order to prevent possible bleeding, especially with liver damage, vikasol, calcium chloride are prescribed 2-3 days before the examination. The gastrointestinal tract and the anterior abdominal wall are prepared as for abdominal surgery.

The first stage of laparoscopy is the imposition of pneumoperitoneum. The abdominal cavity is punctured with a special needle (such as Leriche's needle) at the lower left point of Calc (Fig. 14).

Rice. 14. Classical Calc points for imposing pneumoperitoneum and introducing a laparoscope: the laparoscope insertion sites are indicated by crosses, the puncture site for pneumoperitoneum application is indicated by a circle, the projection of the round ligament of the liver is shaded.

3000-4000 cm3 of air, nitrous oxide or carbon monoxide are introduced into the abdominal cavity. Depending on the task of the study, one of the points is chosen for the introduction of the laparoscope according to the Kalka scheme, most often above and to the left of the navel. A scalpel makes a skin incision 1 cm long, dissects the subcutaneous tissue and the aponeurosis of the rectus abdominis muscle. Then, the anterior abdominal wall is pierced with a trocar with a sleeve, the trocar is removed, and a laparoscope is inserted through its sleeve.

Examination of the abdominal cavity is carried out sequentially from right to left, examining the right lateral canal, liver, subhepatic and suprahepatic space, subdiaphragmatic space, left lateral canal, small pelvis.

If necessary, you can change the position of the patient for a more detailed examination. The nature of the lesion can be determined by the color, the nature of the surface, the shape of the organ, overlays, and the type of effusion: cirrhosis of the liver, metastatic, acute inflammatory process (Fig. 15a, b), necrotic process, etc. To confirm the diagnosis, a biopsy (usually puncture) is performed.

Various therapeutic procedures performed during laparoscopy are widely used: drainage of the abdominal cavity, microcholecystostomy), etc. After laparoscopy is completed and the laparoscope is removed from the abdominal cavity, gas is removed, the skin wound is sutured with 1-2 sutures.

Rice. 15a). Laparoscopic picture in some diseases and pathological conditions of the abdominal organs - gangrenous cholecystitis.

Rice. 15b). Laparoscopic picture in some diseases and pathological conditions of the abdominal organs - fibrous peritonitis.

Complications are rare. The most dangerous are instrumental perforation of the organs of the gastrointestinal tract, damage to the vessels of the abdominal wall with the occurrence of intra-abdominal bleeding, and infringement of hernias of the anterior abdominal wall. As a rule, with the development of such complications, emergency surgery is indicated.

Colonoscopy

Colonoscopy (Greek kolon large intestine + skopeō observe, examine; synonym: fibrocolonoscopy, colonofibroscopy) is a method of endoscopic diagnosis of diseases of the colon. It is an informative method for the early diagnosis of benign and malignant tumors of the colon, ulcerative colitis, Crohn's disease, etc. (Fig. 16.17).

With colonoscopy, it is also possible to perform various medical manipulations - removal of benign tumors, stopping bleeding, removing foreign bodies, recanalization of intestinal stenosis, etc.

Rice. 16. Endoscopic picture of the large intestine in normal conditions and in various diseases: the mucous membrane of the colon is normal.

Rice. 17. Endoscopic picture of the large intestine in normal conditions and in various diseases: sigmoid colon cancer - necrotic tumor tissue is visible in the center of the field of view.

Colonoscopy is performed using special instruments - colonoscopes. Colonoscopes KU-VO-1, SK-VO-4, KS-VO-1 are produced in the Russian Federation (Fig. 18). Colonoscopes of various Japanese firms are widely used.

Rice. 18. Colonoscopes special KS-VO-1 (left) and universal KU-VO-1 (right).

The indication for colonoscopy is the suspicion of any disease of the colon. The study is contraindicated in acute infectious diseases, peritonitis, as well as in the late stages of cardiac and pulmonary insufficiency, severe disorders of the blood coagulation system.

