How is laparoscopy performed in gynecology? Real reviews and results. Features of diagnostic laparoscopy

Surgeons like to repeat: “The belly is not a suitcase, you can’t just open and close it”. Indeed, surgical operations on the abdominal organs are traumatic, full of risks and negative consequences. Therefore, when the laparoscopic method of treating surgical diseases was invented by bright minds, doctors and patients breathed a sigh of relief.

What is laparoscopy

Laparoscopy is an introduction into the abdominal cavity through small (slightly more than one centimeter in diameter) holes, when the hands and eyes of the surgeon act as a laparoscope, which is inserted into the cavity through these holes.

The main parts of the laparoscope are:

The tube serves as a kind of pioneer, which is carefully introduced into the abdominal cavity. Through it, the surgeon looks at what is being done in the inner kingdom of the abdomen, through another hole he introduces surgical instruments, with the help of which he performs a number of surgical manipulations in the abdominal cavity. A small video camera is attached to the other end of the laparoscope tube, which is inserted into the abdominal cavity. With its help, the image of the abdominal cavity from the inside is transmitted to the screen.

The word "laparoscopy" reflects the essence of this method: from the ancient Greek "laparo" means "stomach, belly", "scopy" - "examination". The operation with the help of a laparoscope would be more correct to call laparotomy (from the ancient Greek "tomy" - section, excision), but the term "laparoscopy" has taken root and is used to this day.

Let us immediately state that laparoscopy is not only operations “through the tube”, but also the identification of diseases of the abdominal organs. After all, the picture of the abdominal cavity with all its insides, which can be seen directly with the eye (albeit through an optical system), is more informative than the “encrypted” images obtained, for example, from x-rays, ultrasound or computed tomography - they still need to be interpreted.

The scheme of the laparoscopic method of treatment

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

The scheme of laparoscopy is as follows:

The range of diseases treated with laparoscopy is quite wide.:

and many other surgical pathologies.

Benefits of laparoscopy

Since, unlike the open method of surgical intervention, large incisions are not necessary for examination and manipulation in the abdomen, the “pluses” of laparoscopy are significant:

Disadvantages of laparoscopy

The laparoscopic method has made, without exaggeration, a revolutionary revolution in abdominal surgery. However, it is not 100% perfect and has a number of drawbacks. There are frequent clinical cases when, having started laparoscopy, surgeons were not satisfied with it and were forced to switch to an open method of surgical treatment.

The main disadvantages of laparoscopy are as follows:

• due to observation through optics, depth perception is distorted, and significant experience is needed for the surgeon's brain to correctly calculate the true depth of insertion of the laparoscope;
• the laparoscope tube is not as flexible as the surgeon's fingers, the laparoscope is clumsy to a certain extent, and this limits the range of manipulations;
• due to the lack of tactile sensation, it is impossible to calculate the force of pressure of the device on the tissues (for example, gripping tissues with a clamp);
• it is impossible to determine some characteristics of internal organs - for example, the consistency and density of tissues in a tumor disease, which can only be assessed by palpation with fingers;
• there is a point pattern - at some specific moment, the surgeon sees in the laparoscope only a specific section of the abdominal cavity and cannot visualize it as a whole, as with the open method.

Possible complications of laparoscopic treatment

They are significantly less than with the open method of surgical intervention. However, you need to be aware of the risks.

The most common complications during laparoscopy are:

Advances in laparoscopy

The laparoscopic method is not only considered the most progressive in abdominal surgery - it is constantly evolving. So, the developers have created a smart robot equipped with micro-instruments, which are much smaller in size than standard laparoscopic instruments. The surgeon sees a 3D image of the abdominal cavity on the screen, issues commands with the help of joysticks, the robot analyzes them and instantly turns them into jewelry movements of microinstruments inserted into the abdominal cavity. Thus, the accuracy of manipulations increases several times - like a real living surgeon, but of a reduced size, he climbed through a small hole into the abdominal cavity and performs all the necessary manipulations with reduced hands.

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

Laparoscopy is a modern and minimally invasive method of access to the organs of the abdominal cavity, small pelvis, retroperitoneal space, which has been successfully used by surgeons around the world for the past decades.

Laparoscopic methods of operations are put on stream and are preferred to conventional open operations not only by surgeons, but also by the patients themselves, who do not want to acquire scars on the skin, adhesions in the cavities and experience all the hardships of the postoperative period as after open interventions.

