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Contraindications for laparoscopic surgery. Contraindications and risk factors for laparoscopy

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Minimally invasive, gentle surgery on the abdominal cavity, which is performed using special endoscopic equipment for examination and manipulation, is called laparoscopy. The introduction of such surgical operations has significantly reduced the number of complications. There are some contraindications for laparoscopy.

Purpose of intervention

In clinical practice, there are two main goals for laparoscopy: diagnosis and treatment. In the first case, such an operation is performed to confirm or refute the diagnosis. For therapeutic purposes, the operation is performed in the following cases:

the presence of gynecological pathologies (obstruction of the fallopian tubes, ectopic pregnancy, small neoplasms);
the need for minimally invasive surgical treatment on the abdominal organs (for example, in cases of appendicitis, peptic ulcer, acute cholecystitis).

When is laparoscopy contraindicated?

Carrying out laparoscopic intervention in the presence of absolute or relative contraindications can lead to serious consequences, up to the death of the patient on the operating table. If a patient at risk needs surgical treatment, then preliminary therapy is carried out to stabilize his condition.

Absolute contraindications

Therapeutic and diagnostic laparoscopy of the abdominal cavity is not performed in the following cases:

terminal states of the patient (coma, agony, clinical death);
sepsis;
acute renal failure;
dysfunction of the heart;
severe systemic infections;
hemorrhagic, hypovolemic shock;
post-infarction, post-stroke conditions;
any form of peritonitis.

relative

The group of relative contraindications includes:

extreme degree of obesity (body mass index over 40);
congenital, acquired disorders of blood coagulation;
intestinal obstruction;
recent laparotomic (open abdominal) surgery;
unstable hemodynamics;
age over 75;
heart failure in the stage of subcompensation.

Risk Factors When Injecting Anesthesia

During laparoscopy, the patient is put under general anesthesia. Due to the fact that this type of anesthesia requires intravenous administration potent medicines, there are some risk factors for the administration of anesthesia:

Heart failure under general anesthesia can cause ventricular fibrillation, cardiac arrest, and death.
Liver and kidney disease can lead to acute poisoning medications, coma, toxic shock.
Severe pathologies nervous system often become the cause of a vegetative state, brain death, mental abnormalities.

Is laparoscopy acceptable during pregnancy?

Diagnostic or therapeutic laparoscopy is performed at any stage of pregnancy if there is a threat to the life and health of the mother.

Planned surgical interventions are prescribed for gestational age up to 17-18 weeks. If there are urgent indications for surgical treatment for more than 30 weeks, it is recommended C-section and extraction of the fetus, in order to obtain full access to perform the necessary manipulations.

After laparoscopic intervention in the early stages, during the further period of pregnancy, it is recommended to monitor the dynamics of additional examinations of the fetus to identify possible pathologies caused by the administration of drugs for anesthesia.

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Laparoscopy is a low-traumatic operation performed for therapeutic and diagnostic purposes. Its essence lies in the fact that the doctor can perform an operation on the internal organs of the abdominal cavity through small punctures, avoiding abdominal incisions. Special tubes are inserted into the peritoneum through small holes, and with the help of them the doctor controls the instruments, lights and cameras. In gynecology, laparoscopy (endoscopy in gynecology) is of great importance, because it can be used both for the purpose of diagnosing pathologies and for the purpose of treatment. How is laparoscopy performed?

Laparoscopic surgery is performed under general anesthesia.

A small passage is pierced in the wall of the patient's abdomen, through which air is pumped into the peritoneum. This manipulation helps doctors avoid injuries to organs located nearby, as the stomach increases in volume.

After that, several small micro-incisions are made for the introduction of the laparoscope. A laparoscope is a special device similar to a tube. On the one hand, it has an eyepiece, and on the other, a video camera with a lens. The second incision is necessary for the insertion of the manipulator. After that, the procedure begins. How long does the operation take? Its duration may be different, it depends more on the severity of the disease and the purpose of the procedure. If the task of laparoscopy is diagnostics, then no more than 60 minutes. Treatment can last up to several hours.

When is the choice: laparoscopy or abdominal surgery? Compared with conventional abdominal surgery, laparoscopy is able to provide better visual control with the help of optical magnification several times of the examined organs, the abdominal cavity, and the retroperitoneal space.

During the course of the operation, doctors monitor their own movements and what happens to the patient's organs on a special screen. The surgeon performs the necessary actions, focusing on him.

A video inspection of the area where the operation was performed is mandatory after the procedure is completed. The surgeon must make sure that there is no bleeding, remove the blood or fluid that has accumulated during the operation. Then gas or oxygen is removed. Only after that, the instruments are removed, and sutures are applied to the incisions in the skin.

Drainage at the end of the operation is required without fail. It is placed after laparoscopy in order to remove blood residues, the contents of wounds and abscesses from the peritoneum to the outside. This helps prevent the possibility of peritonitis.

Types of laparoscopy

In gynecology, a distinction is made between elective and emergency laparoscopy. And also diagnostic laparoscopy or therapeutic is carried out. When prescribing a planned operation, the surgeon must carefully study the results of the tests, read the information about chronic diseases, if they are. Important age and indications for laparoscopy, preparation.

