Laparoscopy in the diagnosis of gynecological diseases. The essence and advantages of diagnostic laparoscopy. There are also relative contraindications to diagnostic laparoscopy in gynecology.
Diagnostic laparoscopy is often used in gynecology to assess the patency of the fallopian tubes in cases where other methods have failed to make an accurate diagnosis. In addition, the procedure allows us to identify many diseases. abdominal cavity.
Modern medicine allows many operations to be performed laparoscopically in a minimally invasive manner that does not require a long recovery period. The formation of adhesions after such operations is unlikely, as are the occurrence of complications.
The procedure is a minor surgical operation that allows the doctor to examine the inside of the abdominal cavity, in particular the female genital organs (ovaries, fallopian tubes and the uterus itself).
Laparoscopy allows the doctor to obtain the most complete results of the study in comparison with a conventional incision of the anterior abdominal wall, since special optical equipment provides multiple magnification of the organs being examined.
Using the procedure, you can examine not only the entire abdominal cavity, but also the retroperitoneal space, as well as carry out the necessary medical manipulations. Modern diagnostic laparoscopy is considered an excellent method, used not only for diagnosis gynecological diseases, but also for their treatment.
The procedure is necessary in order to:
- establish the causes of pain in the abdomen or pelvic area;
- establish the nature of the emerging neoplasms (tumors);
- establish obstruction of the fallopian tubes and find out the cause of this disorder;
- establish other possible causes of infertility in cases where the tubes have normal patency;
- conduct full check patency of the fallopian tubes using methylene blue (a special safe dye injected into the uterus for diagnosis, which is later independently and without a trace removed from the body).
When is diagnostic laparoscopy prescribed?
Most often, the procedure requires a condition when a woman has:
- chronic or acute pain in the abdominal area. Most often they are caused by the presence of adhesions, endometriosis, exacerbation of appendicitis, inflammatory processes, bleeding;
- tumor-type neoplasms discovered during examination by a doctor or the patient herself;
- a condition of ascites, when the abdominal cavity fills with fluid. In this case, diagnostic laparoscopy makes it possible to find out the cause of this disorder;
- various liver diseases. In this case, laparoscopy is performed when a change in the surface tissue of the organ has been detected. The procedure allows tissue to be collected for analysis and an accurate diagnosis.
In some cases, a woman may need artificial creation obstruction of the fallopian tubes, which can be done during laparoscopy.
But, in addition, there may be emergency indications for the procedure that require immediate implementation.
Such situations include:
- ovarian apoplexy;
- ectopic pregnancies;
- suspicions of the presence of an ovarian tumor, rupture or torsion of the pedicle of the formation.
- suspected torsion of subserous fibroids;
- inflammatory diseases in the pelvic area;
- gynecological or surgical pathologists in acute form and the need for differential diagnosis between them.
Possible complications
Laparoscopy is a safe diagnostic method and the occurrence of complications after the procedure is very rare, about three cases per thousand patients.
Possible complications include:
- accidental injury to internal organs or blood vessels during the introduction of trocars;
- individual reactions to the anesthesia used and complications associated with it;
- individual reactions to gas introduced into the abdominal cavity;
- formation of seromas and hematomas;
- infectious diseases;
- transient fever;
- postoperative hernias;
- the appearance of adhesions in the pelvic area;
- bowel dysfunction;
- blood clot formation.
To avoid possible complications, it is necessary to take into account contraindications to the procedure, which can be either absolute or relative.
Absolute contraindications include:
- the presence of diseases of the respiratory and cardiovascular systems that have a stage of decompensation;
- uncorrectable coagulopathy;
- hemorrhagic shock;
- liver failure in acute or chronic form;
- some diseases, for example, brain injuries or damage to its blood vessels, in which the patient is prohibited from being placed in the Trendelenburg position (when the shoulder girdle and head of the patient are located below the level of the pelvic region during the operation);
- ovarian cancer, with the exception of situations where the procedure is necessary to control the process and results of radiation or chemical therapy.
Relative contraindications include:
- diffuse peritonitis;
- allergies of a polyvalent nature;
- pregnancy more than 17-18 weeks;
- suspicion of the presence of a malignant process or neoplasm in the uterine appendages;
- the presence of a pronounced adhesive process in the pelvis or abdominal cavity against the background of previous operations.