Due to the mass of advantages, laparoscopy is widely used in abdominal surgery, gynecology and even in some oncological processes, if this does not come at the expense of radicalness and the principles of ablastic surgery. The method is gradually replacing open interventions, most surgeons own it, and the equipment has become available not only to large clinics, but also to ordinary city hospitals.

Today, with the help of laparoscopy, it is possible to diagnose a variety of diseases and treat them at the same time, causing minimal trauma to the patient while reducing the number of complications and operational risks. In this way, it is possible to remove entire organs, large tumors, and perform plastic surgery.

For many patients in serious condition, elderly and senile people, with some concomitant diseases, open surgery may be contraindicated due to the high risk of complications, and laparoscopy makes it possible to reduce the likelihood of adverse effects and conduct surgical treatment, as they say, with “little blood”.

At the same time, one should not forget that laparoscopic surgery is also a surgical treatment, therefore, it must also be preceded by proper preparation, a thorough examination of the patient and an assessment of possible contraindications.

Advantages and disadvantages of laparoscopy as an access method

Doubtless benefits laparoscopic access during operations and at the stage of diagnosis of diseases are considered:

In addition to important advantages for the patient, laparoscopy also provides a number of advantages for the surgeon. Thus, the use of optics and magnifying equipment allows a more detailed study of the affected organ, examining it from different angles with a 40x magnification, which improves the quality of diagnosis and subsequent treatment.

However, like any intervention in the body, accompanied by even minimal trauma, laparoscopy can have limitations , among which:

1. Limited visibility and the ability to move tools in some hard-to-reach areas;
2. Subjective and not always accurate perception of the depth of penetration and parameters of internal organs;
3. Lack of tactile contact and the ability to manipulate only instruments without touching internal tissues with a hand;
4. Difficulty in mastering the skills of laparoscopic intervention;
5. The possibility of tissue injury by cutting tools in conditions of limited visibility and mobility in a confined space of the body.

One of the disadvantages of the method can be considered the high cost of equipment and the high cost of the operation itself in comparison with traditional surgery, so this treatment may not be available to some patients, especially in remote areas with a low level of equipment in medical institutions.

As the skills of surgeons improved, laparoscopy became possible for emergency operations, removal of not only benign, but also malignant tumors, interventions in patients with a high degree of obesity, and a number of other serious concomitant diseases. The most complex operations on internal organs are performed laparoscopically while maintaining the principle of minimally invasiveness and low overall surgical risk.

Instruments used for laparoscopy

If for a conventional open operation the surgeon needs his own hands and familiar tools in the form of scalpels, clamps, scissors, etc., then for laparoscopy a completely different, complex and high-tech equipment is required, which is not so easy to master.

The traditional set of instruments for laparoscopy includes:

• Laparoscope;
• Light source;
• video camera;
• Optical cables;
• Suction systems;
• Trocars with manipulators.

laparoscope - the main tool by which the surgeon enters the internal cavity of the body, introduces a gas composition there, examines the tissues thanks to the lens system. A halogen or xenon lamp provides good lighting, because you have to operate in complete darkness and it is simply impossible to carry out an operation without light.

The image from the video camera hits the screen, with the help of which the specialist examines the organs, controls the movements of the instruments and the manipulations carried out inside the body.

Trocars - These are hollow tubes that are inserted through additional punctures. Tools get inside through them - special knives, clamps, needles with suture material, etc.

To increase the efficiency of laparoscopic surgery allows the use of modern imaging methods, especially relevant if the pathological focus lies not on the surface of the organ, but inside it. For this purpose, interventions are carried out in the so-called hybrid operating rooms, equipped with both laparoscopic instruments and additional diagnostic equipment.

A computer or magnetic resonance tomograph allows you to determine the localization of tumors of the kidneys, liver, pancreas. The use of angiographic examination helps to clarify the location of the neoplasm and the features of its blood supply. The operating microscope makes it possible to examine the affected tissues under high magnification, improving the quality of diagnosis.

Robotic systems, in particular, the well-known Da Vinci robot, are considered the latest development of modern surgery. This device has not only standard manipulators, but also micro-instruments that allow you to operate in the surgical field with high accuracy. The video camera gives a color image in three-dimensional space in real time.

access points to the abdominal organs

The surgeon carefully operates the instruments, and the robot makes his movements even smoother and more precise, which makes it almost impossible to damage the vessels, nerve bundles and tissues in the area of ​​intervention, increasing the efficiency and safety of treatment.

Types of laparoscopic operations and indications for them

Depending on the goal pursued, laparoscopy can be:

1. diagnostic;
2. Medical.