Preparation for colonoscopy in the absence of persistent constipation includes taking patients on the eve of the study in the afternoon (30-50 ml) of castor oil, after which two cleansing enemas are performed at intervals of 1-2 hours in the evening; on the morning of the day of the study they are repeated.

With severe constipation, a 2-3-day preparation is necessary, including an appropriate diet, laxatives and cleansing enemas.

In diseases accompanied by diarrhea, laxatives are not given, it is enough to use small-sized (up to 500 ml) cleansing enemas.

Emergency colonoscopy in patients with intestinal obstruction and bleeding can be performed without preparation. It is effective when using special endoscopes with a wide biopsy channel and active irrigation of the optics.

Colonoscopy is usually performed without premedication. Patients with severe pain in the anus are shown local anesthesia (dicaine ointment, xylocaingel). In case of severe destructive processes in the small intestine, massive adhesive process in the abdominal cavity, it is advisable to perform colonoscopy under general anesthesia, which is mandatory for children under 10 years of age. Complications of colonoscopy, the most dangerous of which is intestinal perforation, are very rare.

Ultrasound examination (ultrasound) is a painless and safe procedure that creates an image of the internal organs on the monitor due to the reflection of ultrasonic waves from them.

At the same time, media of different density (liquid, gas, bone) are displayed differently on the screen: liquid formations look dark, and bone structures look white.

Ultrasound allows you to determine the size and shape of many organs, such as the liver, pancreas, and see structural changes in them.

Ultrasound is widely used in obstetric practice: to identify possible fetal malformations in early pregnancy, the condition and blood supply of the uterus, and many other important details.

This method, however, is not suitable and therefore is not used for examining the stomach and intestines.

It is possible to conduct a visual examination of the internal organs and obtain accurate examination results using diagnostic laparoscopy. This is a minimally invasive surgical operation, often used in gynecology, when ultrasound and other research methods cannot give a complete picture for making a diagnosis.

What is the purpose of diagnostic laparoscopy?

Today, this method is widely used in the field of gynecology and allows you to diagnose almost any disease. Laparoscopy also helps to differentiate surgical and gynecological pathologies. The procedure allows you to get a much more accurate overview of the organs compared to a conventional incision of the abdominal wall due to multiple magnification of the image and the ability to accurately see the organ of interest in the smallest detail.

All floors of the abdominal cavity and retroperitoneal space are subject to review. A diagnostic and treatment laparoscopy can also be performed, during which an examination and the necessary manipulations take place simultaneously.

Indications for diagnostic laparoscopy

Diagnosis by laparoscopic method can be carried out in a number of cases:

• With gynecological disorders, such as adnexitis, oophoritis.
• To identify the causes of infertility, with suspicion of obstruction of the fallopian tubes.
• Acute diseases of organs with indefinite symptoms.
• In acute pancreatitis to determine the condition of the pancreas and peritoneum.
• After spontaneous reduction of hernias.
• For differential diagnosis in jaundice, to monitor the outflow of bile, the appearance of obstruction.
• In the presence of a neoplasm in the pelvic area - ovarian cysts, tumors.
• After closed injuries of the abdominal organs, especially if the patient is unconscious and there are no obvious symptoms.
• In the case of injuries, to determine hemorrhages, inflammation.
• With postoperative peritonitis.
• If there is ascites, formed for an unclear reason.
• For the diagnosis of tumors of the abdominal cavity.

Contraindications

Indications can be relative and absolute. The former often depend on the qualifications of the surgeon, the capabilities of the equipment, the patient's condition, and diseases. That is, after the elimination of the causes of restrictions, the operation can be carried out.

Relative contraindications include:

• Allergy.
• Peritonitis.
• Postoperative adhesions.
• Pregnancy from four months.
• Suspected presence of adnexal tumors.
• The period after suffering acute colds and infectious diseases.

Absolute contraindications:

• State of hemorrhagic shock.
• Serious pathologies of the cardiovascular system.
• Renal and liver failure.
• Uncorrectable coagulopathy.
• Malignant tumor of the ovary, RMT (laparoscopic monitoring is possible with radiation and chemotherapy).

