It is very strange to see how many women still do not know that now most operations can be performed in a gentle way, without an incision, with a short recovery period and with a minimal likelihood of adhesions and relapses. Currently, most operations are performed by a (minimally invasive) laparoscopic approach.
In this section, we will be able to answer some questions:
So what is laparoscopy?
- this is an examination of the abdominal cavity through a hole in the abdominal wall using the optical system of the laparoscope. The operation is carried out under the control of an endovideo camera, the image from which is transmitted to a color monitor with a sixfold increase, using special tools inserted inside through small holes - punctures with a diameter of about 5 mm.
The laparoscope is a metal tube with a diameter of 10 or 5 mm with a complex system of lenses and a light guide. The laparoscope is designed to transmit images from the cavities of the human body using lens or rod optics and having a rigid outer tube. The laparoscope is the first link in the image transmission chain. In the general case, the laparoscope consists of an outer and an inner tube, between which an optical fiber is laid to transmit light from the illuminator into the body cavity. The inner tube contains an optical system of miniature lenses and rods.
Endocamera designed to display a color image of the surgical field from various endoscopic devices - laparoscopes, cystourethroscopes, rectoscopes, hysteroscopes, flexible endoscopes, etc. during surgical operations and diagnostic manipulations.
A bit about the history of the development of laparoscopy
In our country, as well as throughout the world, the development of laparoscopy continues. Unfortunately, in the outback, such operations are still the exception, not the rule, although laparoscopy has existed in the world for more than 100 years.
The first experience of laparoscopy was described as early as 1910, and until the middle of the twentieth century, laparoscopy was diagnostic in nature, it developed, more and more sophisticated equipment was created, and safe lighting systems were developed.
- Consultation of Doctor of Medical Sciences, Professor of Obstetrician-Gynecology
- Preoperative examination in 1 day!
- Expert ultrasound of the pelvic organs with dopplerometry
- Conducting simultaneous operations by combined teams, if necessary (gynecologists, urologists, surgeons)
- Postoperative management
- Histological examination in the leading institutions of Russia
- Consultation on the results and selection of preventive measures
- Preconception preparation
Laparoscopy is one of the methods of operative gynecology (and surgery in general), which allows you to do without a layer-by-layer incision of the abdominal wall. To access the operated organs, the doctor makes small punctures no larger than 5-7 millimeters, which heal quickly after the intervention. During the operation, a special device is introduced into the problem area - a laparoscope, which is a flexible tube equipped with a lens system and a video camera.
The video camera displays a 40 times enlarged image on the monitor, which allows the surgeon to examine the reproductive organs, which are inaccessible during a normal gynecological examination. With the help of a clear image on the monitor, the specialist is able to identify violations and conduct surgical treatment.
Before the invention of the laparoscope, surgeons were forced to operate through a large incision that took a long time to heal in order to examine the problem area in detail. And now, thanks to gynecological laparoscopy, the patient most often gets the opportunity to return home the very next day after the operation - in most cases, there is no need for long-term hospitalization.
Types of laparoscopy
Diagnostic laparoscopy is used to clarify the diagnosis and develop treatment tactics. With the help of a laparoscope, you can notice abnormalities that are not always visible during an ultrasound scan. There is also a therapeutic or therapeutic-diagnostic laparoscopy, when the doctor simultaneously assesses the condition of the internal reproductive organs and performs surgical treatment.
If a planned laparoscopy is possible, the patient can choose a clinic and a doctor she trusts in advance. If an emergency operation is necessary, the situation is different: the intervention is performed as quickly as possible and most often in the first available clinic. Therefore, if there are indications for a gynecological operation, it is better not to waste time and not expect self-healing, but take care of choosing a clinic and a doctor in advance.
Remember: laparoscopy in gynecology is a fairly serious intervention that requires highly qualified operating surgeon and anesthetist, as well as modern equipment in the operating room. Many public and little-known private clinics employ specialists who do not have sufficient experience in performing laparoscopic interventions. They also do not have the opportunity to use high-quality laparoscopes. All this often leads to the fact that the operation, which was originally planned as a laparoscopic one, in the process becomes a general abdominal one, when the doctor cannot cope with the laparoscope and is forced to make large incisions in the abdominal cavity.