In addition, the operation can be planned and emergency.

Diagnostic laparoscopy It is used to examine organs and tissues in cases where no non-invasive diagnostic method allows an accurate diagnosis. It is indicated for closed injuries of the abdominal cavity, suspected ectopic pregnancy, infertility of unknown origin, to exclude acute surgical and gynecological pathology, etc.

The advantage of laparoscopic diagnostics is the possibility of a more detailed examination of organs due to magnifying devices, as well as revision of even poorly accessible removed parts of the abdomen and pelvis.

Therapeutic laparoscopy it is planned with a specific goal - to remove an organ affected by the disease, a tumor, adhesions, restore reproductive function, etc. Diagnostic laparoscopy, if technically possible, can turn into a therapeutic one.

Indications for laparoscopy of the abdominal cavity are considered to be a variety of diseases of the internal organs:

• Acute and chronic cholecystitis, asymptomatic lithiasis in the gallbladder;
• Polyps, cholesterosis of the gallbladder;
• Acute or chronic inflammation of the appendix;
• Adhesions in the abdomen;
• Tumors of the liver, pancreas, kidneys;
• Trauma, suspected internal bleeding.

Laparoscopy in gynecology is performed especially often, which is associated with low tissue trauma and a lower probability of subsequent growth of connective tissue adhesions compared to the traditional operation. Many interventions are indicated for young women who have not given birth or who suffer from infertility, and additional trauma and adhesions can aggravate the course of the pathology, so laparoscopy for infertility is not only a valuable diagnostic procedure, but also an effective and less traumatic treatment.

In addition to laparoscopy, another method of minimally invasive diagnosis and treatment is also used in gynecology -. In fact, laparoscopy and hysteroscopy have the same goals - to clarify the diagnosis, take a biopsy, remove altered tissues with the least trauma, but the technique of these procedures is different. During laparoscopy, instruments are inserted into the abdominal cavity or pelvis, and during hysteroscopy, a flexible endoscope is placed directly into the uterine cavity, where all the necessary manipulations take place.

Indications for laparoscopy in gynecology are:

1. Infertility;
2. uterine fibroids;
3. Tumors and tumor-like lesions (cystoma) of the ovaries;
4. endometriosis;
5. Ectopic pregnancy;
6. Chronic pelvic pain of unknown etiology;
7. Malformations of the genital organs;
8. Chronic inflammatory processes in the pelvis;
9. Adhesive disease.

The above lists only the most common reasons for laparoscopic intervention, but there are quite a few of them. When the gallbladder is affected, minimally invasive cholecystectomy is considered the “gold standard” of treatment, and laparoscopy for infertility has both diagnostic value, allowing you to clarify its cause, and therapeutic value, when during the same intervention the surgeon establishes the nature of the pathology and immediately proceeds to its radical treatment .

Contraindications to laparoscopic access are not much different from those in open surgery. These include decompensated diseases of internal organs, blood clotting disorders, acute infectious pathology, and skin lesions at the site of alleged punctures.

Specific contraindications associated with the technical features of the method are considered to be long gestation periods, high obesity, a common tumor process or cancer of certain localizations, severe adhesive disease, diffuse peritonitis. Some of the contraindications are relative, while others are safer to do an open operation. In each case, the question of the appropriateness of minimally invasive access is decided individually.

Video: laparoscopy in the treatment of female infertility

Preparation for surgery and methods of anesthesia

Proper preparation for laparoscopy is no less important than with classical interventions, because minimally invasiveness does not negate the fact of tissue injury, albeit minimal, and general anesthesia, for which the body must also be ready.

After the surgeon has prescribed laparoscopy, the patient will have numerous examinations and consultations of narrow specialists. The list of procedures that can and should be done before hospitalization includes:

• General and biochemical blood tests;
• Urinalysis;
• Determination of blood clotting;
• Fluorography or X-ray of the lungs;
• Electrocardiogram;
• Testing for HIV, syphilis, hepatitis;
• Ultrasound examination of the abdomen and pelvis;
• Vaginal smears and cytology of the cervix during laparoscopy in gynecology.

To clarify the nature and localization of the pathology, various clarifying studies can be prescribed - CT, MRI, angiography, colonoscopy, hysteroscopy of the uterus, etc.

When all the examinations have been completed and there are no changes in them that prevent the planned laparoscopy, the patient is sent to the therapist. The doctor determines the presence of concomitant pathology and the severity of its course, if necessary, prescribes appropriate treatment or consultations of other specialists - an endocrinologist, a cardiologist, an oncologist and others.

