Diagnostic laparoscopy of the abdomen in gynecology
Diagnostic laparoscopy – a minimally invasive surgical procedure used to diagnose diseases of the abdominal cavity. The particular effect it has in gynecology and emergency surgery. The method allows the surgeon to visually assess the condition of the abdominal cavity, internal organs, and if necessary – to perform surgical interventions (cessation of bleeding, removal of tumors, excision of tissue, etc.). Therapeutic-diagnostic laparoscopy for patients to tolerate much easier than a laparotomy, in which produce a large incision in the abdominal wall. Proper appointment procedures in accordance with the indications and contraindications allows to minimize the risk of complications. In any case, such surgery should be made only after a proper medical examination of the patient and consultation with your doctor.
Endoscopic laparoscopy allows to identify diseases of the organs of the abdominal cavity in the early stages of their development with minimal harm to the human body.
Diagnostic laparoscopy is performed under strict indications. These include:
- This kind of is the best diagnostic for identifying benign and malignant tumors in the abdominal cavity, especially if we are talking about lesions of the uterus, fallopian tubes and ovaries. You have the ability to biopsy suspicious of education for subsequent morphological analysis and accurate diagnosis.
- Laparoscopic research is widely used in gynecology for diagnostic and therapeutic purposes. For example, using this method you can easily identify endometriosis, ectopic pregnancy or the development of inflammatory processes in the uterus and its appendages.
- In addition, endoscopic examination is the gold standard to identify the causes of infertility if you suspect her connection with infectious lesions of the uterus and its appendages, or fibrosis of the fallopian tubes.
- Diagnostic laparoscopy allows easy identification of the damage in the abdominal cavity and assess the extent of the pathological process.
- In some cases, with the help of this method, carried out the tubal ligation procedure for sterilization of women.
- Such a diagnostic method allows easy to go for surgical treatment due to the introduction of additional laparoscope into the abdominal cavity. It can help in the treatment of cholecystitis, appendicitis, torsion of the ovarian vessels, etc.
- Laparoscopy is used in gynecology to detect causes of chronic pelvic pain.
A contraindication to the procedure is the decompensation of the vital functions. In all other cases, laparoscopy can be carried out. The attending physician together with a surgeon selects a volume of the procedure and its completion.
Preparation of the patient for examination
The most important item in the safety and high informativity of this method of examination is careful preparation of the patient, which begins with informing the person’s medical treatment, ending mandatory signing of a consent form for the implementation of laparoscopy.
Psychological preparation is a critical step in the preparation of the patient for the procedure.
It is very important that the patient told the doctor about the allergic reactions to medications, hemostasis disorders or pregnancy. All this allows to significantly improve the prognosis for the procedure.
Preparation for the examination does not take much time and is quite simple:
- For 12-14 hours before examination the patient should give up drinking and meals. Such restrictions help to avoid nausea and vomiting during the manipulation and after it. If the patient is forced to regularly take any medication, then information about them must be clarified with the attending physician.
- All accessories (glasses, jewelry, contact lenses, dentures) must be removed prior to the operation. After it has all the things you will definitely return.
- If you want to carry out additional cleaning of the colon, using special drugs (Fortrans, etc.).
Adherence to simple rules to minimize the risk of complications from the laparoscopy and to the most reliable results, which plays a critical role in diagnosis and prescribing the best treatment.
Endoscopic laparoscopy performed in the operating room, a surgeon or gynecologist. The main method of anesthesia is General anesthesia, but in some cases can be used, and spinal anaesthesia, in which the patient retains consciousness. A specific method of anesthesia is chosen by the attending physician.
One hour prior to the examination it is necessary to empty the bladder. After this pre-medical training of a person and is performed under General anesthesia.
On the anterior abdominal wall, the surgeon makes a small incision(one to two centimeters). It is produced through the introduction of a laparoscope and a special needle used for supplying carbon dioxide into the abdominal cavity. Gas is necessary for straightening the abdominal cavity, which allows you to better see its walls and internal organs. After this the attending physician using a laparoscope, with an installed video camera and a light source to carefully examine the contents of the abdominal cavity, first and foremost, the internal organs (loops of the small and large intestine, liver, gall bladder, uterus, fallopian tubes and ovaries). If you want to do a biopsy or therapeutic intervention, the use of additional manipulators, inserted through additional punctures in the abdominal wall.
After the procedure the gas is released, and the existing holes in the abdominal wall is sutured carefully. This procedure has good cosmetic effect, as it does not leave big scars.
The average duration of the examination was 20-80 minutes, depending on its purpose and the detected changes. After the procedure is finished, the patient stays in the medical hospital for a few days during which monitored by medical staff.
Possible risks and complications
Despite the fact that this method of examination of the abdominal cavity for minimally invasive, yet can be some complications:
- Bleeding from incisions in the abdominal wall.
- Infectious complications associated with the introduction of infection into the skin and into the abdominal cavity.
- Damage to internal organs and blood vessels.
With the development of such complications, the operation stops and begins their treatment, with a possible transition to laparotomy. With the development of purulent-inflammatory complications performed surgical treatment of the wound and prescribed antibiotics.
Prevention of complications is possible with the rules of preparing a person for examination, and in compliance with equipment procedures.
The advantages and disadvantages of the procedure
Laparoscopy has certain positive and negative sides, which is very important to mention. The advantages of this survey technique include:
- Low traumatic procedure for the patient, which is associated with minimal soft tissue of the abdominal wall and internal organs.
- The cosmetic effect after surgery: scars are absent.
- Pain, as a rule, is not observed.
- The short duration of inpatient hospitalization and shorter period of disability that allows a person to quickly return to their normal life.
- The almost complete absence of blood loss.
- The high level of sterility, as the abdominal cavity is entered only sterile laparoscope.
- The possibility of combining the diagnostic procedure with the therapeutic effect.
However, the method has disadvantages, the most important of which is the need for General or spinal anesthesia. In addition, in some cases, after the intervention according to the type of laparoscopy, surgeons have to carry out laparotomy in connection with the need for broad access to the damaged organ.
Thus, laparoscopy is a modern method of minimally invasive examination of the abdominal cavity and internal organs. Undertaking such a procedure has a low risk of early and late complications, as well as a high degree of information content necessary for accurate diagnosis.