In addition, there are contraindications to the planned procedure, which include:
- 3 or 4 degree of purity of vaginal contents;
- various colds or infectious diseases suffered by the patient less than a month before the day of the study.
Carrying out the procedure
In gynecologists, diagnostic laparoscopy is in most cases performed to determine the level of patency of the fallopian tubes and possible reasons female infertility. The procedure includes 3 stages.
Preparing for surgery
Before laparoscopy, a general comprehensive examination and taking an anamnesis, as in preparation for any other gynecological operations.
A mandatory part of the preparation is to conduct a conversation with the patient about the upcoming procedure, explaining all the nuances of the operation, its features and possible complications. The woman should be fully informed that during the operation, transsection or unplanned interventions may be required, if it is necessary to expand the scope of the operation.
The patient must sign a document - consent to the operation and acceptance emergency measures if necessary.
Most women underestimate the seriousness of the operation, since non-surgical doctors often convince patients that such an intervention is completely safe. In fact, laparoscopy when examining the patency of the fallopian tubes and identifying other causes of infertility has the same risks as any other surgical intervention.
When preparing for surgery, the day before the operation, the patient should limit herself in food, eating only light liquid food, gradually switching to water. You should not drink anything 12 hours before surgery.
The evening before the procedure, the patient undergoes the first cleansing enema, and the second is prescribed in the morning 2-3 hours before the operation.
In some cases, medication may be required, but this depends on the type of underlying disease, the surgical plan, and its goals.
Carrying out the operation
Laparoscopy, both diagnostic and therapeutic, is performed only in the abdominal cavity.
In order to be able to insert special instruments into the cavity and be able to visualize the organs being examined, it is necessary to increase the volume of this space. This can be achieved in two ways:
- mechanical elevation of the anterior abdominal wall;
- creation of pneumoperitoneum.
Most often, it is the second method that is used, for which a safe gas, for example, helium, nitrous oxide, carbon dioxide or argon, is introduced into the abdominal cavity, the purpose of which is to raise the abdominal wall.
Gas is administered by puncture with a Veress needle or trocar of the anterior abdominal wall. The gas introduced into the cavity must be completely safe, non-toxic, actively absorbed by tissues, not cause irritation and be incapable of embolization.
Nitrous oxide and carbon dioxide fully meet these requirements. Unlike ordinary air or oxygen, the introduction of these gases does not cause pain in the patient; in addition, nitrous oxide has an excellent analgesic effect, and carbon dioxide, entering the bloodstream, quickly combines with hemoglobin.
Carbon dioxide also affects the respiratory system, leading to an increase in the vital capacity of the lungs, while reducing the possible risks of complications from this side.
The Veress needle has a blunt-ended rod with a spring, inside of which there is a sharp needle. When puncturing the abdominal cavity, the rod rises, exposing the needle, which is used to puncture, after which the upper rod is lowered, covering the sharp tip and protecting internal organs from damage.
The introduction of gas into the abdominal cavity has side effects and increases the risk of complications, for example:
- compression of veins and blood vessels located in the retroperitoneal space, which can cause circulatory problems in the lower limbs, as well as the formation of blood clots;
- the appearance of arrhythmia, decreased cardiac index and other disorders of the heart;
- current disturbances arterial blood in the abdominal cavity;
- heart rotation;
- compression of the diaphragm, accompanied by a decrease in residual lung capacity, as well as the development of hypercapnia and an increase in dead space.
Direct complications may also occur after the introduction of gas into the abdominal cavity, for example, pneumopericardis, pneumothorex, gas embolism, pneumomediastinum, subcutaneous emphasema.
In gynecology, when carrying out a procedure to examine the fallopian tubes or other organs, the choice of place for the puncture depends on the patient’s build and height, as well as on previous operations and their nature.
Essentially, the needle can be inserted anywhere in the abdominal cavity, but with mandatory accounting topography of the epigastric artery. If operations have previously been performed on the woman’s abdominal cavity, then to insert a Veress needle, a point is selected that is as far away from the scars as possible.
Some doctors do not use a Veress needle and perform direct puncture with a trocar, the diameter of which is 10 mm, which can lead to damage to internal organs if the doctor is careless.
If there is a real threat of damage to internal organs, then laparoscopy is performed in an open manner. This method is indicated in cases where there is an adhesive process in the woman’s abdominal cavity caused by previous operations.