The final decision on laparoscopy remains with the therapist, who determines the safety of further surgical treatment. Blood-thinning drugs are canceled approximately 2 weeks before the operation, and antihypertensive drugs recommended for continuous use, diuretics, hypoglycemic drugs, etc., can be taken as usual, but with the knowledge of the attending physician.

At the appointed time and with the results of diagnostic procedures ready, the patient comes to the clinic, where the surgeon talks to him about the upcoming operation. At this moment, the patient should ask the doctor all the questions that interest him regarding the course of the operation itself and the postoperative period, even if they seem stupid and frivolous. It is important to find out everything so that during treatment you do not experience groundless fears.

Without fail, on the eve of the laparoscopic operation, the anesthesiologist talks with the patient, determining the type of anesthesia, finding out what, how and when the patient takes medicines, what are the obstacles to the introduction of specific anesthetics (allergies, negative experience of anesthesia in the past, etc.).

Intubation anesthesia is the most appropriate for laparoscopic operations. This is due to the duration of the intervention, which can take up to an hour and a half or even more, the need for adequate anesthesia during manipulations in the abdomen, retroperitoneal space or pelvis, as well as the injection of gas into the body cavity, which can be quite painful under local anesthesia.

In very rare cases, and if there are serious contraindications to general anesthesia, the surgeon may go for local anesthesia if the operation does not take much time and does not require deep penetration into the body, however, such cases are still the exception rather than the rule.

Before the intervention, the patient must prepare for the upcoming pneumoperitoneum and the subsequent restoration of bowel function. For this, a light diet is recommended, excluding legumes, fresh pastries, fresh vegetables and fruits that provoke constipation and gas formation. Cereals, sour-milk products, lean meat will be useful. On the eve of the operation, a cleansing enema is performed, which removes everything superfluous from the intestines.

With laparoscopy in gynecology, there is a serious risk of thrombosis and embolism, therefore, elastic bandaging of the legs is indicated in the evening before the operation or in the morning. In case of danger of infection and bacterial complications, broad-spectrum antibiotics are prescribed.

Before any laparoscopic surgery, the last meal and water is allowed no later than 6-7 pm the day before. The patient takes a shower, changes clothes, with strong excitement, the doctor recommends a sedative or hypnotic.

Technique of laparoscopic intervention

The general principles of laparoscopy include the insertion of a laparoscope and trocars, imposition of pneumoperitoneum, manipulations inside the body cavity, removal of instruments and suturing of skin punctures. Before the start of the operation, to prevent the reflux of gastric contents into the respiratory tract, a probe is inserted into the stomach, and a catheter is inserted into the bladder to divert urine. The operated person usually lies on his back.

Before manipulations in the cavities, carbon dioxide or another inert gas (helium, nitrous oxide) is injected there with a special needle or through a trocar. The gas raises the abdominal wall in a dome-like manner, which makes it possible to improve visibility and facilitate the movement of instruments inside the body. Experts do not recommend the introduction of cold gas, which predisposes to injuries of the serous cover and a decrease in microcirculation in the tissues.

access points for laparoscopy

The skin before the introduction of instruments are treated with antiseptic solutions. The first hole in abdominal pathology is most often made in the umbilical region. A trocar with a video camera is placed in it. Examination of the contents of the abdominal or pelvic cavity occurs in a laparoscope equipped with a lens system, or through a monitor screen. Manipulators with instruments are inserted through additional punctures (usually 3-4) in the hypochondria, iliac regions, epigastrium (depending on the area of ​​the surgical field).

Focusing on the image from the video camera, the surgeon performs the intended operation - excision of the tumor, removal of the diseased organ, destruction of adhesions. In the course of the intervention, bleeding vessels are “soldered” with a coagulator, and before removing the instruments, the surgeon once again makes sure that there is no bleeding. Laparoscopically, it is possible to suture threads, install titanium clips on vessels, or coagulate them with electric current.

After the end of the operation, a revision of the body cavity is carried out, it is washed with warm saline, then the instruments are removed, and sutures are applied to the skin puncture sites. Depending on the specifics of the pathology, drains can be installed in the cavity or it is sutured tightly.

Laparoscopy makes it possible to remove large tumors or entire organs (uterine fibroids, gallbladder, pancreatic head cancer, etc.) through small holes. In order to make their removal to the outside possible and safe, special devices are used - morcellators, equipped with sharp knives that grind the excised tissue, which is placed in special containers for removal to the outside.

