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

There are diagnostic and operative laparoscopy.

Diagnostic laparoscopy is a surgical 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 abdominal organs, the doctor confirms or rejects any diagnosis, or checks, for example, the patency of the fallopian tubes.

During surgical laparoscopy, the doctor eliminates the detected pathological changes.

Laparoscopic gynecology is a new opportunity for the effective treatment of gynecological diseases, allowing to minimize recovery time and leaving no cosmetic defects

What operations can be done with laparoscopy?

Using laparoscopic access, you can perform almost all operations that are performed in the 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 adnexa, and surgery on the fallopian tubes for ectopic pregnancy.

Solving some surgical problems, such as eliminating genital endometriosis, is generally impossible without the use of laparoscopy. This technology has opened a new era in diagnostics and has made it possible to achieve significant improvements in results. Timely detection and removal of ovarian cysts using laparoscopic access has significantly reduced the incidence of ovarian cancer. We can safely say that the degree of development and implementation of endoscopic technology is the key to the quality of the medical services provided. This must be taken into account 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 a traditional (laparotomy) 15 to 20 centimeter incision in the anterior abdominal wall, these punctures do not injure muscle tissue, so patients experience much less pain after surgery and can usually return to normal life within one week. A 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 two other trocars, special instruments (manipulators) necessary to perform the operation are introduced into the abdominal cavity.

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

What are the advantages of laparoscopic operations in gynecology?

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

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Contraindications to 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 major abdominal surgeries that the patient has undergone in the past due to, for example, peritonitis, intestinal obstruction, etc. In this case, there is a high risk of life-threatening intestinal damage during laparoscopy with serious consequences for the patient.

Another serious contraindication to laparoscopy is severe cardiac dysfunction, because This operation is performed with the patient upside down and the abdominal cavity filled with gas, which can cause cardiac decompensation.

What complications can occur 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. Shelf life of tests for laparoscopy surgery

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

*		Validity period of tests from the date of delivery to surgery
	1. General blood test	2 weeks
	2. General urine test
	3. Clotting time
	4. Platelet count
	5. Prothrombin content
	6. Fibrinogen content
	7. Bilirubin content
	8. Total blood protein content
	9. Blood glucose level
	10. Urea content
	11. Blood type and Rh factor (the stamp in the passport is not enough)
	12. Wasserman reaction, blood for HIV, HBs Ag, HB C Ag.	3 months
	13. Vaginal smear for flora and degree of purity	2 weeks
	14. Smear for oncocytology	1 year
	15. Fluorography data	11 months
	16. ECG (with interpretation)	1 month
	17. Feces on helminth eggs	1 year
	18. Consultation with a therapist

On what day of the cycle is laparoscopy performed?

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

Preparation for laparoscopy

You don't need much to prepare for laparoscopy. Depending on your age, gender and health status, the doctor will prescribe a set of tests for you, including a blood test, ECG, X-ray examinations, ultrasound, etc. Before the procedure, you must refrain from eating for 8 hours. It is necessary to inform your doctor about what medications you are taking, since it is recommended to stop taking some medications several days before laparoscopy (for example, aspirin, ibuprofen, etc.)

Preparation of the gastrointestinal tract before laparoscopy:

1. During the week before surgery, exclude from the diet foods that cause the formation of gases in the intestines - legumes, brown bread, potatoes, vegetables, fruits, unleavened milk. You can eat fish, lean meat, chicken, cottage cheese, kefir, porridge, broth.
2. 5 days before surgery, start taking activated carbon, 2 tablets after meals, 3 times a day (you can use Mezim-Forte, Festal, Pancreatin, Panzinorm).
3. Several cleansing enemas the evening before surgery and one in the morning on the day of surgery.
4. On the eve of the operation, for lunch - only liquid food (first and third courses), for dinner - only drinks. On the day of surgery, you should not drink or eat.

Preparing the surgical area before laparoscopy

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

Psycho-emotional preparation before laparoscopy

A few days before surgery, 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 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 surgery. Start with short walks, gradually increasing the distance and duration. There is no need to follow a strict diet. Painkillers should be taken as directed by your doctor.

Gynecology has come a long way since laparoscopic operations became possible in any clinic. This method of surgical intervention has made it possible to combat many problems and diseases that previously could not be eliminated in the usual way. Laparoscopy in gynecology is so low-traumatic and safe that it has long since moved from the category of surgical interventions to a diagnostic method.

Laparoscopic diagnosis and treatment of problems associated with infertility has the most positive reviews 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 and other problems that interfere with natural conception. If you watch a video of such an operation, you will see that high technology is already being successfully used in treatment. Through tiny incisions, the doctor can remove the terrible diagnosis of infertility from your life in just an hour.

Laparoscopy in gynecology has incomparably more advantages than disadvantages. First of all, it is minimally traumatic; in videos 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 are arranged in a triangle. The top incision is often made in the belly button, so it won't be visible at all, and the bottom two scars will be hidden by underwear or a swimsuit. Inside the cavity, damage from the operation is also minimal, because through special optics the doctor sees on video exactly where to start working with a scalpel.