Preparation for diagnostic laparoscopy

The preparatory stage includes a preliminary examination, as with any surgical intervention. This is the collection of anamnesis, blood tests, urine tests, smears, EKUG and ultrasound. Before the operation, the patient must follow a mostly liquid diet, do not eat food that causes excessive gas formation. Taking special medications may be necessary depending on the nature of the disease, the presence of concomitant pathologies. When preparing, it is very important to follow all the doctor's instructions so that the operation is as easy as possible and gives accurate results.

How is diagnostic laparoscopy performed?

The procedure is carried out in several stages:

1. The introduction of anesthesia - general or local, this is determined individually.
2. Injection of gas into the abdominal cavity using a special tool and a small incision (usually in the navel). The gas is completely safe and serves to elevate the abdominal wall, providing volume for a good view.
3. Introduction of the instrument and camera through two other miniature holes.
4. After carrying out all the necessary manipulations, the instrument and gas are removed, stitches and bandages are applied.
5. Most often, the patient can go home the day after the operation.

Results of diagnostic laparoscopy

During the study, the doctor carefully goes through all the necessary areas, paying attention to the presence of visible pathologies, adhesions, inflammatory processes, formations, cysts. What is seen during the diagnostic process is recorded, after which the patient is given a conclusion.

Diagnosis by laparoscopy in gynecology

The approach is effective for most gynecological diseases. The main indications, emergency and planned, include:

• Ectopic pregnancy, torsion, cyst rupture.
• Apoplexy of the ovaries.
• Endometriosis, ovarian tumors.
• Pain in the lower abdomen of unknown origin.
• Pathologies of the development of the genital organs.

Laparoscopic diagnosis for infertility

This method makes it possible to diagnose infertility, indicate the exact cause of the violations. Among the disorders leading to infertility and diagnosed by laparoscopy:

• Inflammatory processes in the pelvic area.
• Endometriosis, fibroids.
• Ovarian cysts, polycystic and sclerocystosis.
• Adhesions, obstruction of the fallopian tubes.

During the study, dissection of adhesions and other actions can be performed.

Where to do diagnostic laparoscopy in Moscow

And to carry out laparoscopy for the purpose of diagnosis or treatment, it is possible in the modern clinic of the Central Clinical Hospital of the Russian Academy of Sciences. equipped with the latest equipment, qualified doctors will conduct the study competently. Make an appointment using the feedback form or in another convenient way, ask questions about price, rules for the preparation and conduct of the procedure.

One of the best and most effective methods of examination is considered to be laparoscopy, which allows to identify many types of pathologies, to establish their cause. Thanks to the use of modern devices equipped with a video camera, diagnostic laparoscopy opens up the possibility for the doctor to visualize a multiply enlarged organ under examination on the monitor screen. In gynecology, a minimally invasive procedure is also used for treatment.

The essence of laparoscopy

The procedure of the endoscopic method of research is classified as a small surgical operation. During its implementation, the doctor gets the opportunity to examine the retroperitoneal organs, examine them from the inside, and perform the required manipulations. Diagnosis is performed by a laparoscope with an endovideo camera and additional instruments that are inserted into the abdominal cavity through small holes (5-7 mm) or the navel.

The camera of a modern endoscopic device (laparoscope) provides a broadcast on a color monitor of what is happening inside the process at a 6-fold increase. Other instruments are necessary for the surgeon to change the position of the organ under study, to perform manipulations during endovideosurgery.

In the case of general surgery, a diagnostic examination of the peritoneum is relevant for clarifying the diagnosis and prescribing treatment in the following situations:

• with acute and unexplained chronic pain in the abdominal area;
• if you suspect the appearance of neoplasms to identify and determine the nature of the tumor;
• to find out the cause of ascites (fluid in the abdominal cavity);
• with pathologies of the liver;
• with closed injuries of the abdomen and injuries of the trunk.