If you do not want to risk your health and strive for a successful laparoscopic operation and do not require long-term rehabilitation, contact only reliable clinics that have been on the market for many years and have managed to win the trust of patients during this time.
Indications for laparoscopy in gynecology
Most often, laparoscopy is prescribed for the diagnosis and treatment of the following diseases and conditions:
- anomalies in the development of the reproductive organs;
- endometriosis;
- uterine fibroids;
- obstruction of the fallopian tubes;
- tumor neoplasms, including cysts;
- ovarian diseases, including polycystic;
- emergency gynecological pathology (ectopic pregnancy, cyst rupture);
- inflammation of the appendages;
- infertility of unknown origin.
Also, laparoscopy is required before planning IVF (in vitro fertilization), with chronic pelvic pain, if necessary, biopsy of the ovaries and uterus, as well as in order to monitor the results of previous treatment. In all possible cases, organ-preserving operations are performed, after which the woman will be able to have children.
Preparation and conduct of laparoscopy in gynecology
Before laparoscopy, it is necessary to pass a number of laboratory tests and studies, including an ECG, pelvic ultrasound, urine and blood tests, and a vaginal swab.
A few days before the operation, it is necessary to limit the use of foods that cause increased gas formation. On the eve of the intervention, it is necessary to do a cleansing enema.
During the operation, after the application and the onset of anesthesia, the doctor makes small punctures in the navel and above the pubis, after which he inserts a laparoscope there. Preliminary, carbon dioxide is injected into the abdominal cavity, which is harmless to the body and allows you to better view the internal organs. Next, the specialist conducts diagnostics and surgical treatment. After that, the punctures on the skin are sutured with cosmetic sutures.
Properly performed gynecological laparoscopy is accompanied by minimal blood loss (no more than 15 ml), leaves practically invisible puncture sites after their healing and does not impair the function of the reproductive organs.
The editors thank ON CLINIC for their help in working on the material.
Gynecology has come a long way since laparoscopic surgery has become possible in any clinic. This method of surgical intervention made it possible to fight many problems and diseases that could not be eliminated in the usual way before. Laparoscopy in gynecology is so low-traumatic and safe that it has long moved from the category of surgical interventions to the number of diagnostic methods.
Laparoscopic diagnosis and treatment of problems associated with infertility has the most positive feedback from both patients and surgeons.
Every year, thousands of women get the opportunity to experience the joy of motherhood thanks to the opportunity to study the condition of the reproductive organs and eliminate adhesions, cysts, endometriosis foci and other problems that interfere with natural conception. If you watch a video of such an operation, you will see that high technologies are already being successfully used in treatment. Through tiny incisions, the doctor can remove the terrible diagnosis “infertility” from your life in just an hour.
Laparoscopy in gynecology has an incomparably greater number of pluses than minuses. First of all, it is minimal trauma, in the video and photos from medical sites you will see that the scars from this operation are barely noticeable. These three small holes are 0.5-1 cm in size and arranged in a triangle. The upper incision is often made in the navel, so it is not visible at all, and the two lower scars will be hidden by underwear or a swimsuit. Inside the cavity, the damage from the operation is also minimal, because through special optics, the doctor on the video sees exactly where to start working with a scalpel.
Compared to abdominal surgery, where you often have to cut at random, not knowing exactly where to look for the problem, the laparoscope has become just a magic wand that allows you to get by with a little blood - literally and figuratively. Thanks to him, you can avoid large tissue incisions to get to your destination. And this means that not only will there be less pain, but significantly less blood will enter the abdominal cavity during the operation, so the risk of adhesions during the healing process will be much lower.
The second advantage of laparoscopy is a very short rehabilitation period. After a routine exploratory surgery or adhesion dissection procedure, you may be discharged from the hospital as early as 3-4 days. More serious surgeries, such as removal of an ectopic pregnancy, tumors, fibroids, or pelvic organs, may require a longer stay under medical supervision. But anyway, you will be discharged in no more than 6-10 days, and you will start getting up and walking the next day. But it's not just about the timing, although they are important in our busy time.
The main thing is that pain after laparoscopy is several times less than after abdominal surgery. In a few weeks, you will already feel like a completely healthy person, although there are still some restrictions. For example, for several months you can not lift weights or play active sports in order to avoid divergence of the seams. According to the majority of patients, within a week after discharge, they returned to their normal daily routine.