Currently, diagnostic laparoscopy (in other words, endoscopic surgery in gynecology - diagnosis through natural openings or 0.5 cm punctures) is often used by surgeons. One of the main advantages of this method is considered to be low tissue trauma, a minimum of complications and a rather quick return of the patient to the normal rhythm of life.

Diagnostic laparoscopy allows the doctor, with the help of a tube with a video camera inserted into the abdominal cavity, to have a good opportunity to examine in detail the organs of the patient's abdominal cavity. This allows you to assess the situation and understand the cause of the disease, ways to eliminate it. Or make sure the woman is healthy.

It often happens when diagnostic laparoscopy, according to the indications that emerged during the procedure, is reclassified as a medical one. This happens if the surgeon during the operation sees that there is an opportunity to help the patient right now. At the same time, laparoscopy, now aimed at treatment, leads to recovery, complete or partial.

As a rule, interventions by this method are done according to the prescription of the attending gynecologist. Before a laparoscopy is performed, tests are preliminarily given and an examination is performed.

Emergency execution is assigned in certain cases. Laparoscopy, indications for urgent conduction:

Rupture of the ovary (apoplexy);
, ovary;
flowing in acute form infectious and purulent diseases;
With a ruptured cyst;
Necrosis of the myomatous node;
If the pregnancy is ectopic and progresses;
Puncture of the uterine wall during a medical abortion;
If diagnostics is necessary for acute pain syndrome in the lower abdomen with an unclear etiology.

Emergency laparoscopy in gynecology is necessary in a situation where surgical intervention needs to be performed urgently. Its purpose can be both therapeutic and diagnostic.

Indications for laparoscopy

Gynecological diseases lead to the need for an operation.

Indications for laparoscopy:

Infertility
Obstruction of the fallopian tubes (for example, when diagnosing infertility - if it was not possible to find out by other methods), excision of adhesions in the small pelvis
Endometriosis (If combined with other ailments of unclear etiology)
Ovarian cyst (laparoscopic cystectomy)
Myoma node
Menstrual irregularities
Inflammatory processes in the pelvic area
Suspicion of ectopic pregnancy
Tumor in the ovarian region of unknown nature
Polycystic
To clarify the development and nature of anomalies of the internal genital organs of a woman
To control the treatment, aimed at suppressing inflammation in the pelvis.
To clarify the stages of development of a pathological and malignant nature (when there is a question about surgical treatment and its volume)
To control the integrity of the uterine wall during hysteroresectoscopy

Quite often, diagnostic laparoscopy during surgery is retrained as a medical one.

Statistics show that the number of complications associated with infertility due to obstruction of the fallopian tubes is approaching 40% relative to all others. Therefore, laparoscopy of the fallopian tubes is a fairly common procedure in the gynecological profile. Obstruction can be caused by inflammatory processes, the consequences of past interventions, when adhesions form, infections.

Laparoscopy of the fallopian tubes can be performed for both diagnostic and therapeutic purposes. At the same time, diagnostics during the operation can become a stage of therapeutic intervention in the process, for example, laparoscopy of adhesions.

It turns out that laparoscopy of the fallopian tubes becomes an excellent alternative to conventional abdominal surgery: it is less traumatic, the rehabilitation period is short, and it allows the doctor to perform all the necessary manipulations.

Despite the fact that surgical intervention using laparoscopy is less traumatic, there are several contraindications to its implementation.

They are divided into absolute And relative.

The first group includes:

Respiratory ailments (decompensation diseases, exacerbation of asthma);
Cardiovascular diseases, including cerebral vessels, diaphragmatic hernia or infirmity of the esophageal opening, that is, those ailments that can prevent a woman from giving the correct body position on the operating table for the work of surgeons;
Poor blood clotting;
severe exhaustion;
Shock of any kind and coma. A state of shock can occur if a rupture of the fallopian tube or cyst has occurred. Then laparoscopic operations are replaced by abdominal ones;
Hypertension in severe degree;
Acute viral infections;
Acute renal or hepatic failure.

The second group includes (relative):

Cancers of the ovaries, cervix or any other localization;
Obesity (3, 4 degree);
Pathological formations in the small pelvis of a significant volume;
Adhesions in the abdominal cavity that have arisen after previous operations;
Hemorrhage in the peritoneum;
Inflammation of the peritoneum (peritonitis);
Allergy;
Pregnancy more than 16 weeks;
Fibroids larger than 12 weeks.

Contraindications to laparoscopy will also be situations if the patient has a lot of adhesions in the small pelvis, if tuberculosis is detected in the organs of the reproductive system, if endometriosis is in severe form, and if the hydrosalpinx is large.

Since there are indications and contraindications for laparoscopy in gynecology, it is necessary to undergo an examination before the procedure.

The doctor determines whether it is possible to carry out laparoscopy of the abdominal cavity in each individual case after examining all the tests, getting acquainted with the results of the ultrasound. It happens that the positive effect of treatment with laparoscopy is quite difficult, then a laparotomy is prescribed (an operation with an incision in the abdominal wall).

How to prepare for laparoscopy should be explained in detail by the attending physician. In addition to the gynecologist-surgeon and the anesthetist, the patient must undergo consultations of related specialists. All comorbidities are identified. Since the operation is performed under general anesthesia, the preparation of the patient for laparoscopy should take place at a serious level. Before the operation, a woman should visit:

therapist
Neurologist
Nephrologist
Dentist and other doctors, to detect possible chronic foci of infection.