Hollow organs, for example, the gallbladder, are closed in advance in special containers, and only then they are opened to reduce their volume in order to prevent the contents from entering the free abdominal cavity.

Postoperative period and possible complications

Recovery after laparoscopy is quite fast and much easier than with classical open surgeries - this is one of the main advantages of the method. By the evening after the operation, the patient can get out of bed, and early activation is very welcome, as it helps to quickly restore bowel function and prevent thromboembolic complications.

Immediately after laparoscopy, the operated patient may feel pain at the injection sites, and therefore analgesics may be prescribed to him. As the gas is absorbed, discomfort from the abdomen disappears, and bowel function is restored. At the risk of infectious complications, antibiotics are indicated.

The first day after operations on the abdominal organs, it is better to refrain from eating, limiting yourself to drinking. The next day, it is already possible to take liquid and light foods, soups, dairy products. The diet is gradually expanding, and after a week the patient can easily switch to a common table if there are no contraindications for this due to a specific disease (postponed cholecystitis or pancreatitis, for example).

Stitches after laparoscopy are removed on the 7-10th day,but you can go home earlier - for 3-4 days. It is worth remembering that the healing of internal scars is somewhat slower, so for the first month you can’t play sports and hard physical labor, lift weights at all, and for the next six months - no more than 5 kg.

Rehabilitation after laparoscopy is quite easy due to less surgical trauma. After 1-2 weeks after treatment, depending on the characteristics of the pathology, the patient can return to his usual life and work. With water procedures - a bath, a sauna, a pool - you will have to wait a little, and if the work is associated with physical effort, then a temporary transfer to easier work is advisable.

Nutrition after laparoscopy has some features only in the early postoperative period, when there is a risk, albeit minimal, of intestinal paresis and constipation. In addition, the diet can be shown in the pathology of the digestive system, and then the attending physician will prescribe its features in the recommendations.

The food consumed after the operation should not be rough, too spicy, greasy or fried. It is important not to overload the intestines while the sutures are healing. Legumes, cabbage, confectionery products that provoke bloating and delayed bowel emptying are excluded from the menu. To prevent constipation, you need to eat sour-milk products, prunes, cereals with dried fruits, bananas are useful, and it is better to temporarily refuse apples and pears.

Laparoscopy is gaining popularity every year, and this method is preferred by doctors of different areas of medicine. Its implementation requires modern equipment that allows you to make accurate incisions and visually control the process in order to avoid erroneous actions of the surgeon.

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

Areas of use

Laparoscopy is a minimally invasive method of diagnosis and surgical treatment. In the process of its implementation, all surgical manipulations are performed through a small (about 10-15 mm) opening in the abdominal cavity using special tools. And to visualize what is happening during the procedure allows the laparoscope, which is equipped with a video system.

Most often, laparoscopy is resorted to when performing such operations:

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

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

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

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

Gynecological practice

In gynecology, a combination of hysteroscopy and laparoscopy often occurs when it is necessary to make an accurate diagnosis and immediately implement a number of therapeutic actions. So, hysteroscopy allows you to diagnose, take material for histological analysis, or immediately eliminate minor defects in the uterus (septa or polyps). And laparoscopy, unlike the first procedure, allows you to remove even tumors. It can completely replace abdominal surgery.

These diagnostic manipulations are indispensable when a woman is examined for infertility. If during hysterosalpinography obstruction of the fallopian tubes was confirmed, then, according to indications, under general anesthesia, laparoscopy of the hydrosalpinx is done. After its removal, the chances of successfully getting pregnant increase to 40-70%. If the removal of the tube was required, then the woman can resort to IVF.

Contraindications

With all its advantages, laparoscopy has a number of absolute and relative contraindications. It is absolutely impossible to perform such a procedure in such cases:

• acute blood loss;
• proliferation of connective tissue strands in the peritoneum;
• purulent cavities on the walls of the peritoneum;
• pain in the abdomen and severe flatulence;
• postoperative hernia at the site of the scar;
• severe cardiovascular pathologies;
• brain damage;
• liver and kidney failure;
• severe pathologies of the respiratory system;
• adnexal malignancies.

In addition, there are a number of other restrictions:

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

In such cases, laparoscopy is not completely excluded, but the best options are sought for each individual patient.

Preparing for the operation

If emergency laparoscopy is recommended, preparation is limited to cleansing the gastrointestinal tract with an enema and emptying the bladder. The most necessary tests are given - a clinical analysis of blood and urine, RW, they check the heart on an electrocardiogram and evaluate blood clotting on a coagulogram.