In this case, the first trocar with optical instruments is inserted into the prepared hole in the abdominal cavity. In recent years, a video trocar or optical needle has become increasingly used, which helps avoid accidental injury to internal organs.
Gas is injected evenly in a volume of about 3 liters, lifting the abdominal wall. Patients who have a large build or excess weight, a larger volume of injected gas may be required. If the patient has heart failure or other disorders of the heart, the abdominal wall is lifted mechanically using various devices.
In gynecology, when performing laparoscopy to determine the causes of infertility, chromosalpingoscopy is also required - filling the fallopian tubes with methylene blue to assess their patency.
The laparoscope is inserted into the abdominal cavity through the first trocar, after which a thorough examination of all organs is carried out with the obligatory recording of the entire examination process on a removable medium, so that in the future the doctor can review the entire process again.
If, during an examination of the organs, the doctor discovers a disorder that requires surgical correction, 2 additional trocars are inserted into the abdominal cavity (in the iliac region on both sides) to perform the operation. If necessary, a fourth trocar can be inserted; in this case, a puncture is made between the navel and the womb.
Recovery
Rehabilitation after laparoscopy largely depends on the extent of the operation and the anesthesia used. Since the operation is performed under general anesthesia, after it, patients may experience drowsiness and weakness, nausea, vomiting, the appearance of delirium and hallucinations, as well as sore throat caused by the installation of an endotracheal tube.
As a rule, after the procedure the body quickly recovers, and after 10-12 hours the woman can already get up and walk independently.
Almost all patients experience discomfort caused by the presence of residual gas in the abdominal cavity, and note a feeling of bloating, as well as pain in the chest, since the gas is eliminated mainly through the lungs. It is necessary to speed up the process of eliminating gas from the body; for this you need to move more and eat right.
You need to eat about 6 times a day, in small portions, following a diet. The diet should consist of light baked, stewed or boiled pureed foods rich in fiber, carbohydrates and proteins.
It is prohibited to consume fried, pickled, fatty, salty foods, alcoholic and carbonated drinks, hot chocolate and coffee, fatty meats, smoked meats and lard, and confectionery.
After the operation, the patient remains in the hospital for 2-3 days. After which she is discharged with a mandatory explanation of the rules of nutrition, behavior, procedures for caring for puncture sites and the appointment of a day for removing postoperative sutures.
You should avoid any physical activity for 3 weeks after surgery. Sexual contacts can be resumed one month after the procedure. If all recommendations are followed, women quickly recover and return to their usual rhythm.
Compared to conventional surgeries and operative exploration procedures, laparoscopy is less traumatic and requires a shorter recovery period.
In recent decades, large medical centers have begun to use the four-armed Da Vinci robot to perform laparoscopy in gynecology, which makes it possible to increase the accuracy of surgical intervention and reduce the risks of possible complications.
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Diagnostic laparoscopy - modern method diagnostics, which is considered one of the most informative and reliable. As a rule, laparoscopy is performed on the abdominal and pelvic organs, which is reflected in the very name of the procedure: the term “laparoscopy” is a derivative of the Greek words “womb” and “to look”. Synonyms for the concept of “laparoscopy” are “peritoneoscopy” and “ventroscopy”. This procedure involves examining internal organs through small holes using a special instrument - a laparoscope.
Laparoscopic diagnosis is carried out if other types of examination turned out to be insufficiently informative.
Historical reference
Before the advent of laparoscopy the only way A laparotomy was performed to examine the abdominal organs. In other words, the patient’s abdomen was cut open and examinations and operations were performed through this incision. Laparotomy was a difficult and painful procedure for the patient. Scars remained on the anterior abdominal wall, the risk of complications was incredibly high, and the patients recovered very slowly.
Diagnostic laparoscopy was first discussed at the beginning of the 20th century, but the technique remained practically in its infancy until the 1960s.
The pioneer of laparoscopy is the Russian doctor Ott. It was he who, in 1901, first conducted endoscopic examination the patient's abdomen using a frontal reflector, an electric lamp and a mirror. He called his method ventroscopy. In the same year, in Germany, Professor Kelling conducted the first endoscopic examination of the abdominal organs in animals.