Another plus of such a quick recovery and low trauma during laparoscopy is the ability to plan a pregnancy in 1-3 months, while after abdominal surgery it is recommended to protect yourself for at least 6, and sometimes 12 months. Although here the period of protection may be slightly longer, it is determined by your surgeon based on the nature of the operation performed and the state of your body.
And last but not least, the advantage is the convenience of the laparoscope for the surgeon. All internal organs are perfectly visualized on the video, the doctor can accurately determine the problem and eliminate it as accurately as possible. During the operation, accurate diagnoses are made, sometimes problems are revealed that were not shown by any examination. For example, during a planned operation to cut the surface of a polycystic ovary, the surgeon can detect adhesions and cut them so that they do not interfere with conception and do not become a risk factor for ectopic pregnancy.
What are the disadvantages of this operation?
Among the disadvantages of laparoscopy, one can first of all name the risk of adhesion formation. Even such a minimally invasive operation is still a surgical intervention. Incisions, small blood leaks, the natural inflammatory process that accompanies surgery, and some other factors lead to the formation of adhesions. To avoid the occurrence of adhesions, you need to fulfill all the surgeon's prescriptions: take anti-inflammatory and absorbable drugs, be sure to undergo a course of physiotherapy and do not forget about sports, or at least about exercises and hiking. This whole set of measures is aimed at preventing the formation of new adhesions.
General anesthesia also does not have a very beneficial effect on the body, it is not in vain that it is done only in case of emergency and is selected individually. After anesthesia, complications at work are possible:
- gastrointestinal tract;
- cardiovascular;
- nervous systems;
- skin reactions.
There is a risk of complications with any method of treatment, even with medication, to say nothing of surgical interventions. All organisms are different, and surgeons are not gods, and cannot accurately predict and guarantee the result. There is always the possibility of adverse reactions, but you should be reassured that there are hundreds of thousands of reviews of happy patients about laparoscopy and the statistics of this operation indicate a minimal risk of unpleasant consequences.
Therefore, the decision on the operation should be made carefully and based on the ratio of the expected benefits and possible risks. It is worth consulting several doctors and comparing their recommendations in your particular case.
Of course, now we are talking about laparoscopy as a diagnosis or to eliminate adhesions and cysts, which can be treated with medication. If you need to eliminate the fetal egg during an ectopic pregnancy, remove tumors or organs, then the choice will definitely be in favor of laparoscopy before abdominal surgery.
In cases where surgery is required for medical reasons and there is a choice between laparoscopy and abdominal surgery, most doctors recommend laparoscopy, and this is not surprising, given all the benefits. If an operation is to be performed, it is better to carry it out with the least risk to the patient's health.
But what if laparoscopy is recommended solely for diagnostic purposes? Still, this is a rather serious operation, which has its own risks and consequences. Say, if you just need to check the patency of the fallopian tubes, then it is quite possible to get by with metrosalpingography.
If we are talking about a comprehensive examination, when the presence of adhesions has already been established, there are suspicions of:
- cysts;
- fibromas;
- fibroids;
- endometriosis;
or other diseases that are difficult to detect during external examination, then the operation makes sense.
Laparoscopy is often prescribed as a diagnostic tool for unexplained infertility or mixed problems, such as adhesions and endometriosis together, as well as for chronic pelvic pain and severe menstrual irregularities.
What is this operation - laparoscopy in gynecology? This is a minimally invasive surgical intervention in which a layer-by-layer incision is made in the anterior wall of the peritoneum. It is carried out using special endoscopic (optical) equipment in order to study the organs located in the abdominal cavity. Thanks to its introduction into practice, the possibilities of specialists in the urological, gynecological and general surgical areas are significantly expanded. Much experience has been accumulated so far showing a much easier and shorter recovery after laparoscopy compared to the traditional laparotomy approach.
What is laparoscopy in gynecology? More on that below.
Use of the method in the field of gynecology
Laparoscopy in the gynecological field has become very important. It is used both for the diagnosis of various pathological conditions, and for surgical therapy. According to various sources, in many gynecological departments, approximately 90% of the operations performed are performed through this access. For example, laparoscopy of uterine fibroids.
When is the operation performed?