It is mandatory to pass tests:

Blood and urine on general analysis;
Biochemistry of blood;
On the level of glucose and sugar;
Blood type;
For syphilis and HIV;
For hepatitis;
Coagulogram (blood clotting test);
Smear on flora.

Before the operation, the patient also receives referrals for fluorography, cardiograms, ultrasound of the pelvic organs.

If a laparoscopy of the uterus or other organ is performed urgently, then the number of studies and analyzes is limited to general ones, because in this situation not only the woman's health, but also her life can be in danger.

The minimum is blood type and Rh, general blood and urine tests, coagulation, cardiogram, pressure is measured. The rest are performed when absolutely necessary.

Before an emergency operation, food and water intake is prohibited for two hours. They put a cleansing enema, wash the stomach in order to prevent vomiting and release of the contents of the stomach into the respiratory tract under the influence of anesthesia.

During the planned preparation for the operation, a strict diet is prescribed before laparoscopy: do not eat anything in the evening, and do not drink anything in the morning either. A cleansing enema is prescribed both in the evening and in the morning.

On what day of the cycle do laparoscopy? Usually this is the date of the planned operation is appointed after the fifth - seventh day from the onset of menstruation. During the period of menstruation, they try not to carry out laparoscopy, since the bleeding of tissues increases. However, this is not a contraindication, but is taken into account by the operating surgeon and anesthesiologist.

Is laparoscopy a danger or a benefit?

Many patients are afraid of laparoscopy, removal of cysts and fibroids. Are their fears justified? How dangerous is this procedure? How is the rehabilitation going?

There are risks, of course. After all, laparoscopy is a full-fledged operation and it is performed under general anesthesia. However, such a surgical intervention is considered much less dangerous compared to, for example, abdominal surgery. This information is correct based on the fact that when it is carried out, the risk of complications is reduced to a minimum. The main rule is to obey the doctor and follow all the recommendations during preparation and after.

Advantages and disadvantages of the laparoscopy procedure

This method of operation has both advantages and disadvantages. Let's take a look at them.

The advantages include:

Small incisions on the abdominal wall instead of a wide one;
After the operation, there is practically no pain;
Scars do not remain due to the lack of an incision;
The need for hospitalization is minimal;
Pretty soon after the operation, you can get up and walk;
Sometimes you can go home on the same day in a maximum of 2-3 days. With abdominal operations, this period will be 14–21 days;
The rehabilitation period passes quickly and you can return to normal life;
Postoperative hernias are rare. So, after simple operations, this complication is common;
The surgeon gets a more convenient view of the organs due to the multiple magnification of the optics;
Blood loss is much lower;
Tissues are less injured;
It is possible to clarify the diagnosis, and hence the change in treatment tactics;
It is possible to identify comorbidities;
It is permissible to perform two operations without unnecessary skin incisions and the introduction of additional instruments into the abdominal region. For example, ovarian resection and simultaneous plastic surgery;
The adhesive process, which can lead to infertility, and other serious pathological ailments, is minimal, since during laparoscopy there is no need to use gloves with talc, gauze wipes, and there are fewer manipulations with the intestines;
There are practically no divergences of seams;
The use of laparoscopy for diagnosis allowed physicians to negate exploratory operations (cavitary diagnostic operations used when it is impossible to make a diagnosis);
With the use of this sparing method, even laparoscopic hysterectomy (amputation of the uterus) is easier for the body to tolerate.

In the treatment of women's diseases, the use of laparoscopic technology is especially important, since there are many operations that require only a ten-minute intervention to heal an organ. And at the same time, making a large incision of 15 centimeters is impractical.

How much does laparoscopy cost depends on the clinic.

However, we can say that usually free insurance is enough to cover the cost of the operation.

The disadvantages of this method of diagnosis and treatment include:

The high cost of equipment, the rapid deterioration of instruments, disposable consumables, the uniqueness of the laparoscopy method requires special training - hence the high cost of the procedure;
General anesthesia;
Some laparoscopic operations take longer than usual, because the control of the equipment reduces the freedom of manipulation;
There are a number of postoperative complications associated with laparoscopy. They are rare, yet they exist. About 1% of patients suffer from subcutaneous emphysema (accumulation of air in tissues), malfunction of the cardiac and respiratory systems due to gas in the abdominal cavity, burns of trocar wounds during coagulation.

What you need to know about complications

After such a type of surgical intervention as laparoscopy, complications in gynecology are extremely rare, provided that the preparation for laparoscopy has been completed correctly. The laparoscopic operation itself in gynecology is more easily tolerated by the body, therefore, severe consequences occur in exceptional cases.

If an experienced surgeon operates, then there should be no complications.

After laparoscopic intervention, the following consequences may occur:

Complications of laparoscopy - this is when, during the implementation of surgical procedures, the internal organs were accidentally damaged. The reason may be poor visualization of the progress of the operation;
Bleeding in the abdomen;
Violation of the integrity of one or more vessels when piercing the abdominal wall;
Gas embolism (blockage of the vessel with air bubbles) as a result of gas entering the damaged vessel;
subcutaneous emphysema;
Damage to the outer lining of the intestine.

How is the postoperative period

Upon completion of the laparoscopy, the operated woman wakes up immediately after anesthesia, on the operating table. Doctors have to make sure that her condition is normal and that her reflexes are working properly. The patient is then transferred to the recovery room.