During the 1920-1930s, a large number of publications devoted to endoscopic studies appeared. Their authors were scientists from Switzerland, Denmark, Sweden and the USA. They extol laparoscopy as highest degree effective method for the diagnosis of liver diseases. During the same period, the first, still extremely imperfect, laparoscopes appeared. In the 1940s, the design of devices for laparoscopy was improved, and laparoscopes equipped with devices for biopsy appeared. During the same period, laparoscopy began to be used in gynecology.
In the 1960s, laparoscopy began to be actively used for the diagnosis and treatment of diseases of the abdominal organs.
Indications for the procedure
Today, diagnostic laparoscopy is in the stage of active development. It is used in various fields of medicine, since this diagnostic method makes it possible to choose the right treatment tactics and subsequently carry out radical surgery without laparotomy.
Diagnostic laparoscopy is indicated for various diseases abdominal cavity. So, with ascites, this diagnosis makes it possible to identify the root causes of the appearance of fluid in the abdominal cavity. In case of tumor-like formations of the abdominal cavity, the doctor, during diagnostic laparoscopy, has the opportunity to carefully examine the formation and perform a biopsy. For patients suffering from liver diseases, laparoscopy is one of the most safe methods, which allow you to obtain a piece of organ tissue for research. In addition, diagnostic laparoscopy is used in gynecology for a more complete diagnosis of patients suffering from infertility, endometriosis, uterine fibroids and cystic formations in the ovaries. Finally, the doctor may recommend diagnostics for pain in the abdomen and pelvic area of unknown etiology.
Contraindications for diagnosis
Since diagnostic laparoscopy is a minimally invasive surgical procedure, the list of contraindications for this procedure should be taken extremely seriously.
Thus, there are absolute and relative contraindications for this research method. Laparoscopy is strictly prohibited in case of hemorrhagic shock caused by severe blood loss and in the presence of adhesions in the abdominal cavity. Also reasons for refusing the procedure are liver and kidney failure, acute form cardiovascular diseases, lung diseases. Laparoscopy is contraindicated in cases of severe bloating and intestinal colic, and also when oncological diseases ovaries.
Relative contraindications for diagnostics are allergies to several types of medications, the presence of fibroids large sizes, pregnancy period exceeding sixteen weeks, diffuse peritonitis. The procedure is not recommended if the patient suffered from an acute respiratory viral infection or a cold less than four weeks ago.
Benefits of diagnostics
Compared to laparotomy, laparoscopy has a huge number of advantages:
- First of all, this method is minimally invasive. In other words, the surgical effect is very gentle, the risk of infection is minimal, and blood loss is practically absent. In addition, since the peritoneum is not damaged, adhesions will not form after the procedure. The pain syndrome is also minimal, since during abdominal operations the source of the main discomfort is the sutures placed on the incision. The cosmetic effect is also important - after laparoscopy, unaesthetic scars do not form, which are the result of laparotomy.
- In addition, after laparoscopy the patient recovers faster. Due to the fact that there is no need to comply with strict bed rest, the risk of thrombosis is reduced.
- Finally, diagnostic laparoscopy is a highly informative diagnostic method, which makes it possible to literally “shed light” on the condition of internal organs, find out the etiology of the disease and select the optimal method of therapy. By displaying a multiply magnified image of the internal organs on the screen, the doctor is able to study the tissues in detail from different angles.
Disadvantages of the procedure
However, like everyone else medical manipulations, diagnostic laparoscopy has not only advantages, but also disadvantages.
First of all, it must be taken into account that this diagnosis performed under general anesthesia. The effect of this type of anesthesia on each organism is strictly individual, and therefore before carrying out the manipulation it is necessary to carry out everything necessary research to avoid complications.
In addition, if the doctor performing the diagnosis is insufficiently qualified, there is a risk of injury to organs when inserting instruments. Due to the fact that the doctor operates instruments “remotely,” he sometimes cannot adequately assess the force applied to the tissues. Tactile sensations are reduced, which can complicate diagnosis if the doctor does not yet have enough experience.
Diagnostic laparoscopy in gynecology
Diagnostic laparoscopy is widely used in gynecology. During the procedure, the doctor may conduct a detailed examination of the woman’s internal genital organs: the ovaries, uterus and fallopian tubes.