Compared to abdominal surgery, where you often have to cut at random, not knowing where exactly to look for the problem, the laparoscope has become simply a magic wand that allows you to get by with little blood - literally and figuratively. Thanks to it, you can avoid large tissue incisions to get to your destination. This means that not only will there be less pain, but also 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 operation or adhesions dissection procedure, you may be discharged from the hospital within 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 all the same, you will be discharged in no more than 6-10 days, and you will begin to get up and walk the next day. But it's not just about deadlines, although they are important in our busy times.

The main thing is that the 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, you should not lift weights or engage in active sports for several months to avoid dehiscence. According to reviews from most patients, within a week after discharge they returned to their normal routine.

Another advantage of such a quick recovery and low trauma during laparoscopy is the ability to plan a pregnancy after 1-3 months, while after abdominal surgery it is recommended to use protection for at least 6, and sometimes 12 months. Although here the period of protection may be a little longer, it is determined by your surgeon based on the nature of the operation performed and the condition of your body.

Last but not least on the list is the convenience of the laparoscope for the surgeon. All internal organs are perfectly visualized on 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 identified that were not shown by any examination. For example, during a planned operation to dissect the surface of polycystic ovaries, the surgeon can detect adhesions and dissect them so that they do not interfere with conception or become a risk factor for ectopic pregnancy.

What are the disadvantages of this operation?

Among the disadvantages of laparoscopy, one can first of all mention the risk of formation of adhesions. 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 follow all the surgeon’s instructions: take anti-inflammatory and absorbable medications, be sure to undergo a course of physical procedures and do not forget about sports, or at least exercise and walking. This entire 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 for nothing 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 treatment method, even with medication, let alone 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 by the fact that there are hundreds of thousands of reviews from happy patients about laparoscopy and the statistics of this operation indicate a minimal risk of unpleasant consequences.

Therefore, the decision about surgery should be made carefully and based on the ratio of expected benefits and possible risks. It is worth consulting with 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 remove the fertilized 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 medically necessary and there is a choice between laparoscopy and abdominal surgery, most doctors recommend laparoscopy, and this is not surprising, given all the benefits. If you are going to have an operation, it is better to do it 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. For example, if you just need to check the patency of the fallopian tubes, then you can 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;
• fibroids;
• fibroids;
• endometriosis;

or other diseases that are difficult to detect during external examination, then surgery makes sense.

Laparoscopy is often prescribed as a diagnosis for infertility of unknown origin or mixed problems, for example, adhesions and endometriosis together, as well as in the presence of chronic pelvic pain and serious disorders of the monthly cycle.

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 in size, which heal quite quickly after the intervention. During the operation, a special device is inserted 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-fold magnified image on the monitor, which allows the surgeon to examine reproductive organs that are inaccessible during a regular gynecological examination. With the help of a clear image on the monitor, the specialist is able to identify violations and carry out surgical treatment.

Before the invention of the laparoscope, surgeons were forced to operate through a large and long-healing incision 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. Using a laparoscope, you can notice abnormalities that are not always visible during ultrasound. There is also therapeutic or therapeutic-diagnostic laparoscopy, when the doctor simultaneously assesses the condition of the internal reproductive organs and conducts surgical treatment.

If elective laparoscopy is possible, the patient can choose in advance a clinic and a doctor whom she trusts. If an emergency operation is necessary, the situation is different: the intervention is performed as quickly as possible and, most often, in the first clinic available. Therefore, if there are indications for gynecological surgery, it is better not to waste time and not expect self-healing, but to 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 surgeons and anesthesiologists, as well as modern operating room equipment. 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 initially planned as a laparoscopic one, becomes a general abdominal operation during the process, 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 want the laparoscopic operation to be successful and not require long-term rehabilitation, contact only reliable clinics that have been on the market for many years and during this time have managed to gain the trust of patients.

Indications for laparoscopy in gynecology

Most often, laparoscopy is prescribed for the diagnosis and treatment of the following diseases and conditions:

• developmental abnormalities of the reproductive organs;
• endometriosis;
• uterine fibroids;
• obstruction of the fallopian tubes;
• tumor neoplasms, including cysts;
• ovarian diseases, including polycystic disease;
• emergency gynecological pathology (ectopic pregnancy, cyst rupture);
• inflammation of the appendages;
• infertility of unknown origin.

Laparoscopy is also required before planning IVF (in vitro fertilization), for chronic pelvic pain, if it is necessary to perform a biopsy of the ovaries and uterus, as well as 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 performance of laparoscopy in gynecology

Before laparoscopy, it is necessary to undergo a number of laboratory tests and studies, including an ECG, pelvic ultrasound, urine and blood tests, and a vaginal smear.