It is recommended to start moving lying down after an hour. And literally after 5 hours (according to well-being), a woman begins to get out of bed in order to activate blood circulation, to prevent intestinal paresis (lack of peristalsis). Recommend independent trips to the toilet, food. You need to move carefully, smoothly and slowly, avoiding sudden movements. You can’t eat on the first day, only drink non-carbonated water.

The seams are looked after with the help of antiseptics. There are small scars on the abdomen from punctures. The stitches will be removed about a week after the operation. And the discharge will be carried out depending on how large the volume of intervention was - in 2-5-7 days. After laparoscopic extirpation of the uterus, sometimes a little later.

Pain in the abdomen and lower back after surgery is relative. It disappears approximately 3 days after the intervention. Often you can do without painkillers. But if necessary, you need to tell your doctor about it. Evening or morning next day possible discharge with ichor, and then without it. The temperature can rise up to 37 o. Allocations can last up to 1.5–2 weeks.

At the beginning of the recovery period after the laparoscopy, discomfort and heaviness in the lower abdomen, as well as nausea, are possible. These symptoms are the result of carbon dioxide introduced into the abdominal cavity. As soon as the gas is completely released, all unpleasant feelings will stop.

Most women who have undergone laparoscopy leave positive feedback about the procedure. Quick recovery and good health are always joy and satisfaction. Some managed to completely get rid of the disease, which had long tormented and disturbed, others partially.

If you strictly follow all the recommendations of the doctor, then the operation will be successful and the recovery period will be short - laparoscopy is the least traumatic operation.

Laparoscopy is a minimally invasive operation, which is why it is so popular in gynecology. Its main advantage is the ability to perform a complex operation without severe tissue damage. This allows you to significantly reduce the rehabilitation period, up to 1-2 days.

Laparoscopy is a minimally invasive method for diagnosing and treating pathologies of the pelvic organs. During laparoscopy, all manipulations are carried out with the help of special instruments through small holes in the abdominal cavity. The advantage of the method is the ability to visually control the progress of the operation, since a telescopic tube with a video system (endoscope) is attached to the instruments. Laparoscopy can be performed by a surgeon and a gynecologist.

The operation consists in penetration through the abdominal cavity into the small pelvis through just a few punctures. This was made possible thanks to the invention of an innovative apparatus, the manipulators of which are equipped with micro-tools, illumination and a camera. For this, laparoscopy is considered an exceptional operation, giving good review with minimal tissue damage.

Surgical intervention is carried out under general anesthesia. To prevent the abdominal wall from obstructing the view, it is raised by filling the abdominal cavity with air (pneumoperitoneum).

What surgeries are performed laparoscopically?

diagnosis in infertility;
conservative myomectomy (removal of fibroids);
hysterectomy (removal of the uterus);
removal of formations from the ovaries and fallopian tubes (cyst, cystadenoma, polycystic);
emergency care for acute conditions (,);
adnexectomy (removal of the ovaries and fallopian tubes).

Gynecological operations by laparoscopy are becoming the standard. The method allows to carry out intervention of different volume and complexity with minimal tissue damage. Previously, many operations required open access and extensive abdominal surgery, which caused severe postoperative discomfort and many complications. By comparison, laparoscopy is indeed an exceptional innovative technique.

Indications and contraindications for laparoscopy

Today, laparoscopy is the standard for diagnosing and treating the causes of female and male infertility. Compared to abdominal operations, which severely injure the pelvic organs and negatively affect general state patient, laparoscopy has a number of important advantages. Not surprisingly, this is the best treatment for young patients.

Indications for laparoscopy:

infertility of unknown etiology;
lack of effect from hormone therapy;
acute and chronic pathologies of the uterus, ovaries and fallopian tubes;
adhesive process;
ectopic pregnancy;
diagnosis of disorders in the small pelvis.

Contraindications:

blood clotting disorder;
pronounced changes in clinical analyzes;
exhaustion of the body, weakened immunity;
shock, coma;
severe pathologies of the heart and blood vessels;
severe lung disease;
hernia of the diaphragm, white line of the abdomen and abdominal wall.

Planned laparoscopy should be postponed for a month with the development of acute respiratory viral infection. For hypertension and bronchial asthma surgery is prescribed in case of urgent need.

Advantages and disadvantages of laparoscopy

Laparoscopic surgery remains the procedure of choice. The doctor must take into account the nature of the pathology, the presence of complications and contraindications, choosing a method of treatment. Until now, laparoscopy has not been sufficiently improved, so there are pathologies that are better to operate with traditional methods. If there are no conflicting factors, laparoscopy should be chosen, since the minimally invasive approach is safe and easier for patients to tolerate.

Benefits of laparoscopy:

no large scars;
reduction of pain and postoperative discomfort;
fast recovery;
a short period of stay in the hospital;
minimal risk of complications, including adhesions and thromboembolic disorders.

After laparoscopy, patients quickly return to their usual activities due to the low trauma of the operation, so hospitalization takes 1-2 days. Since laparoscopy is often performed as part of a gynecological treatment, a good cosmetic effect is very important.