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

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

The success of the operation depends on compliance with the following rules:

• 3-5 days before the operation, it is forbidden to drink alcohol;
• within 5 days, take drugs that reduce gas formation;
• just before the operation, clean the intestines with enemas;
• on the day of laparoscopy, take a shower and shave the hair in the necessary places;
• no later than 8 hours before the operation, you should refrain from eating;
• empty the bladder 60 minutes before the laparoscopy.

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

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

Performing laparoscopy

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

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

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

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

Recovery period

The postoperative period, as a rule, passes quickly and without pronounced complications. After a few hours, you can and even need to move. You can drink and eat in the usual amount only in a day. The discharge from the surgery department takes place the next day. It hurts in the lower abdomen, as a rule, only the first 2-3 hours after the manipulation.

In some patients, the temperature rises slightly (37.0-37.5 ° C). If the operation was performed on the gynecological part, then spotting may be observed within 1-2 days. On the first day, patients may experience indigestion, and on subsequent days with a violation of the stool (diarrhea or constipation).

In the photo you can see postoperative scars

Patients who were examined in this way due to the inability to have children, may try to become pregnant as early as a month after the procedure. If a benign tumor was removed in the process, then you can try to conceive a child only after six months. Removal of sutures after laparoscopy is carried out after 7-10 days. The attending physician decides. If the seam does not heal for a long time, then the period may increase to one month, and throughout this time they should be properly looked after.

Laparoscopy- this is one of the types of modern surgical operations, when without an incision, with the help of optical instruments (gastroscope or laparoscope), the doctor can examine the organs from the inside. Laparoscopy, literally translated, examination of the abdominal organs.

There are diagnostic and operative laparoscopy.

Diagnostic laparoscopy is an operative research technique in which the doctor examines the abdominal organs with his own eye without making large incisions on the abdominal wall. During laparoscopy, you can directly see the woman's internal genital organs with the eye and, thanks to this, obtain comprehensive information about their condition. During diagnostic laparoscopy, after examining the organs of the abdominal cavity, the doctor confirms or rejects any diagnosis, or checks, for example, the patency of the fallopian tubes.

With operative laparoscopy, the doctor eliminates the detected pathological changes.

Laparoscopic gynecology is a new possibility for the effective treatment of gynecological diseases, which allows to shorten the recovery time as much as possible and does not leave cosmetic defects.

What operations can be done with laparoscopy?

With the help of laparoscopic access, it is possible to perform almost all operations that are performed in an open way, i.e. using a cut. These include: removal of various ovarian cysts, separation of adhesions and restoration of patency of the fallopian tubes, removal of nodes (with preservation of the uterus), removal of the uterine body and uterine appendages, as well as operations on the fallopian tubes for ectopic pregnancy.

The solution of some surgical tasks, such as the elimination of genital endometriosis, is generally impossible without the use of laparoscopy. This technology opened a new era in diagnostics and allowed to achieve a significant improvement in results. Timely detection and removal of ovarian cysts by laparoscopic access has significantly reduced the incidence of ovarian cancer. We can safely say that the degree of development and implementation of endoscopic equipment is the key to the quality of medical services provided. From this it is necessary to proceed when choosing a gynecological hospital.

How is laparoscopic surgery performed?

The surgeon makes 3 small punctures of the anterior abdominal wall 5 and 10 millimeters in diameter (as thick as a ballpoint pen). Unlike the traditional (laparotomy) incision of the anterior abdominal wall, which is 15 to 20 centimeters long, these punctures do not injure muscle tissue, so patients experience much less pain after surgery and can usually return to their normal life within one week. The puncture of the abdominal wall is carried out with a thin special tube - a trocar. Through it, a small amount of gas is introduced into the abdominal cavity (to create volume), a telescope tube, to which a special small video camera and a light source are connected. This allows you to view the image of the abdominal organs and the surgeon's manipulations during the operation on the screen of a special TV with high magnification and record the progress of the operation on a video recorder. Through the other two trocars, special instruments (manipulators) necessary for performing the operation are inserted into the abdominal cavity.

Diagnostic laparoscopy is usually performed under local anesthesia, operative - under anesthesia, and both last no longer than a conventional operation. Painful sensations in the area of ​​punctures disappear, as a rule, after 1-2 days, after which the patient does not experience discomfort, which is typical for the postoperative period of traditional surgical operations. The patient is discharged home 2-3 days after the operation, and it is possible to return to a full life after 5-6 days. However, medical supervision is necessary throughout the recovery period to avoid complications.