A few days before surgery, it is necessary to limit the consumption 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 of anesthesia and the onset of action, the doctor makes small punctures in the navel area and above the pubis, after which he inserts a laparoscope there. Carbon dioxide is first introduced into the abdominal cavity, which is harmless to the body and allows a better view of the internal organs. Next, the specialist carries out diagnostics and surgical treatment. After this, 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 puncture sites practically invisible after healing and does not disrupt the function of the reproductive organs.

The editors thank ON CLINIC for their assistance in working on the material.

Anna Mironova

Reading time: 16 minutes

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The diagnostic type of laparoscopy is prescribed in cases where it is difficult to make an accurate diagnosis for diseases in the pelvic or abdominal area. This is the most popular modern procedure for examining the abdominal cavity.

How is laparoscopy performed?

Video: how laparoscopy is performed and what “tubal obstruction” is

Indications for laparoscopy

Contraindications for laporoscopy

Absolute

Relative

What complications are possible after the procedure?

Complications with this procedure are rare.

What could they be?

Preparation for the operation

Before undergoing a planned operation, the patient must undergo a certain number of various examinations. As a rule, they are carried out directly in the hospital, or the patient enters the department with a complete card of all the necessary tests. In the second case, the number of days required to spend in the hospital is reduced.

An approximate list of examinations and tests:

• Coalogram;
• Blood biochemistry (total protein, urea, bilirubin, sugar);
• General analysis of urine and blood;
• Blood group;
• HIV test;
• Test for syphilis;
• Test for hepatitis B and C;
• Fluorography;
• Vaginal smear for flora;
• Therapist's conclusion;
• Ultrasound of the pelvis.

If there are existing pathologies of any body system, the patient should undergo consultation with a specialist to assess the presence of contraindications and develop management tactics before and after surgery.

Mandatory actions and instructions before surgery:

Performing the operation and postoperative period

Laparoscopy is not performed:

• During menstruation (taking into account the risk of increased blood loss during surgery);
• Against the background of acute inflammatory processes in the body (herpes, acute respiratory infections, etc.);
• Other (described above) contraindications.

The optimal time for the operation is from 15 to 25 days of the menstrual cycle (with a 28-day cycle), or the first phase of the cycle. The day of the operation directly depends on the diagnosis.

What can and cannot be done after laparoscopy?

Duration of laparoscopy

• The timing of the operation depends on the pathology;
• Forty minutes – for coagulation of endometriosis foci or separation of adhesions;
• One and a half to two hours - when removing myomatous nodes.

Suture removal, nutrition and sex life after laparoscopy

You are allowed to get up after surgery in the evening of the same day. An active lifestyle should begin the next day. Required:

Pregnancy after laparoscopy

When can you start getting pregnant after surgery is a question that worries many. It depends on the operation itself, on the diagnosis and on the characteristics of the postoperative period.

When can you go to work?

Based on the standards, after surgery, sick leave is issued for seven days. Most patients are already fully capable of working by this time. The exception is work involving heavy physical labor.

Advantages and disadvantages of laparoscopy

Pros:

Flaws:

• The effect of anesthesia on the body.

Post-operative regimen

Real reviews and results

Lydia:

I found out about my endometriosis in 2008, and had surgery the same year. 🙂 Today I’m healthy, pah-pah-pah, so as not to jinx it. I myself was finishing my studies in gynecology, and then suddenly I found myself a patient. :) An ultrasound found a cyst and sent me for surgery. I arrived at the hospital, chatted with the anesthesiologist, and the tests were all ready. After lunch I went to the operating room. It’s uncomfortable, I’ll say, lying naked on the table when there are strangers around you. :) In general, after the anesthesia I don’t remember anything, but I woke up in the ward. My stomach hurt like crazy, I felt weak, there were three holes in my belly under the bandages. :) Added to the pain in my stomach was the pain from the anesthesia tube. She left within a day, and went home a day later. Then I was treated with hormones for another six months. Today I am a happy wife and mother. :)

Oksana:

And I had a laparoscopy because of an ectopic one. 🙁 The test constantly showed two lines, but the ultrasound doctors could not find anything. Like, you have a hormonal imbalance, girl, don’t compost our brains. At this time, the child was developing right in the tube. I went to another city, to normal doctors. Thank God the pipe didn’t burst while we were driving. The doctors there looked and said that the period was already 6 weeks. What can I say... I burst into tears. The tube was removed, the adhesions of the second tube were cut... She recovered quickly after the operation. On the fifth day I already went to work. All that was left was a scar on his stomach. And in the soul. I still can’t get pregnant, but I still believe in a miracle.

Alena:

The doctors diagnosed me with an ovarian cyst and said there were no options, only surgery. I had to lie down. I didn’t pay for the operation; everything was done as directed. At night - an enema, in the morning an enema, in the afternoon - an operation. I don’t remember anything, I woke up in the ward. To avoid adhesions, I ran circles around the hospital for two days. :) They injected me with some hemostatic drugs, I refused analgesics, and was discharged a day later. Now there are almost no traces of holes. Pregnancy, however, for now too. But I would have to do it anyway. If necessary, then necessary. For their sake, the cubs. 🙂

If you liked our article and have any thoughts on this matter, share with us! It is very important for us to know your opinion!