Another advantage of laparoscopy is accuracy. Endoscopic devices allow the surgeon to visualize the desired area well. Modern equipment can magnify images up to forty times, which helps when working with small structures. Due to this, diagnostic laparoscopy and therapeutic laparoscopy are often performed in one procedure. The disadvantages of laparoscopy include the presence of complications, but the consequences occur after any other intervention in the body.

Application area

Laparoscopy cannot be performed without modern equipment, so such operations are carried out exclusively in equipped clinics. The method is used to diagnose and treat pathologies of the peritoneum and pelvic organs.

Features of laparoscopy:

diagnosis of tumors in the peritoneum and pelvis;
determination of treatment for various conditions (endometriosis,);
identification and treatment of causes of infertility;
obtaining tissue for biopsy;
assessment of the spread of the cancer process;
detection of damage;
sterilization;
determining the causes of pelvic pain;
removal of the uterus, ovaries, gallbladder, appendix, spleen;
complex resections (removal of the colon).

Laparoscopy is carried out according to all the rules of surgery. It is allowed to carry out both planned operations with additional preparation and examination, and emergency ones necessary to save a person's life.

Indications for elective laparoscopy:

Sterilization.
Endometriosis (growth of the endometrium of the uterus).
Relapse of endometrial hyperplasia.
Fibroids and other benign pathologies of the uterus.
Pathologies causing infertility.
Tumors and cysts in the ovaries.
Defects in the anatomy of the genital organs (congenital and postoperative).
Syndrome of chronic pelvic pain.

Indications for urgent laparoscopy:

Ectopic pregnancy.
Rupture of the cyst.
Ovarian apoplexy (tissue rupture accompanied by hemorrhage).
Complications with benign formations in the uterus (hemorrhage, tissue death).
Adnexal torsion.
Bleeding with adenomyosis (germination of the endometrium in the layers of the uterus).
Acute lesions of the fallopian tubes, accompanied by inflammation.
Differential diagnosis in the presence of unclear symptoms of acute pathology.

Thanks to innovative devices, the doctor is able to follow the process and make incisions with perfect accuracy. Laparoscopy has significantly reduced the percentage of medical errors, but such an operation can only be trusted by a professional.

Preoperative diagnostics

Preparation for laparoscopy should be thorough, but in case of emergency, it is reduced to save time. Before a planned operation, it is necessary to take tests, it is important to determine the degree of blood clotting and glucose levels. Checking the blood type and Rh factor is required.

Within a month before laparoscopy, the patient is checked for syphilis, hepatitis, and HIV. Before the operation, an ECG and fluorography are prescribed, a control ultrasound of the pelvic organs is done and gynecological smear.

If there are any individual characteristics of the body and chronic pathologies, the permission of the therapist is required, in particular, for anesthesia. The anesthesiologist should check for allergies and contraindications to anesthesia. Before surgery, you need to tell the doctor about a history of severe blood loss (if any) and taking drugs that increase bleeding. The possibility of pregnancy in the future should also be discussed.

In some cases, psychological or medical preparation for laparoscopy may be prescribed. Immediately before the operation, the surgeon must tell the patient about the procedure and list all the steps. In the absence of contraindications, the patient signs a written consent to the treatment and the selected type of anesthesia.

Stages of laparoscopy

Planned operations are carried out in the morning. It is usually recommended to follow a light diet before the procedure. On the day before the operation, you can not eat, it is forbidden to drink after ten in the evening. Lack of food and liquid in the stomach prevents vomiting during surgery.

Before the patient is taken to the operating room, additional bowel cleansing is performed with an enema. If there is a risk of thrombosis, the legs are bandaged with an elastic material, or anti-varicose compression stockings are put on. Glasses, contact lenses and dentures should be removed before laparoscopy.

Both inhalation and intravenous anesthesia are possible. During the operation, an endotracheal tube is placed in the trachea to support breathing, and in bladder- a catheter for monitoring the functionality of the kidneys.

The number of punctures during laparoscopy will depend on the location of the pathology and the extent of the intervention. Usually 3-4 punctures are made. The doctor inserts a trocar (a device for piercing tissues and inserting instruments) under the navel, two more on the sides of the peritoneum. One of the trocars is equipped with a camera, others are instruments, and the third illuminates the cavity.

Through the trocar, the abdominal cavity is filled with carbon dioxide or nitrous oxide to improve access to the small pelvis. Usually, the technique and volume of the operation are determined after the introduction of instruments and examination of the pathology.

Laparoscopy without surgical complications can last from 15 minutes to several hours. It all depends on the severity of the disease. At the end of the manipulations, the doctor examines the cavity again, checks the results, removes blood and fluids that have accumulated in the process. It is very important to check for bleeding.

After the control revision, the gas is removed and the trocars are removed. The punctures are sutured subcutaneously, cosmetic sutures are applied to the skin.

Rehabilitation after laparoscopy

Typically, patients are brought back to consciousness on the operating table to check reflexes and condition. Then they are transported to the recovery room for control. After the operation, drowsiness and fatigue are felt.

With proper laparoscopy, postoperative pain is negligible. Depending on the anesthesia chosen, the pain may persist for several days. There are also unpleasant sensations in the throat after the tube is there, but they can be eliminated with a therapeutic rinse.

Depending on the complexity of the intervention and the presence of complications, discharge occurs for 2-5 days. After laparoscopy, special care for the sutures is not required, only the use of antiseptics.