What are the advantages of laparoscopic surgery in gynecology?

The advantage of endoscopic operations is their low trauma, short stay of patients in the hospital (2-3 days), rapid recovery of health and ability to work after interventions. The operation under multiple magnification makes it possible to perform any surgical intervention more accurately and less traumatically. Minimal trauma to the anterior abdominal wall contributes to the rapid recovery of the functions of all organs and systems: respiration, activity of the cardiovascular system, motor-evacuation function of the intestines and bladder. During the healing period of the wound, there are no painful sensations, which eliminates the need to prescribe potent painkillers. In addition, there are no postoperative scars, which is observed in conventional incision operations.

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Contraindications for laparoscopy

Both diagnostic and operative laparoscopy may not be performed in all patients. The main contraindication to laparoscopy is a massive adhesive process in the abdominal cavity, associated with large abdominal operations, which the patient underwent in the past due to, for example, peritonitis, intestinal obstruction, etc. In this case, there is a high risk of life-threatening damage to the intestine during laparoscopy with severe consequences for the patient.

Another serious contraindication to laparoscopy is a pronounced violation of cardiac activity, tk. this operation is performed in the position of the patient upside down and when the abdominal cavity is filled with gas, which can cause decompensation of cardiac activity.

What are the possible complications after laparoscopy?

Complications after laparoscopy are rare, including bleeding as a result of trauma to the vessels of the abdominal wall and abdominal organs (with laparoscopy, as with any other operation, there is always a risk of damage to internal organs), perforation of organs, and infection.

Tests before laparoscopy. Expiry date of analyzes for laparoscopy operation

An approximate list of tests required for hospitalization:(if necessary, the scope of the examination can be expanded by your doctor)

On what day of the cycle is laparoscopy performed?

Laparoscopy operation is not performed during menstruation and 1-3 days before menstruation. It is also impossible to perform an operation against the background of acute inflammatory processes (ARI, herpes, etc.). The most optimal time for performing a laparoscopic examination for infertility is after ovulation (with a 28-day cycle - from the 15th to the 25th day of the cycle), and for some operations - the first phase of the cycle (immediately after menstruation).

Preparation for laparoscopy

It doesn't take much to prepare for laparoscopy. Depending on your age, gender and state of health, the doctor will prescribe a set of tests for you, including a blood test, ECG, X-ray, ultrasound, etc. Before the procedure, you must refrain from eating for 8 hours. You should tell your doctor what medications you are taking, as some medications are recommended to stop a few days before the laparoscopy (eg aspirin, ibuprofen, etc.)

Preparation of the gastrointestinal tract before laparoscopy:

1. During the week before the operation, exclude from the diet foods that cause the formation of gases in the intestines - legumes, black bread, potatoes, vegetables, fruits, unleavened milk. You can eat fish, lean meat, chicken meat, cottage cheese, kefir, cereals, broths.
2. 5 days before the operation, start taking activated charcoal 2 tablets after meals 3 times a day (you can use mezim-forte, festal, pancreatin, panzinorm).
3. Several cleansing enemas on the evening before the operation and one on the morning of the operation.
4. On the eve of the operation for lunch - only liquid food (first and third courses), for dinner - only drink. On the day of the operation, you can not eat or drink.

Preparation of the area of ​​operation before laparoscopy

On the morning of the operation, you need to take a shower, shave off the hair in the navel, lower abdomen and perineum.

Psycho-emotional preparation before laparoscopy

A few days before the operation, it is advisable to start taking herbal sedatives (valerian, motherwort, persen).

Contraception before laparoscopy

In the cycle in which the operation is performed, it is necessary to protect against the onset of pregnancy by non-hormonal means (condom).

After laparoscopy

Compared to conventional surgery, laparoscopy is less traumatic (muscles and other tissues are less damaged). For this reason, there are fewer restrictions on your physical activity than you might expect. Walking is allowed and even encouraged within a few hours after the operation. Start with small walks, gradually increasing the distance and duration. There is no need to follow a strict diet. Pain medications should be taken as directed by your doctor.

Laparoscopy is a gentle method of surgical treatment, in which access is made through punctures on the anterior wall of the abdomen. This reduces the recovery period, and the operation itself is less traumatic. It is used in abdominal surgery, gynecology.