Currently, laparoscopic operations are very widespread. Their share in the treatment of various surgical diseases, including gallstones, ranges from 50 to 90%, since laparoscopy is a highly effective, and at the same time relatively safe and low-traumatic method of surgical interventions on the abdominal and pelvic organs. That is why laparoscopy of the gallbladder is currently performed quite often, becoming a routine operation recommended for cholelithiasis as the most effective, safe, low-traumatic, fast and with minimal risk of complications. Let us consider what the concept of “gall bladder laparoscopy” includes, as well as what are the rules for performing this surgical procedure and subsequent rehabilitation of a person.

Laparoscopy of the gallbladder - definition, general characteristics, types of operations

The term “gallbladder laparoscopy” in everyday speech usually means an operation to remove the gallbladder, performed using a laparoscopic approach. In more rare cases, this term may mean that people are removing stones from the gallbladder using laparoscopic surgery.

That is, “laparoscopy of the gallbladder” is, first of all, a surgical operation, during which either the complete removal of the entire organ is performed, or the stones present in it are removed. A distinctive feature of the operation is the access through which it is performed. This access is carried out using a special device - laparoscope, and therefore is called laparoscopic. Thus, laparoscopy of the gallbladder is a surgical operation performed using a laparoscope.

In order to clearly understand and imagine what the differences are between conventional and laparoscopic surgery, it is necessary to have a general understanding of the process and essence of both techniques.

So, a usual operation on the abdominal organs, including the gallbladder, is carried out using an incision in the anterior abdominal wall, through which the doctor sees the organs with his eye and can perform various manipulations on them with instruments in his hands. That is, it is quite easy to imagine a regular operation to remove the gallbladder - the doctor cuts the stomach, cuts out the bladder and stitches the wound. After such a conventional operation, a scar always remains on the skin in the form of a scar corresponding to the line of the incision made. This scar will never allow its owner to forget about the operation performed. Since the operation is performed using an incision in the tissue of the anterior abdominal wall, such access to the internal organs is traditionally called laparotomy .

The term "laparotomy" is formed from two words - "lapar-", which translates as belly, and "tomia", meaning to cut. That is, the general translation of the term “laparotomy” sounds like cutting the stomach. Since as a result of cutting the abdomen, the doctor is able to manipulate the gallbladder and other abdominal organs, the process of such cutting of the anterior abdominal wall is called laparotomy access. In this case, access refers to a technique that allows the doctor to perform any actions on internal organs.

Laparoscopic surgery on the abdominal and pelvic organs, including the gallbladder, is performed using special instruments - a laparoscope and trocar manipulators. A laparoscope is a video camera with a lighting device (flashlight), which is inserted into the abdominal cavity through a puncture on the anterior abdominal wall. Then the image from the video camera is shown on a screen on which the doctor sees the internal organs. It is based on this image that he will carry out the operation. That is, during laparoscopy, the doctor sees the organs not through an incision in the abdomen, but through a video camera inserted into the abdominal cavity. The puncture through which the laparoscope is inserted has a length of 1.5 to 2 cm, so a small and almost invisible scar remains in its place.

In addition to the laparoscope, two more special hollow tubes called trocars or manipulators, which are designed to control surgical instruments. Through hollow holes inside the tubes, instruments are delivered into the abdominal cavity to the organ that will be operated on. After this, using special devices on the trocars, they begin to move the instruments and perform the necessary actions, for example, cutting adhesions, applying clamps, cauterizing blood vessels, etc. Controlling instruments using trocars can be roughly compared to driving a car, airplane or other device.

Thus, laparoscopic surgery involves the insertion of three tubes into the abdominal cavity through small punctures 1.5–2 cm long, one of which is intended for obtaining an image, and the other two for performing the surgical procedure itself.

The technique, course and essence of the operations that are performed using laparoscopy and laparotomy are exactly the same. This means that the removal of the gallbladder will be performed according to the same rules and steps both using laparoscopy and during laparotomy.

That is, in addition to the classic laparotomy approach, laparoscopic access can be used to perform the same operations. In this case, the operation is called laparoscopic, or simply laparoscopy. After the words “laparoscopy” and “laparoscopic”, the name of the operation performed is usually added, for example, removal, after which the organ on which the intervention was performed is indicated. For example, the correct name for removing the gallbladder during laparoscopy would be “laparoscopic removal of the gallbladder.” However, in practice, the name of the operation (removal of part or the entire organ, enucleation of stones, etc.) is skipped, as a result of which only an indication of the laparoscopic approach and the name of the organ on which the intervention was performed remains.

Two types of gall bladder interventions can be performed using laparoscopic access:
1. Removal of the gallbladder.
2. Removing stones from the gallbladder.