Possible Complications

The number of unpleasant consequences after laparoscopy is minimal, as is the chance of their development. After traditional operations with extensive incisions, complications occur much more often. The low invasiveness of the method allows you to shorten the list possible complications during and after the operation. This became possible with the use of special instruments that almost do not affect tissues and organs that are not subject to surgery.

However, there is always the risk of injury. internal organs and vessels by tractors. Sometimes bleeding occurs after laparoscopy, usually minor. With the introduction of gas, subcutaneous enphysema may form. Complications of laparoscopy include bleeding that occurs when there is insufficient cauterization of blood vessels in the operated area. Most of the consequences of the operation are mild and reversible.

Undoubtedly, laparoscopy is a grandiose achievement of medicine. This operation greatly simplifies the treatment of many gynecological pathologies, allowing women to quickly return to their usual rhythm of life without complications.

Laparoscopy in gynecology is a minimally invasive, without a layer-by-layer incision of the anterior abdominal wall, an operation performed using special optical equipment for examining the uterus and ovaries. Such diagnostics are carried out for the purpose of visual analysis of the state of the reproductive organs and targeted treatment pathologies.

Laparoscopy in gynecology is a method that causes the least amount of trauma, damage during diagnosis or surgery, with the smallest number of internal penetrations.

In one laparoscopic session, the doctor:

performs diagnostics of gynecological diseases;
clarifies the diagnosis;
provides the necessary treatment.

The study allows the doctor to examine in detail the internal reproductive organs through a mini camera. In order to perform medical manipulations in a timely manner, special instruments are introduced into the abdominal cavity along with the camera.

In what cases is it carried out and for what?

Laparoscopy in gynecology is used to diagnose and solve problems in the field of female diseases.

This low-traumatic method allows surgeons to:

remove affected areas, adhesions or organs;
perform a tissue biopsy;
perform ligation, resection or plastic tubing;
put stitches on the uterus, etc.

Indications for carrying out

The operation finds its application in the following indications:

severe pain of unclear etiology in the lower abdomen;
suspected ectopic pregnancy;
ineffectiveness of hormonal therapy in infertility;
myomatous lesion of the uterus;
clarification of the causes of infertility;
surgical treatment of endometriosis, fibroids, etc.;
preparation for IVF;
biopsy of affected tissue.

Contraindications for laparoscopy

Before the operation, the gynecologist should carefully study the patient's medical record, as there are a number of contraindications to laparoscopy of the uterus (including the cervix) and appendages.

Absolute contraindications

It is forbidden to do laparoscopy for patients with such a pathology as:

acute infections of the reproductive organs;
diseases of the heart, blood vessels, lungs (severe forms);
blood clotting disorder;
acute disorders of the liver or kidneys;
significant depletion of the body;
bronchial asthma;
hypertension;
hernia of the white line of the abdomen and anterior abdominal wall;
coma;
shock state.

Patients who have had ARVI are allowed a month after recovery.

Relative contraindications

The attending physician analyzes the risks and decides whether it is advisable to perform laparoscopy in patients with these diagnoses:

abdominal operations in a six-month history;
extreme obesity;
pregnancy for a period of 16 weeks;
tumors of the uterus and appendages;
a large number of adhesions in the pelvis.

Operation types

There are two types of laparoscopy in gynecology: planned and emergency. Planned is carried out both for the purpose of research and for the treatment of pathologies. Diagnostic surgery often turns into a therapeutic one. An emergency operation is performed if there is a threat to the patient's life for an unexplained reason.

Planned diagnostic laparoscopy is performed for the following purposes:

clarification of such diagnoses as "obstruction of the fallopian tubes", "endometriosis", "adhesive disease" and other causes of infertility;
determination of the presence of tumor-like neoplasms in the small pelvis to determine the stage and the possibility of treatment;
collection of information about anomalies in the structure of the reproductive organs;
finding out the causes of chronic pelvic pain;
biopsy for polycystic ovary syndrome;
tracking the effectiveness of treatment of inflammatory processes;
control over the integrity of the uterine wall during resectoscopy.

Planned therapeutic laparoscopy is carried out for:

surgery of the pelvic organs in the presence of endometriosis, cysts, tumors, sclerocystosis, fibroids;
performing temporary or complete sterilization (tubal ligation);
treatment of uterine cancer;
removal of adhesions in the pelvis;
resection of the reproductive organs.

Emergency therapeutic laparoscopy is performed when:

interrupted or progressing tubal pregnancy;
apoplexy or rupture of an ovarian cyst;
necrosis of the myomatous node;
acute pain syndrome in the lower abdomen of unclear etiology.

Laparoscopy and the menstrual cycle

The menstrual cycle after laparoscopy has a number of features:

The regularity of menstruation after laparoscopy is restored within two to three cycles. With successful treatment of endometriosis, uterine fibroids and polycystic ovaries, impaired menstrual cycle is leveled and, as a result, the reproductive function is restored.
Normally, menstrual flow should first appear in the next day or two after surgery and last about four days. This is due to a violation of the integrity of the internal organs and is the norm, even if the discharge is quite a lot.
The next cycle may shift, the discharge may become unusually scarce or plentiful for a while.
A delay of up to three weeks is considered acceptable, more than a probable pathology.
If menstruation is accompanied severe pain urgent consultation with a gynecologist is necessary to prevent postoperative complications. Also, the brown or green color of the discharge and an unpleasant odor should alert - these are signs of inflammation.