Interesting facts: as a method of examination, laparoscopy has been known for a long time. A report on the results of the first examination of a dog through holes in the abdomen appeared in the press in 1901. Hans Jacobeus performed the first diagnosis of a person, the scientist became the author of the term "laparoscopy". In 1929, the German Heinitz Kalk managed to equip the laparoscope with an optical lens with an inclination.

Method of examination in gynecology

In the field of gynecology, modern diagnostic laparoscopy is very popular not only as a method of examination, but also as a way to treat gynecological problems. The procedure does not turn into a lot of stress for a woman, does not require transverse or longitudinal incisions of the peritoneum with subsequent scarring of the suture. The technique is ideal for performing simple manipulations, for example, to eliminate the adhesive process or remove foci of endometriosis.

In gynecology, the following types of laparoscopic surgery are used:

• diagnostic examination to clarify the diagnosis;
• the method of operative endovideosurgery eliminates the problem;
• follow-up examination after surgery.

In many gynecological departments of most modern clinics, almost 90% of surgical operations are performed using the modern method of laparoscopic access. Diagnostics is prescribed for a planned examination, the implementation of emergency measures.

Indications for planned manipulations

1. Sterilization technique. The operation leads to artificial obstruction of the fallopian tubes, the egg does not enter the uterine cavity. Another medical method of sterilization is carried out by applying a special clip to the fallopian tubes.
2. Conducting a biopsy. The procedure is prescribed for any type of tumor processes in the genital area. To eliminate the consequences of the abnormal development of the genital organs (internal), plastic laparoscopy is performed.
3. Infertility. A minimally invasive operation is prescribed to determine the causes of infertility, eliminate adhesions on the fallopian tubes in tubal infertility. With a purulent adhesive process during laparoscopy, the fallopian tubes are removed (tubectomy).
4. Oncology. In malignant processes in the uterus, the stage of the disease is determined, which makes it possible to clarify the possibility of surgical treatment, to establish the volume of hysterectomy (complete removal of the uterus).
5. Removal. Laparoscopy is prescribed for uterine fibroids to remove mobile nodes (on the leg), benign tumors on the ovaries. With endometriosis, resection of the nodes in most cases contributes to the onset of pregnancy.

Important: when the bladder is lowered, a laparoscopically performed operation will help relieve the woman of the symptoms of genital prolapse (prolapse of the genitals). Endovideosurgery allows you to fix the correct position of prolapsed organs while maintaining their mobility, even tissue elasticity.

Indications for emergency diagnosis

1. Suspicion of a possible perforation of the walls of the uterus during diagnostic curettage or instrumental abortion.
2. Suspicion of an ectopic (tubal pregnancy), rupture or twisting of a cyst (tumor) of the ovaries, fibromatous nodes of the uterus.
3. Suspicion of the development of acute conditions - inflammatory processes, purulent pathologies, pain syndromes of unclear etiology in the lower abdomen.

In some cases, diagnostic laparoscopy, which helps to clarify the diagnosis, turns from a diagnostic method into a therapeutic manipulation. Together with the examination, it becomes possible to take material for detailed study and analysis in the laboratory. To obtain reliable results, as well as to eliminate unpleasant problems, you need to properly prepare for the examination.

When diagnosis is contraindicated

• In severe diseases of the cardiovascular and respiratory systems.
• If there are severe problems with blood clotting.
• With acute renal and hepatic insufficiency.
• If the pelvic organs are affected by the malignant process.

Preparatory process

In the course of preparation for the procedure, a woman needs to conduct a comprehensive examination with an anamnesis. An examination by a gynecologist is mandatory, consultation with an anesthesiologist is especially important, since the study is performed with the connection of general anesthesia. In addition, consultations of narrow specialists may be required before a medical diagnostic examination.

An important stage of preparation: the patient should be informed about the nuances of the operation, warned about possible complications, the likelihood of an unplanned intervention with abdominoplasty. Therefore, a woman will have to sign a document confirming her consent to the operation, as well as to the elimination of possible consequences.