Currently surgery to remove gallstones is almost never performed for two main reasons. Firstly, if there are a lot of stones, then the entire organ should be removed, which is already too much pathologically changed and therefore will never function normally. In this case, removing only the stones and leaving the gallbladder is unjustified, since the organ will constantly become inflamed and provoke other diseases.

And if there are few stones or they are small, then you can use other methods to remove them (for example, litholytic therapy with ursodeoxycholic acid preparations, such as Ursosan, Ursofalk, etc., or crushing stones with ultrasound, due to which they decrease in size and independently exit the bladder into the intestine, from where they are removed from the body along with food bolus and feces). For small stones, litholytic therapy with medications or ultrasound is also effective and avoids surgery.

In other words, the current situation is that when a person needs surgery for gallstones, it is advisable to remove the entire organ completely, rather than remove the stones. This is why surgeons most often resort to laparoscopic removal of the gallbladder, rather than stones from it.

Laparoscopy of the ovaries (removal of a cyst, fallopian tube or the entire ovary, etc.) - advantages, description of types of laparoscopy, indications and contraindications, preparation and progress of the operation, recovery and diet, reviews, price of the procedure

Thank you

Ovarian laparoscopy is a common name, convenient for everyday use, for a number of operations on a woman’s ovaries, performed using laparoscopy techniques. Doctors usually call these therapeutic or diagnostic procedures laparoscopic operations. Moreover, the organ on which the surgical intervention is performed is most often not indicated, since this is clear from the context.

In other cases, in surgery, the essence of this medical manipulation is more precisely formulated, indicating not only the use of the laparoscopy technique, but also the type of operation performed and the organ undergoing intervention. An example of such detailed names is the following - laparoscopic removal of ovarian cysts. In this example, the word “laparoscopic” means that the operation is performed using laparoscopy. The phrase “removal of a cyst” means that a cystic formation was removed. And “ovary” means that doctors removed a cyst from this particular organ.

In addition to enucleating the cyst, during laparoscopy foci of endometriosis or inflamed areas of ovarian tissue, etc. can be removed. The entire complex of these operations can be performed laparoscopically. Therefore, for a complete and correct name of the intervention, it is necessary to add the type of operation to the word “laparoscopic”, for example, removal of a cyst, foci of endometriosis, etc.

However, such long names of interventions at the everyday level are often replaced by the simple phrase “ovarian laparoscopy,” when uttered, a person implies that some kind of laparoscopic operation was performed on the woman’s ovaries.

Laparoscopy of the ovaries - definition and general characteristics of the operation

The term "ovarian laparoscopy" refers to several operations on the ovaries performed using the laparoscopic method. That is, ovarian laparoscopy is nothing more than surgical operations on this organ, for which laparoscopy techniques are used. To understand the essence of laparoscopy, you need to know what the usual techniques and methods for performing surgical operations on the abdominal and pelvic organs are.

So, a typical operation on the ovaries is performed as follows: the surgeon cuts the skin and muscles, moves them apart and sees the organ with the eye through the hole made. Then, through this incision, the surgeon removes the affected ovarian tissue in various ways, for example, enucleates the cyst, cauterizes foci of endometriosis with electrodes, removes part of the ovary along with the tumor, etc. After the removal of the affected tissue is completed, the doctor sanitizes (treats) the pelvic cavity with special solutions (for example, Dioxidine, Chlorhexidine, etc.) and sutures the wound. All operations performed using such a traditional incision in the abdomen are called laparotomies, or laparotomies. The word "laparotomy" is formed from two morphemes - lapar (stomach) and tomia (incision), respectively, its literal meaning is "cutting the abdomen."

Laparoscopic surgery on the ovaries, unlike laparotomy, is performed not through an abdominal incision, but through three small holes with a diameter of 0.5 to 1 cm, which are made on the anterior abdominal wall. The surgeon inserts three manipulators into these holes, one of which is equipped with a camera and a flashlight, and the other two are designed to hold instruments and remove excised tissue from the abdominal cavity. Next, focusing on the image obtained from the video camera, the doctor, using two other manipulators, performs the necessary operation, for example, enucleates a cyst, removes a tumor, cauterizes foci of endometriosis or polycystic disease, etc. After the operation is completed, the doctor removes the manipulators from the abdominal cavity and sutures or seals three holes on the surface of the anterior abdominal wall.

Thus, the entire course, essence and set of operations on the ovaries are absolutely the same both with laparoscopy and with laparotomy. Therefore, the difference between laparoscopy and conventional surgery lies only in the method of access to the abdominal organs. With laparoscopy, access to the ovaries is made using three small holes, and with laparoscopy - through an incision in the abdomen 10 - 15 cm long. However, since laparoscopy is much less traumatic compared to laparotomy, there are currently a huge number of gynecological operations on various organs, including including the ovaries, is produced precisely by this method.