There are such types of diagnostic laparoscopy as emergency and planned.
For routine diagnostics, there are the following indications:
- Tumor-like formations of unknown origin in the ovarian region.
- The need for differential diagnosis of the resulting tumor of the internal genital organs and intestines.
- A biopsy procedure that is performed for polycystic ovary syndrome or other tumors. Indications for laparoscopy in gynecology are very extensive.
- With the possibility of an ectopic unbroken pregnancy.
- A study of the patency of the uterine tubes, which is performed to determine the cause of infertility (if it is impossible to diagnose using more gentle methods).
- Clarification of the presence and characteristics of abnormal signs in the development of internal genital organs.
- Establishing the stage of the process of a malignant nature, thanks to which the question of the possibility and extent of surgical intervention is decided.
- Differential study of chronic pelvic pain in endometriosis with other pain of unknown etiology.
- Monitoring in the dynamics of the effectiveness of therapy for inflammation processes in the pelvic organs.
- The requirement for control in order to maintain the integrity of the uterine wall during hysteroresectoscopic operations.
What is laparoscopy in gynecology?
When is the emergency?
Such emergency diagnosis is carried out in the situations described below:
- If perforation of the uterine wall with a curette is expected during the procedure of diagnostic curettage or instrumental abortion.
- If there is suspicion of torsion of the cyst leg, myomatous subserous node or ovarian tumor; ovarian apoplexy or cyst rupture; tubal pregnancy of a progressive nature or ectopic pregnancy with violations in the form of tubal abortion; necrosis of the myomatous node; pyosalpinx, tubo-ovarian inflammatory formation, especially with destruction of the uterine tube and the occurrence of pelvioperitonitis. In these cases, it is carried out very often.
- If within 12 hours the symptoms intensify or for two days there is no positive dynamics in the treatment of an acute inflammatory process in the uterine appendages.
- Pain in the acute form in the lower abdomen, of unknown origin, as well as the need for differential diagnosis with perforation of the ileum diverticulum, with acute appendicitis and necrosis of the fat suspension, with terminal ileitis.
Transition to medical
After the diagnosis is clarified, often diagnostic laparoscopy develops into a therapeutic one, when laparoscopic removal of the uterine tube, ovary is performed, when the uterus is perforated, sutures are applied to it, with necrosis of the myomatous node - emergency myomectomy, dissection of abdominal adhesions, resumption of patency of the fallopian tubes, etc. P.
Elective surgeries, in addition to some of those listed above, are tubal ligation and plastic surgery, therapy for polycystic ovaries and endometriosis, elective myomectomy, hysterectomy, and a number of others.
However, not everyone knows what laparoscopy in gynecology is.
The operation is performed under general anesthesia, in connection with which, during the preparation of the patient, the anesthesiologist and the operating gynecologist, and, if necessary, also other specialists are examined, which depends on the simultaneous presence of other pathologies or doubtful questions regarding the diagnosis of the underlying disease (urologist, surgeon, therapist, etc.). ).
In addition, additional instrumental and laboratory studies are assigned. Before laparoscopy, the same mandatory tests are performed as before other surgical interventions, that is, general urine and blood tests, a biochemical study of the blood composition, which includes the content of electrolytes, glucose, prothrombin, etc., a coagulogram, identification of the patient's blood group and Rhesus -factor, tests for hepatitis, syphilis and HIV.
A fluorographic examination of the chest is also carried out, if necessary, repeated ultrasound of the pelvic organs, electrocardiography. Before the operation in the evening it is forbidden to eat, and on the day of the operation in the morning - both food and liquid. In addition, a cleansing enema is done in the evening and in the morning.
When performing laparoscopy for emergency indications, the number of examinations is limited only by general blood and urine tests, coagulogram, electrocardiogram, determination of the Rh factor and blood type. Other analyzes are carried out only if necessary. The method of laparoscopy in gynecology is now used more and more often.
Two hours before the emergency operation, it is forbidden to drink liquids and eat food, a cleansing enema is performed, if possible, the stomach is also washed with a probe to prevent regurgitation of its contents into the respiratory tract during induction anesthesia, as well as vomiting.