Stages of the diagnostic process

Threat of complications

The fact of the appearance of complications after the diagnostic procedure depends on the complexity of the surgical intervention, the experience and qualifications of the surgeon. The likelihood of undesirable consequences increases when performing operations of high complexity associated with the removal of fibroids, endometriosis nodes, and hysterectomy. The most common problems after laparoscopy are:

• the development of massive bleeding due to a violation of the integrity of the abdominal wall, injury to large vessels (retroperitoneal);
• the appearance of a gas embolism, if the expanding gas enters the cavity of the damaged vessel;
• injury to the outer shells of the organs of the pelvic area with instruments, most often the intestines suffer.

An interesting fact: thanks to progressive scientific developments, laparoscopic diagnostics was entrusted to a modern robot named Da Vinci. A robot equipped with four arms does not make mistakes that lead to unpleasant inspection consequences.

Features of the postoperative period

The severity of recovery after laparoscopic diagnosis depends on how extensive the operation was, how much anesthesia was applied. During the day, bed rest is required to cope with the unpleasant consequences of general anesthesia. It is allowed to start motor activity almost 12 hours after the manipulation, so that the gas leaves the body faster. After two hours, you can take a few sips of water (non-carbonated), this will neutralize the urge to vomit.

Nutrition during the recovery period should be fractional, dietary with an increase in the amount of fiber consumed. You will have to spend up to three days in the hospital. Usually, after laparoscopy, the recovery of the body passes without any problems. However, pains in the lower abdomen are possible, especially in the places of punctures of the abdominal cavity, then gentle painkillers are allowed.

Important: after performing a gynecological examination, a woman will have to give up sexual contact for a month. It is necessary to take hormonal drugs, anti-inflammatory and antibacterial drugs are also prescribed.

If you are scheduled for a diagnostic laparoscopy, do not be afraid. The procedure is considered the safest method, and the risk of complications is minimal. The main condition is to follow all the doctor's instructions before and after the examination.

Diagnostic laparoscopy is a modern diagnostic method, which is considered one of the most informative and reliable. As a rule, laparoscopy is performed on the organs of the abdominal cavity and pelvis, which is reflected in the very name of the procedure: the term "laparoscopy" is a derivative of the Greek words "womb" and "look". Synonyms for the concept of "laparoscopy" are "peritoneoscopy" and "ventroscopy". This procedure involves examining the internal organs through small openings using a special instrument called a laparoscope.

Laparoscopic diagnostics is carried out if other types of examination were not informative enough.

History reference

Before the advent of laparoscopy, the only way to view the abdominal organs was laparotomy. In other words, the patient's stomach was cut open, and examination and operations were carried out through this cut. Laparotomy was a difficult and painful procedure for the patient. Scars remained on the anterior abdominal wall, the risk of complications was incredibly high, and the patients recovered very slowly.

For the first time, they started talking about diagnostic laparoscopy at the beginning of the 20th century, but the technique remained practically in its “rudimentary” state until the 1960s.

The pioneer of laparoscopy is the Russian doctor Ott. It was he who, in 1901, first conducted an endoscopic examination of the patient's abdominal cavity using a forehead reflector, an electric lamp and a mirror. He called his method ventroscopy. In the same year, in Germany, Professor Kelling was the first to conduct an endoscopic examination of the abdominal organs in animals.

During the 1920s and 1930s, a large number of publications devoted to endoscopic studies appeared. Their authors were scientists from Switzerland, Denmark, Sweden and the USA. They praise laparoscopy as a highly effective method for diagnosing liver disease. In the same period, the first, still extremely imperfect, laparoscopes appeared. In the 1940s, the design of laparoscopy devices improved, laparoscopes equipped with biopsy devices appeared. In the same period, laparoscopy began to be used in gynecology.

In the 1960s, laparoscopy began to be actively used for the diagnosis and treatment of diseases of the abdominal organs.

