Diagnostic laparoscopy: surgery
The degree of effectiveness and accuracy of diagnostic laparoscopy is one of the best methods. Currently, she is subject to a pathology that would require a determination of the nature of their formation and appointment follow-up treatment. This is made possible through the use of videoendoscopes (laparoscope) devices, allowing to see the subject on the screen with magnification several times.
The scope of
Diagnostic laparoscopy is usually assigned when there are difficulties in accurate diagnosis on the basis of other preliminary studies, as it allows you to perform many actions:
- to estimate with high accuracy the condition of the inspected bodies;
- to establish the presence of adhesions, cysts, tumor of the phenomena, to reveal their sizes, location;
- to diagnose fallopian tube, by setting the degree of their permeability, as well as quickly identify an ectopic pregnancy;
- to identify the extent of endometriosis, abnormal proliferation of the endometrium – the inner covering of the uterus;
- to clarify the root cause of pain and appeared uncomfortable manifestations in various organs of the abdominal cavity.
The advantages and possible disadvantages
Properly conducted diagnostic laparoscopy has significant advantages, if compared with other traditional common survey methods:
- The physician visually observes all the internal organs, which is important for determining the nature of the pathology.
- A unique opportunity of collection of material for subsequent laboratory study.
Of course, laparoscopy has the character of rapid penetration into the inner tissues. Compared to ultrasound, it will be more time-consuming and associated with some pain manifestations and the necessity of following the doctor’s advice during the healing period of cuts. But such inconveniences kompensiruet accuracy of diagnosis.
Assigned to diagnostic laparoscopy for different types of medical settings.
- neoplastic phenomena in the ovaries;
- genital endometriosis;
- uterine fibroids;
- Osmania persistent pain localized in the lower abdomen.
- apoplexy (rupture) ovarian;
- the need to confirm or exclude torsion legs, and possible gap formation in the form of ovarian tumor;
- ectopic pregnancy;
- acute inflammatory pathology in the area of the pelvis.
Preparation for the procedure
In their specificity, diagnostic laparoscopy at the stage of preparation involves the passage of several mandatory surveys, to prevent negative consequences. There are several groups of factors that may serve as a pretext to abandon the laparoscopy or postponing its implementation.
Absolute contraindications precluding surgery include negative state of the body:
- the onset of decompensation in the presence of pathologies of the respiratory or cardiovascular system;
- hemorrhagic shock;
- complex disturbances, leading to insufficient blood clotting;
- changes in the blood vessels of the brain due to injuries or diseases that do not allow the patient to take the desired Trendelenburg position (pelvis above the head) during the examination;
- hepatic (or renal) failure – chronic and acute;
Relative contraindications that affect the decision of a doctor about the feasibility of diagnostic laparoscopy:
- polyvalent Allergy, that is manifesting in a complex of allergens.
- spilled infectious peritonitis;
- more than 16 weeks of pregnancy;
- extensive adhesions as a result of the operations.
Are contraindications recent colds or disease of an infectious nature. It will take time after his recovery, which is about a month.
In the conversation that precedes diagnostic procedure, the physician explains in detail the essence of the intervention, characteristics, algorithm execution, purpose, and possible complications. If diagnostic laparoscopy refers to the planned effects, the preparation includes the transition on the eve of a light diet, including the final evening reception of liquid food, and assigned enema. Morning drinking is impossible.
The first stage of diagnosis
All manipulations with the diagnostic tools occur in a limited internal space in the body, so at the first stage, measures are taken for its expansion. This is done in 2 ways: automatic admission of increase of the operated cavity and pneumoperitoneum.
This allows the condition of the patient, in the practice of physicians used the technology of creating of pneumoperitoneum through the introduction of carbon dioxide or nitrous oxide (may also be used helium or argon). There are several methods of delivery of gas through the trocar or Veress needle. The most widely carbon dioxide due to non-toxicity, good absorption by the tissue. It does not cause unwanted discomfort, does not irritate the skin and quickly dissipates. Almost the same figures of nitrous oxide.
It should be noted that pneumoperitoneum has side effects:
- circulatory disorders of the feet due to the crushing of the venous vessels;
- introduction imbalance in the normal functioning of the arterial blood flow;
- decrease of lung capacity due to the compression of the diaphragm;
- irregular heart rhythms.
When bezguzova technique – laperriere, the abdominal wall, to increase the amount raised through the use of different devices. It is indicated if there is cardiac and vascular disease and — hypertension stage II – III. The disadvantage may be the not enough ample space to conduct an adequate diagnosis. Qualified doctors have to include all the negative aspects, so they can cause complications.
Methodology of diagnostic research
The number of trocars depends on the goal. If you completely investigated the whole abdominal cavity, the laparoscope is first introduced into the upper sector to explore the aperture, to perform a stomach condition. Then surveyed other departments; evaluated all pathological formation, adhesions, inflammatory foci. If the algorithm is part of diagnostic examination of the small pelvis, it introduced additional trocars.
Possible complications after diagnostic procedures
The specific negative consequences specific to the laparoscopy include complications.
- Extraperitoneal the insufflation, manifested in the wrong use of the Veress needle; in the penetration of gas, in addition to the abdomen, in the fat layer under the skin (subcutaneous ephysema), and in other tissues.
- The application of various damage, such as perforation of the vessels of the abdominal wall, retroperitoneal major blood channels or wounding any parts of the gastrointestinal tract.
- Sometimes there is a heavy condition – gas embolism if a gas through a Veress needle falls directly into a major vessel.
If any of these situations are taken immediate measures to remedy the problem.
Prevention of complications
To minimize the risk of complications, it is necessary to observe a number of preventive measures that include proper and thorough preparatory examinations before the diagnostic laparoscopy, with an analysis of all contraindications. At the time of the doctor the scope of the study should be sufficiently free for the manipulation of optical devices and provide a visual overview, and all the tools must be in good condition.
In any case, you must understand that such kind of diagnosis becomes one of the dominant contributing to further healing, as it allows you to make an accurate diagnosis.