How to prepare for surgery

Preparation for gynecological laparoscopy includes several stages. First, a consultation with a therapist is required in order to identify contraindications.

Then research is carried out:

blood (general analysis, coagulogram, biochemistry, HIV, syphilis, hepatitis, Rh factor and blood group);
urine (general);
pelvic organs through ultrasound, taking a smear for flora and cytology;
cardiovascular system (ECG);
respiratory system (fluorography).

Here is how to prepare the patient before the operation:

eat at least 8-10 hours before;
no later than 3 hours, it is allowed to drink a glass of non-carbonated water;
exclude nuts, seeds, legumes from the diet for 2 days;
cleanse the intestines in the evening and in the morning with laxatives or enemas.

In emergency laparoscopy, preparation is limited to:

examination by a surgeon and an anesthesiologist;
urine (general) and blood tests (general, coagulogram, blood type, Rh, HIV, hepatitis, syphilis);
refusal of food and liquid intake for 2 hours;
bowel cleansing.

A planned operation is prescribed after the 7th day of the menstrual cycle, since in the first days there is increased bleeding of the tissues of the reproductive organs. Urgent laparoscopy is performed on any day of the cycle.

Ter-Ovakimyan A.E., Doctor of Medical Sciences, tells in detail about why laparoscopy is done and how to prepare for the procedure on the MedPort. ru".

Execution principle

The execution principle is as follows:

The patient is given anesthesia.
An incision (0.5 - 1 cm) is made in the navel, into which the needle is inserted.
Through the needle, the abdominal cavity is filled with gas, so that the doctor can freely manipulate surgical instruments.
After removing the needle, a laparoscope penetrates into the hole - a mini camera with illumination.
The rest of the instruments are inserted through two more incisions.
The enlarged image from the camera is transferred to the screen.
Diagnostic and surgical manipulations are carried out.
Gas is expelled from the cavity.
A drainage tube is installed through which the outflow of postoperative fluid residues from the abdominal cavity, including blood and pus, occurs.

Drainage is a mandatory prevention of peritonitis - inflammation of the internal organs after surgery. The drainage is removed within 1-2 days after the operation.

Photo gallery

Photos give an idea of how the operation is carried out.

Entering tools The principle of laparoscopy laparoscopic procedures. Inside view Incisions in the healing stage

Features of transvaginal laparoscopy

Features of transvaginal laparoscopy are that this method is more gentle, but it is used only to diagnose pathologies. Treatment of identified diseases is possible through traditional laparoscopy.

Transvaginal surgery is carried out in several stages:

Anesthesia (local or general) is administered.
The posterior wall of the vagina is punctured.
Through the opening, the pelvic cavity is filled with a sterile liquid.
A backlit camera is placed.
The reproductive organs are being examined.

Hydrolaparoscopy is most often prescribed for patients with infertility of unknown origin.

Postoperative period

After the operation, there are:

pain in the abdomen and lower back (disturb from several hours to several days, depending on the type of operation and the amount of surgical intervention);
discomfort when swallowing;
nausea, heartburn, vomiting;
temperature rise to 37.5°C.

walk 5-7 hours after surgery to restore blood circulation and activate bowel function;
drink water in small sips after at least two hours;
eat food the next day, giving preference to easily digestible foods;
within a week, observe restrictions on fatty, spicy, fried foods;
avoid sunlight for up to three weeks;
2-3 months do not lift heavy objects and limit yourself to charging instead of active sports;
maintain sexual rest for 2-3 weeks;
baths and saunas to be replaced with showers for a period of 2 months;
give up alcohol.

Possible Complications

Laparoscopy in gynecology is associated with some risks and complications.

Possible, but rare:

massive bleeding as a result of injury to the vessel;
gas embolism;
violation of the integrity of the intestinal wall;
pneumothorax;
emphysema - the ingress of gas into the subcutaneous tissue.

Complications arise when the first instrument is inserted (without camera control) and the abdominal cavity is filled with gas.

Postoperative consequences:

suppuration of the sutures due to a decrease in immunity or improper asepsis;
the formation of an adhesive process in the pelvis, which can cause infertility and intestinal obstruction;
the appearance of postoperative hernias.
development of peritonitis.

Complications during surgery and its consequences are rare. Their appearance depends on the quality of the preoperative examination of the patient and the qualifications of the surgeon.

The video was prepared by the MedPort. ru".

Recovery after surgery

After laparoscopic surgery, the patient expects a long recovery, while:

discharge from the hospital occurs 3-5 days after the operation, if there are no complications;
full rehabilitation after diagnosis takes about a month, after treatment - no more than four months, subject to the doctor's recommendations;
conception can be planned 1-2 months after the diagnostic operation and 3-4 months after the surgical one;
scars heal completely after 3 months.

Diagnostic Benefits

The procedure has the following advantages:

less traumatic - instead of a cavity incision, three small punctures are performed;
fast holding - about 30 minutes;
full preservation of fertility;
invisible postoperative scars instead of a long scar.

What is the price?

Prices for laparoscopy vary depending on its type, volume of treatment and region:

Video

The video illustrates the procedure of laparoscopy in the treatment of infertility. Represents the "Drkorennaya" channel.