Indications for the procedure

Today, diagnostic laparoscopy is under active development. It is used in various fields of medicine, since this diagnostic method makes it possible to choose the right treatment tactics and subsequently carry out radical surgery without laparotomy.

Diagnostic laparoscopy is indicated for various diseases of the abdominal cavity. So, with ascites, this diagnosis makes it possible to identify the root causes of the appearance of fluid in the abdominal cavity. With tumor-like formations of the abdominal cavity, the doctor during the diagnostic laparoscopy gets the opportunity to carefully examine the formation and conduct a biopsy. For patients suffering from liver diseases, laparoscopy is one of the safest methods that allow you to get a piece of organ tissue for research. In addition, diagnostic laparoscopy is used in gynecology for a more complete diagnosis of patients suffering from infertility, endometriosis, uterine fibroids and cystic formations in the ovaries. Finally, the doctor may recommend a diagnosis for unknown etiology of pain in the abdomen and pelvis.

Contraindications for diagnosis

Since diagnostic laparoscopy is a minimally invasive but surgical intervention, the list of contraindications for this procedure should be taken very seriously.

So, there are absolute and relative contraindications for this research method. Laparoscopy is strictly prohibited in hemorrhagic shock caused by severe blood loss, and in the presence of adhesions in the abdominal cavity. Also, the reason for refusing the procedure is liver and kidney failure, an acute form of cardiovascular disease, and lung disease. Laparoscopy is contraindicated with severe bloating and intestinal colic, as well as with ovarian cancer.

Relative contraindications for diagnostics are allergies to several types of drugs, the presence of large fibroids, a gestation period exceeding sixteen weeks, and diffuse peritonitis. The procedure is not recommended if the patient has had ARVI or a cold less than four weeks ago.

Diagnostic Benefits

Compared to laparotomy, laparoscopy has many advantages:

1. First of all, this method is minimally invasive. In other words, the surgical effect is very sparing, the risk of infection is minimal, and there is practically no blood loss. In addition, since the peritoneum is not damaged, adhesions will not form after the procedure. The pain syndrome is also minimal, since during abdominal operations the source of the main discomfort is the stitches applied to the incision. The cosmetic effect is also important - after laparoscopy, unaesthetic scars are not formed, which are the result of laparotomy.
2. In addition, after laparoscopy, the patient recovers faster. Due to the fact that there is no need to comply with strict bed rest, the risk of thrombosis is reduced.
3. Finally, diagnostic laparoscopy is a highly informative diagnostic method, which makes it possible to literally “shed light” on the state of internal organs, find out the etiology of the disease and choose the best method of therapy. Due to the display of a multiply enlarged image of the internal organs on the screen, the doctor gets the opportunity to examine the tissues in detail from different angles.

Disadvantages of the procedure

However, like all medical procedures, diagnostic laparoscopy has not only advantages, but also disadvantages.

First of all, it must be borne in mind that this diagnosis is carried out under general anesthesia. The effect of this type of anesthesia on each organism is strictly individual, and therefore, before carrying out the manipulation, it is necessary to carry out all the necessary studies in order to avoid complications.

In addition, with insufficient qualifications of the doctor who conducts the diagnosis, there is a risk of injury to organs during the introduction of instruments. Due to the fact that the doctor operates with tools "remotely", he sometimes cannot adequately assess the force applied to the tissues. Tactile sensations are reduced, which can complicate diagnosis if the doctor does not yet have enough experience.

Diagnostic laparoscopy in gynecology

Diagnostic laparoscopy is widely used in gynecology. During the procedure, the doctor can conduct a detailed examination of the internal genital organs of a woman: the ovaries, uterus and fallopian tubes.

Gynecological laparoscopy is performed either under general anesthesia or local anesthesia combined with sedation. The method of its implementation is almost the same as with conventional laparoscopy. A cannula is inserted into the abdominal cavity, through which gas enters, as a result of which the abdominal wall rises with a dome. A small incision is then made through which the trocar is inserted. The latter is used to introduce a tube equipped with a video camera lens and a light bulb into the abdominal cavity. The image of the pelvic organs is displayed on the monitor, and the course of diagnostic laparoscopy is recorded on an information carrier.