Contraindications for laparoscopy
The operation is not performed when:
- diseases of the respiratory and cardiovascular systems;
- hemorrhagic shock;
- ovarian cancer;
- stroke
- myocardial infarction;
- poor clotting;
- fallopian tube cancer;
- liver and kidney failure;
- coagulopathy, not amenable to correction.
Laparoscopy is directly related to the woman's menstrual cycle. During menstruation, tissue bleeding is very high. That is why a planned operation is usually carried out at any time after five to seven days from the start of the last menstruation. When performing laparoscopy of uterine fibroids on an emergency basis, the presence of menstruation does not act as a contraindication, but is taken into account by the anesthesiologist and surgeon.
Features of direct preparation for surgery
With laparoscopy, general anesthesia can be performed intravenously, but endotracheal anesthesia is most often used, it can be combined with intravenous anesthesia. Subsequent preparation for the operation is carried out in several stages:
- an hour before the transfer of the patient to the operating room, in the ward, premedication is carried out on the recommendation of the anesthesiologist, that is, the necessary drugs are introduced that help prevent certain complications during the introduction of the patient into anesthesia and improve its course;
- a woman is placed in the operating room with a dropper for intravenous administration of necessary medications, as well as monitor electrodes to constantly monitor the functioning of the heart and blood hemoglobin saturation during anesthesia and the operation itself;
- carrying out anesthesia of an intravenous type with further introduction of relaxants into the vein, contributing to the absolute relaxation of all the muscles of the patient, which allows you to insert an endotracheal tube into the trachea and increases the possibility of viewing the peritoneum during the operation;
- an endotracheal tube is inserted and attached to the anesthesia machine, whereby artificial ventilation of the lungs is performed, as well as inhalation anesthetics that maintain anesthesia, and this can be carried out in combination with intravenous anesthesia or without them.
This completes the preparation for the operation of laparoscopy of the ovarian cyst.
Methodology
Directly, the methodology for its implementation includes:
- the imposition of pneumoperitoneum, when gas is injected into the abdominal cavity, and due to this it is possible to increase the volume by creating a free space in the abdomen, which provides a view and allows easy manipulation of instruments, reducing the risk of damage to organs located nearby;
- the introduction of tubes into the abdominal cavity - hollow tubes that are intended for passing endoscopic instruments through them.
Now it is clear what kind of operation it is - laparoscopy in gynecology.
What complications are possible?
When performing diagnostic laparoscopy, there are very few complications. The most dangerous among them can occur with the introduction of carbon dioxide and trocars. These include:
- severe bleeding due to injury to a large vessel in the anterior wall of the peritoneum, inferior vena cava, aorta or mesenteric vessels, internal iliac vein or artery;
- gas embolism caused by the penetration of gas into a damaged vessel;
- damage to the outer lining of the intestine, that is, deserosis or intestinal perforation;
- pneumothorax;
- emphysema, widespread under the skin, characterized by compression of organs or displacement of the mediastinum.
The period after surgery and some negative consequences
The immediate and long-term negative consequences after laparoscopy are adhesions that can cause intestinal dysfunction, infertility, and intestinal obstruction. Their formation can be the result of manipulations that caused injury if the surgeon is not experienced enough or if there is a pathology in the abdomen. However, most often it depends on the specifics of each female body.
Another significant complication after surgery is slow bleeding from damaged small vessels into the abdominal cavity or due to a small rupture of the liver capsule, which can appear during a panoramic revision of the peritoneum. A similar complication occurs when the damage went unnoticed and the doctor did not eliminate them during the operation, but this is very rare.
Other consequences that are not dangerous are hematomas and a small amount of gas in the tissues under the skin in the area where self-absorbable trocars are inserted, as well as purulent inflammation in the wound area (very rarely) and the appearance of a postoperative hernia.
Complications after laparoscopy in gynecology, we examined.
Recovery period
Recovery after laparoscopy is usually quick and without complications. Already in the first hours, you can make active movements in bed, and walk after a few hours, which depends on the patient's well-being. This prevents intestinal paresis. Usually, after seven hours or the next day, the woman is discharged.
In the first few hours after laparoscopy, some soreness in the lower back and abdomen remains, which does not require the use of pain medications. On the day of surgery, in the evening, or the next, subfebrile temperature, as well as sanious discharge from the genital tract, may be observed. Subsequently - mucous membranes without blood impurities. They may stay for one or two weeks.
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