This means that the indications for laparoscopy (as well as for laparotomy) are any diseases of the ovaries that cannot be treated conservatively. However, due to its low morbidity, laparoscopy is used not only for surgical treatment of the ovaries, but also for diagnosing various diseases that are difficult to recognize using other modern examination methods (ultrasound, hysteroscopy, hysterosalpingography, etc.), since the doctor can examine the organ from the inside and, if necessary, take tissue samples for subsequent histological examination (biopsy).

Advantages of laparoscopy over laparotomy

So, operations on a woman’s ovaries performed using the laparoscopic method have the following advantages over manipulations performed during laparotomy:

• Less tissue trauma, since the incisions during laparoscopy are much smaller than during laparotomy;
• Less risk of developing adhesions, since during laparoscopy internal organs are not touched and compressed as much as during laparotomy surgery;
• Postoperative rehabilitation after laparoscopy occurs several times faster and easier than after laparotomy;
• Low risk of infectious and inflammatory process after surgery;
• Almost complete absence of risk of seam divergence;
• No large scar.

This is the most effective method of treating various diseases of the female genital organs. Before the discovery of this method, no doctor would have even thought of prescribing surgery for a pregnant woman (unless the question was about life and death). This would most likely threaten termination of pregnancy. Nowadays, women not only successfully become pregnant after operations on the ovaries and uterus, such operations can be performed directly during pregnancy. Read our article to the end, and you will find out how long after such a procedure you can plan a pregnancy, how much time the body needs to restore reproductive function after this treatment method, and much more useful information.

The patient remains in the clinic for 24 hours after the operation. During this time, he recovers from anesthesia, and doctors can monitor his adaptation. When performing more complex interventions on vital organs, the patient remains under the supervision of doctors for up to three days. But, as a rule, after a day the reclining position is allowed, and after another day you can move around.
If the operation was performed on the genitals or liver, then a special diet is not required. Liquid intake is prohibited for some time after surgery. In other cases, the patient is allowed a special diet. Usually you can eat dietary foods, boiled or baked, broths, cereals, and fermented milk products. You should eat at least five times a day, in small portions. Drink about one and a half liters of various diet drinks.
If the intervention was directly on the digestive organ, you can only drink for a day or a day and a half. The first meal is possible after three days and solid food is prohibited. Over time, other foods are introduced into the diet. The patient must adhere to a strict diet for a month.
However, regardless of which organ was operated on, you should completely abstain from heavy food and alcohol for at least 30 days. Thanks to this, it is easier for the body to cope with the adaptation period.
It is forbidden to take a bath for fifteen days, and after taking water procedures, it is mandatory to lubricate the seams with a disinfectant. If it is necessary to remove sutures, this is done a week after the operation.
Twenty days after laparoscopic interventions, a person can lead a normal lifestyle.

The current development of laparoscopy makes it possible to solve almost any problem that arises with the female genital organs. Moreover, if a woman cannot have children and only surgical methods can help, then this study solves the problem accurately and humanely. More than half of the cases are associated with obstruction or deformation of the fallopian tubes. Such problems are easily detected and solved using a laparoscope. Many infectious diseases, including sexually transmitted ones, leave their traces in the body in the form of adhesions. Chlamydia and ureaplasmosis are very common today. These diseases often cause unwanted processes in the tubes, into which the infection rises from the external genitalia. Sometimes the infection penetrates through the flow of physiological fluids. More often, both tubes become diseased at once and in advanced cases, the result, as a rule, is the inability to have children. Moreover, blockage of the tubes often provokes ectopic pregnancies, and this is already a threat to the patient’s life.

Using a laparoscope, you can cope with adhesions in the female genital organs. This effect causes minimal damage to nearby organs and is quite effective. Then the patient is prescribed restorative procedures, as well as exposure to antimicrobial drugs.

The results of this study are verified using x-rays and ultrasound.
In addition to adhesions, laparoscopy can be used to get rid of endometriosis, a fairly common disease. With endometriosis, the inner surface of the uterus grows and interferes with the normal functioning of the organ.

Laparoscopy is a form of treatment when, without harming the patient’s skin, an intervention is performed and surgical problems are solved or diagnostics are carried out in doubtful cases.
In order for the patient to be allowed to undergo surgery, many laboratory tests must be done. This is a routine checklist that is requested in any hospital before any operation. It consists of a large number of points and based on the results of these studies, one can judge the patient’s health status.

The reason for a temporary ban on laparoscopy is menstruation. In addition, the procedure is postponed if the patient is in the midst of ARVI, influenza and similar conditions. If a woman wants to conduct such a study to identify the reasons for the inability to have children, then it is better to do this from the fifteenth to the twenty-fifth day of the cycle.

On the day of laparoscopic examination or surgery, you should not eat food. If the patient takes any medications, this must be told to the doctor, since there are drugs that are prohibited to take some time before the study. In addition, some drugs can interact with anesthesia and produce unpredictable consequences.
Seven days before the procedure, it is advisable not to eat gas-forming foods. The menu should be easily digestible and not heavy.