Laparoscopy is a low-traumatic method of diagnostics and surgical intervention.

Laparoscopy is carried out by penetrating into the abdominal cavity to the pelvic organs with the help of several punctures, and then manipulator instruments are inserted through them.

The manipulators are equipped with micro-instruments, illumination and micro-cameras, which allow performing operations with visual control without making large incisions, which reduces the risk of postoperative complications, minimizes surgical tissue trauma and shortens the rehabilitation period.

When carrying out laparoscopy, so that the abdominal wall does not interfere with the examination and operations, it is raised by forcing air into the abdominal cavity - pneumoperitoneum is applied (the stomach is inflated).

The operation is accompanied by incisions and painful irritations, therefore it is performed under general anesthesia.

Indications

Laparoscopy is very widely used in gynecology:

with infertility of an unclear cause, which was not identified during a detailed non-invasive study.
with the ineffectiveness of hormonal therapy for infertility,
during operations on the ovaries (sclerocystosis, ovarian cysts, ovarian tumors),
with suspicion of endometriosis, adhesive disease,
with chronic pelvic pain,
with endometriosis of the uterine appendages, ovaries, pelvic cavity,
with myomatous lesions of the uterus,
with tubal ligation, ectopic pregnancy, rupture of the tube,
with ovarian torsion, cysts, ovarian apoplexy, internal bleeding,
when examining the pelvis.

Contraindications for laparoscopy

Absolutely contraindicated laparoscopy in gynecology

with severe cardiovascular and pulmonary diseases,
in a state of shock, in a state of coma,
with severe depletion of the body,
with violations in the coagulation system.

Operation by laparoscopy is also contraindicated for hernias of the white line of the abdomen and the anterior abdominal wall, for hernias of the diaphragm.

Planned laparoscopy is contraindicated in ARVI, it is necessary to wait at least a month from the moment of illness. The operation is also prohibited with pronounced changes in blood and urine tests, with bronchial asthma, with hypertension with high blood pressure.

Training

Laparoscopy operations can be planned and emergency.

In emergency operations, preparation may be minimal when it comes to saving the patient's life.

For planned operations, a complete examination with the delivery of all tests is necessary:

blood (general, biochemistry according to indications, for hepatitis, syphilis and HIV, for coagulation),
blood for glucose.

Be sure to study the blood type and Rh factor.

Before the operation, a gynecological smear, ECG and fluorography, ultrasound of gynecological organs are required, and if there are chronic diseases, the conclusion of the therapist about the safety of anesthesia.

Before the operation, the surgeon explains the essence of the procedure and the scope of the intervention, and the anesthesiologist examines and identifies the presence of allergies and contraindications to anesthesia.

If necessary, medical and psychoprophylactic preparation for surgery is prescribed.

In the absence of contraindications to the operation and anesthesia, the woman signs a written consent to the operation separately for this type of anesthesia.

Operation

Planned operations are usually prescribed in the morning, and before that, a light diet is prescribed a few days in advance, and in the evening before the operation, the intestines are cleansed with an enema.

Prohibit the intake of food, and after 22.00 and water, and repeat the enema in the morning. Before the operation, it is forbidden to drink and eat.

If there is a risk of thrombosis, elastic bandaging of the legs or wearing anti-varicose compression stockings is indicated before the operation.

The essence of laparoscopic surgery

Depending on the volume of the operation and its localization, three or four punctures are used.

One of the trocars (a device for puncturing the abdominal cavity and maintaining instruments) is inserted under the navel, the other two on the sides of the abdominal cavity. At the end of one trocar there is a camera for visual control, at the other end there is a light installation, a gas blower and instruments.

Carbon dioxide or nitrous oxide is injected into the abdominal cavity, the volume and technique of the operation are determined, the abdominal cavity is inspected (its thorough examination) and manipulations are started.

On average, laparoscopic operations last from 15-30 minutes to several hours, depending on the volume. Anesthesia can be inhalation and intravenous.

At the end of the operation, an audit is carried out again, the blood or fluid accumulated during the operation is removed. Carefully check the clamping of the vessels (if there is any bleeding). Eliminate the gas and withdraw the instruments. At the trocar insertion sites on the skin and subcutaneous tissue, sutures are applied, and cosmetic sutures are applied to the skin.

After laparoscopy

The patient regains consciousness on the operating table, doctors check her condition and reflexes, and transfer her to the postoperative room on a gurney.

With laparoscopy, an early rise from bed and the intake of food and water are shown, a woman is raised to the toilet and to activate blood circulation in a few hours.

The extract is carried out in two to five days from the moment of the operation, depending on the extent of the intervention. Seams are cared for every day with antiseptics.

Complications

The complication rate for laparoscopy is low, much lower than for operations with extensive incisions.

With the introduction of a trocar, there may be injuries to internal organs, damage to blood vessels with bleeding; when gas is injected, there may be subcutaneous emphysema.

Complications can also be internal bleeding with insufficient clamping or cauterization of vessels in the operating area. All these complications are prevented by exact observance of the technique and a thorough revision of the abdominal organs during surgery.

in comparison with abdominal and severely traumatic operations in gynecology, laparoscopy has a number of undoubted advantages, especially at a young age: there are practically no scars from the operation,
less risk of postoperative complications and adhesions,
the recovery period is significantly reduced.