In gynecology, diagnostic laparoscopy is indicated when the cause of diseases of the reproductive system cannot be identified using ultrasound and radiological methods. In particular, diagnostic laparoscopy can be used in gynecology to identify the cause of pain, clarify the nature of tumor formations in the pelvis, confirm previously diagnosed endometriosis and inflammatory diseases. Also, this procedure helps to check the fallopian tubes and identify the cause of their obstruction.

Preparation for diagnostics

In order for the procedure of diagnostic laparoscopy to pass without complications and to be as informative as possible, it is necessary to conduct a number of preliminary examinations and follow the recommendations of physicians.

Preparation for a planned diagnostic laparoscopy is recommended to begin approximately one month before the procedure. During this period, the patient must undergo the most thorough examination, which includes a complete history taking, as well as laboratory diagnostics and consultations of narrow specialists. Doctors must find out what diseases the patient had previously suffered, whether he had serious injuries, whether he was subjected to surgical interventions. It is mandatory to check for an allergic reaction to medications.

To find out if the patient is suffering from diseases that can be considered as contraindications for diagnostics, it is imperative to visit a therapist and gynecologist and other specialists. Ultrasound, fluorography and a standard blood test are also performed, as well as a coagulogram, tests for HIV, hepatitis and syphilis. The blood type and Rh factor are determined in case of complications.

Despite the fact that this surgical intervention is considered relatively safe, patients should be informed about all the details of the procedure and possible "pitfalls".

Two weeks before the diagnosis, it is usually recommended to stop taking blood thinners. In addition, the diet is adjusted. It is usually recommended to minimize or completely exclude spicy and fried foods, smoked meats, as well as dishes that stimulate gas formation from the menu. Two or three days before the laparoscopic examination, it is necessary to reduce the amount of food taken, and the day before - to minimize it.

Dinner on the eve of the procedure should be very light. Doctors usually recommend a cleansing enema in the evening.

Diagnostic laparoscopy is performed exclusively on an empty stomach. A consultation is carried out immediately before the operation.

Diagnostic laparoscopy technique

As noted above, laparoscopic diagnostics is most often performed under general anesthesia. It begins with the fact that a puncture of the abdominal cavity is performed, after which heated carbon dioxide is introduced into it. This is necessary in order to increase the volume of the internal space - so the doctor can more easily manipulate the instruments and the examination of the organs will not be difficult.

After that, small incisions are made at certain points in the abdomen, into which a laparoscope is inserted - an instrument with which the organs are examined and all manipulations are monitored. The laparoscope is equipped with a high-resolution video camera that displays the image on the screen.

If necessary, several more punctures are made on the anterior abdominal wall, through which various manipulators are introduced, allowing, for example, a biopsy or dissection of adhesions. After the introduction of the laparoscope, the doctor begins to examine the upper sections of the abdominal cavity, assesses the condition of the organs.

After the operation is completed, the instruments are removed, gas is removed from the abdominal cavity, and small incisions are treated with an antiseptic and stitched.

Mode after diagnostic laparoscopy

Since diagnostic laparoscopy is a low-traumatic diagnostic method, and damage to the muscles and tissues of the body is minimal, patients recover much easier. As a rule, one day after the procedure, you can be discharged from the hospital and return to your normal lifestyle with minor restrictions.

Within a few hours after the manipulation, patients are allowed to walk. Moreover, walking is even welcomed, since physical activity avoids the adhesive process and the occurrence of blood clots.

However, you should not be particularly zealous - it is better to start with walking a short distance, gradually increasing the load and pace.

There is also no need to adhere to a strict diet after diagnostic laparoscopy. The doctor may recommend temporarily excluding foods that stimulate gas formation from the diet: black bread, legumes, raw vegetables,.

Painkillers may be prescribed to relieve discomfort in the puncture area.