Five days in advance, drink absorbents and enzyme preparations.
The night before laparoscopy, perform procedures to empty the intestines.
During the day, exclusively dietary food, and in the evening, liquid food.
It is recommended to drink herbal-based sedatives a week in advance.

If we literally translate the term “laparoscopy”, it means “looking into the stomach.” There are other methods to look into the internal organs of a person, but the fundamental difference is that to conduct this study, a hole is made in the abdominal wall and all the necessary instruments are inserted into it to carry out an examination or perform an operation. The examination is carried out under local anesthesia, and surgical interventions are performed under general anesthesia.
Sometimes, after doing many tests and examinations, doctors are not sure what is really going on with the patient. In many cases, laparoscopy can be helpful.

Doctors recommend such a study to confirm the disease in cases where: the patient has discomfort in the stomach or nearby organs; if a tumor is detected in the same area. Sometimes the discovery is made by the patient himself, sometimes by a doctor. Laparoscopy helps to clearly examine the tumor and take a puncture for analysis. If there is fluid in the epigastric region, this study will clearly show what is happening. Laparoscopy is indicated for liver problems. Only this examination makes it possible to take a liver puncture and do tests.

This method is good because usually after surgery, patients recover quickly and do not suffer from any undesirable consequences. Problems sometimes occur due to damage to blood vessels and nearby organs. Perhaps microorganisms entered the wound. But similar cases also occur with conventional surgery, and the failure rate here is much higher.

After laparoscopy, there may be problems that are common for surgical interventions, and specific ones that are characteristic of this type of treatment. More often this happens due to the use of special tools.
Instruments used to make a hole in the abdominal wall are inserted without visual control. To prevent errors, there is a special technique, checks are carried out during work, and there are also devices to help avoid injuries. Some models are equipped with a laparoscope to see the direction of the instrument. However, the possibility of injury to nearby organs cannot be completely denied. If the injury is detected in time, everything can be corrected quickly.

After laparoscopy, the formation of blood clots is sometimes activated. This complication is typical for people who are overweight, have problems with the cardiovascular system, varicose veins, and elderly patients. To avoid the formation of blood clots, special procedures are carried out, the patient is given drugs that prevent excessive blood clotting.
Injecting CO into the body can lead to deterioration in the functioning of some organs, such as the lungs. To reduce the risk of this complication, closely monitor CO pressure; it should be minimal.

CO often accumulates under the patient’s skin, but this is not dangerous to life or health and goes away on its own after some time.
Sometimes during the intervention, tissues are burned. This is probably due to a hardware malfunction. If the burn is not detected, tissue death may begin.
Infection of the puncture site occurs due to weak body resistance, or may be a consequence of surgical manipulations.

In different medical institutions, the technique of laparoscopic operations may differ slightly.
Preoperative measures are no different from those carried out before classical surgery. In addition, under certain circumstances it is sometimes necessary to complete such an operation in the classical way.

Such an operation is impossible without preliminary injection of CO into the abdominal cavity. Gas injection is necessary so that all areas to be operated on are visible and can be reached with special tools. The body is wiped with disinfectants, covering an area slightly larger than necessary, so that if necessary, an incision can be made. When the patient is fully anesthetized, a puncture is made in the center of the abdomen and a special Veress mechanism is inserted into it. This mechanism is designed for laparoscopic operations and acts as carefully as possible in relation to the human body. There are special tests by which the doctor determines that the mechanism has reached the desired point and gas is pumped through it under the peritoneum. When the gas injection is completed, the Veress mechanism is pulled out and the next instrument is inserted into this hole, which makes a hole in the right place; now the laparoscope and the mechanisms with which the operation will be performed are inserted into it.

A laparoscope is a device consisting of a micro-camera and a light bulb for illuminating the abdominal cavity. The camera sends a video signal to the monitor, through which the surgery is performed.

Laparoscopy as a branch of surgery has been known for almost a century. But in the twenty-first century it received a new development. Studies of this method have made it possible to better understand the processes taking place, assess the preoperative and postoperative condition of patients, and, among other things, revise the list of diagnoses for which this study is undesirable. Scientists have not entirely reached consensus on this issue; discussions are still ongoing. But we will provide the reader with a list of contraindications that do not cause controversy in scientific circles.

Contraindications to laparoscopic operations can be categorical and those that can be neglected in certain circumstances. In addition, they may relate to specific organs, or they may relate to the state of the body as a whole. This classification is not academic in nature and varies depending on the individual case. For example, if a woman is carrying a child and is in the second trimester, then she will be prohibited from laparoscopic surgery to remove a hernia, but surgery on the gall bladder will be allowed without problems.

Categorical contraindications include the patient being in a coma, disturbances in the functioning of the cardiovascular and respiratory systems in the developmental phase, extensive inflammatory and abscess processes, any complications of the patient’s health in which laparoscopy is dangerous. In addition, it is undesirable to perform surgery if the patient has a very increased body weight, a tendency to form blood clots, is pregnant in the last trimester, or if the patient is sick with a contagious disease.