The use of laparoscopy in gynecology

Gynecologists perform laparoscopic operations for both diagnosis and surgical treatment. In some cases, diagnostic laparoscopy can turn into therapeutic or even laparotomy. For example, initially there is a suspicion of an ectopic pregnancy. When the laparoscopy surgeon finds such a diagnosis, he will proceed to remove the tube.

Indications

Laparoscopy is performed both planned and emergency.

Indications for emergency surgery

1. Ovarian cyst with torsion, cyst rupture.
2. Diagnosed tubal pregnancy.
3. Necrosis of uterine fibroids.
4. Traumatization of the uterus during medical manipulations.
5. Purulent formation in the pelvic cavity.
6. Diagnosis in acute abdominal pain.

Indications for planned operations

1. A tumor-like formation in the ovaries, tubes or uterus.
2. Taking tissue for histological and cytological examination (biopsy).
3. Suspicion of an ectopic pregnancy.
4. Suspicion of congenital anomalies in the development of internal genital organs.
5. Examination for patency of the fallopian tubes.
6. Monitoring the dynamics of the disease in the course of treatment.
7. Surgery for uterine fibroids, endometriosis, polycystic ovaries, to remove the tubes or ligate them, adhesions in the pelvic cavity.

The operation can also be performed for the purpose of differential diagnosis. This may be necessary when laboratory and instrumental research methods do not allow an accurate diagnosis and determine the cause of complaints.

Contraindications

Preparing for the operation

The main list of mandatory examinations is as follows.

• Clinical blood and urine tests.
• Blood test for biochemistry, coagulogram, Rh factor and group affiliation, HIV, viral hepatitis, RW.
• Fluorography of the chest organs.
• Electrocardiography with decoding.
• Conclusions of the therapist and gynecologist.
• Research on worm eggs.
• Ultrasound of the pelvic organs.

Additionally, other analyzes and consultations of narrow specialists may be prescribed.

Immediately before the operation, the patient is examined by an anesthesiologist and a gynecologist. The type of anesthesia is selected, the dosage of the drug, taking into account age, body weight and height. On the evening before the operation, you can only drink water. Eating is prohibited. In the evening and in the morning, a cleansing enema is done.

With a planned operation, the date is assigned taking into account the menstrual cycle. During menstruation, bleeding is increased, so even laparoscopy is contraindicated. The best option is the middle of the cycle. Normally, ovulation already occurs at this time. With infertility, this is especially important, so the doctor can see if ovulation has occurred or not, and, if not, what has become an obstacle.

During an emergency operation, the most necessary tests are made - blood and urine, for clotting.

How is the operation

The surgeon makes several incisions. The first step is to supply carbon dioxide to the abdominal cavity, which is necessary to improve visibility. A laparoscope is inserted into one of the punctures - a tube with a video camera. The image from the camera is displayed on the monitor. The doctor thus performs all the necessary manipulations with maximum accuracy.

Surgical instruments are inserted into other punctures.

Postoperative period

The rehabilitation period is easier and faster than with laparotomy. Immediately after waking up, a woman can move, roll over. On the same day, she can get out of bed and walk as much as possible. Such motor activity will help prevent adhesions and intestinal paresis.

If everything goes well, the next day the patient is discharged home.

On the day of the operation, only drinking is allowed. Over the next 2-3 days, liquid food is allowed in small quantities. Gradually, the diet expands. A detailed meal plan is displayed in the statement. During the week, the patient should limit physical activity, she should not lift weights. In a week she can go to work.

Possible Complications

1. Damage to the vessel and intra-abdominal bleeding.
2. Damage to the intestinal wall, bladder.
3. Entry of gas into a blood vessel.
4. Entry of gas under the skin, into the pleural cavity.
5. Purulent-septic complications.

Fortunately, these complications are extremely rare. Experienced surgeons perform all their actions clearly, calmly, conduct an audit of the organs until they "exit" from the abdominal cavity and suturing.

The long-term consequences of surgery are adhesions. They lead to impaired bowel function, pain, and infertility. Adhesions can be prevented by adequate antibiotic therapy and the use of enzyme preparations.

Benefits of laparoscopy

When can you plan a pregnancy?

If the operation is planned, the menstrual cycle does not suffer and the next menstruation comes on time. And you can plan a pregnancy in a month, but it all depends on the reason for the operation and the condition of the woman. In some cases, for example, when removing an ovarian cyst or fibroids, you need a long recovery time, and in these cases you need to protect yourself for six months or even more.

If laparoscopy is performed for infertility, IVF can be planned no earlier than in 2-3 months. Your doctor will tell you the exact date.