There was a joke among European doctors that said: “a big master makes big stitches.” Many generations of doctors were raised on a similar theory. There were periods in surgery when doctors competed in cutting and sewing skills. Attempts to connect various parts of the human body with the help of surgical instruments, various amputations were the main directions of medicine. It is remarkable that “surgery” in the ancient language is “handicraft”.

The development of medicine has gone through stages in which little attention was paid to the holistic functioning of the human body as a single system. Doctors did not think about the fact that the operation itself was a blow to health. Therefore, when working, surgeons primarily cared about their own comfort; the length of the suture did not matter, the main thing was the quality of suturing.

The idea of ​​performing operations with minimal disruption of the skin arose at the end of the twentieth century, and was met with hostility among professionals. But the denial was quite short. Surgical innovators began to promote laparoscopy, because a more gentle method of surgical intervention had not yet been invented.

Patients who have undergone laparoscopy have many times fewer side effects, and adaptation after the intervention occurs much faster.

A special conversation about patients who are overweight. During classic surgery, a huge number of fat cells are cut. This greatly worsens the body’s condition and complicates adaptation after the intervention. These tissues are an excellent breeding ground for pathogenic microflora. The suture heals worse, abscesses are possible.

It turns out that there are categories of citizens who are positively influenced by computer games. That is, not on themselves, but on their professional skills. A study was conducted in Israel among doctors working in endoscopic surgery. It turns out that those specialists who like to play computer games are more likely to perform laparoscopic operations. At the same time, such specialists’ manipulation of devices is more complex and targeted.

Laparoscopy differs fundamentally from classical surgical technologies. The fact is that all manipulations are carried out not with a scalpel, but with microinstruments, which are introduced into the patient’s body through several punctures in the abdominal cavity. All instruments fit into tubes with a diameter of half a centimeter. Therefore, microscopic precision is required to control such equipment. The doctor sees the entire progress of the operation on a computer monitor. “Friendship” with electronic equipment also helps here.

Israeli scientists underwent special tests, based on the results of which they were given points. It turned out that the more skillfully a surgeon plays electronic games, the more skillfully he performs laparoscopic operations. Those doctors who played more than three hours every seven days had almost forty percent fewer inaccuracies in operations than their non-gaming colleagues.

Such data allow us to speak with confidence about the positive impact of computer games on the eye, reaction speed, and fine motor skills. At the same time, a person is better oriented in nearby space. If you are a fan of playing, do not forget to support your vision with special exercises, as well as dietary supplements (dietary supplements).

Today, pancreatitis is a serious medical problem, as the number of patients is growing every year. Pancreatitis is difficult to treat and also difficult to recognize. At the same time, the number of cases with a sad ending reaches half! The high level of alcoholism in society contributes to the development of this disease. In addition, a blow can provoke pancreatitis.

Laparoscopy greatly facilitates the recognition and complete relief of pancreatitis.
It is performed under local anesthesia. Before this, classical drug therapy is carried out. General anesthesia is given only in special cases, for example, if the patient is weak or very old.

Through the hole, the laparoscope is inserted into the patient's abdomen. Before this, the stomach is pumped with gas. In some cases it is air, and in some cases it is CO.
During the operation, pathologically deformed parts of the organ are cut off and the fluid is pumped out. After this, the organ is cleaned using disinfectants. Special therapy is carried out for tissues, especially those damaged by the disease. In addition, medications, including antimicrobial ones, are poured into the cavity.

According to practical medicine, the effectiveness of this study in identifying and treating pancreatitis is almost one hundred percent. This method makes it possible to identify the disease quickly and urgently begin the process of its treatment. In addition, the further use of a laparoscope to control the course of the disease makes it possible to find the most effective methods of therapy. If conservative methods are not enough, laparoscopy helps determine the optimal time for surgery.

This is a young branch of surgery; one might even say that laparoscopy is taking its first confident steps in the history of medicine.
The starting point in the development of such operations can be considered the publication of a work on this topic by the doctor and inventor Kurt Semm. This happened in the seventies of the twentieth century. Since Semm was a specialist in the treatment of specific female diseases, the first laparoscopic interventions were on the genitourinary system. A whole team of like-minded people worked with him. Many of the devices used today in such operations were developed by these enthusiasts.

By the end of the eighties, the number of such interventions numbered in the tens of thousands. There were less than half a percent of side effects after surgery. These data served as convincing evidence of the feasibility of such operations.
The introduction of laparoscopy spurred the largest medical equipment manufacturers to create more advanced devices for this type of medicine.
The end of the seventies was marked by the introduction of laser technology into the process. From that moment on, lasers began to be improved by manufacturers.

The most important role in the operation is played by the microcamera and lenses. At the beginning of the twentieth century, the first endoscopic images were performed. The first images were very imperfect. Even by the mid-twentieth century they were still too small. In the early sixties, the photolaparoscope was invented.
The advent of electronic equipment made it possible to construct small cameras that produce color images.