Gynecological laparoscopy is performed either under general anesthesia or local anesthesia in combination with sedation. The method of performing it is almost the same as with conventional laparoscopy. A cannula is inserted into the abdominal cavity, through which gas enters, as a result of which the abdominal wall is raised into a dome. Next, a small incision is made through which the trocar is inserted. The latter is used to insert a tube equipped with a video camera lens and a light bulb into the abdominal cavity. The image of the pelvic organs is displayed on the monitor, and the progress of diagnostic laparoscopy is recorded on an information medium.
In gynecology, diagnostic laparoscopy is indicated when the cause of the disease is reproductive system cannot be detected by ultrasound and X-ray methods. In particular, diagnostic laparoscopy can be used in gynecology to identify the cause pain syndrome, clarification of the nature of tumor formations in the pelvis, confirmation of previously diagnosed edometriosis and inflammatory diseases. This procedure also helps to check the fallopian tubes and identify the cause of their obstruction.
Preparing for diagnostics
In order for the diagnostic laparoscopy procedure to be carried out without complications and to be as informative as possible, it is necessary to conduct a number of preliminary examinations and follow the recommendations of doctors.
It is recommended to begin preparations for routine diagnostic laparoscopy approximately one month before the procedure. During this period, the patient must undergo the most thorough examination, including a complete medical history, as well as laboratory diagnostics and consultation with specialists narrow profile. Doctors must find out what diseases the patient has previously suffered, whether he has had serious injuries, or whether he has undergone surgical interventions. It is imperative to check for the presence of an allergic reaction to medications.
To find out whether the patient suffers from diseases that may be considered as contraindications for diagnostics, it is necessary to visit a therapist, gynecologist and other specialists. Ultrasound, fluorography and a standard blood test are also performed, as well as a coagulogram, tests for HIV, hepatitis and syphilis. The blood type and Rh factor are determined in case complications arise.
Despite the fact that this surgical procedure is considered relatively safe, patients must be informed about all the details of the procedure and possible pitfalls.
Two weeks before testing, it is usually recommended to stop taking blood thinning medications. In addition, the diet is adjusted. It is usually recommended to minimize or completely eliminate spicy and fried foods, smoked foods, and dishes that stimulate gas formation from the menu. Two to three days before the laparoscopic examination, it is necessary to reduce the amount of food taken, and the day before, reduce it to a minimum.
Dinner the night before the procedure should be very light. Doctors usually recommend a cleansing enema in the evening.
Diagnostic laparoscopy is performed exclusively on an empty stomach. A consultation is held immediately before the operation.
Methodology for diagnostic laparoscopy
As noted above, laparoscopic diagnosis is most often performed under general anesthesia. It begins with a puncture of the abdominal cavity, after which heated carbon dioxide is injected into it. This is necessary in order to increase the volume of internal space - this way the doctor can more easily manipulate the instruments and examining the organs will not be difficult.
After this, small incisions are made at certain points in the abdomen, into which a laparoscope is inserted - an instrument with which organs are examined and all manipulations are monitored. The laparoscope is equipped with a high-resolution video camera that displays the image on the screen.
If necessary, several more punctures are made on the anterior abdominal wall, through which various manipulators are inserted, allowing, for example, to perform a biopsy or cut adhesions. After inserting the laparoscope, the doctor begins the examination upper sections abdominal cavity, assesses the condition of organs.
Once the operation is complete, the instruments are removed, gas is removed from the abdominal cavity, and the small incisions are treated with antiseptic and stitches.
Regimen after diagnostic laparoscopy
Since diagnostic laparoscopy is a low-traumatic diagnostic method, and damage to the muscles and tissues of the body is minimal, patients recover much easier. As a rule, within a day after the procedure you can be discharged from the hospital and return to your normal lifestyle with minor restrictions.
Within a few hours after the procedure, patients are allowed to walk. Moreover, walking is even encouraged, since physical activity helps to avoid adhesions and the occurrence of blood clots.
However, you shouldn’t be particularly zealous - it’s better to start with walking a short distance, gradually increasing the load and pace.
There is also no need to adhere to a strict diet after diagnostic laparoscopy. Your doctor may recommend temporarily eliminating foods that stimulate gas formation from your diet: brown bread, legumes, raw vegetables, etc.
To eliminate discomfort in the puncture area, regular painkillers may be prescribed.
Laparoscopy(from the Greek λαπάρα - groin, belly and Greek σκοπέο - look) - a modern method of surgery in which operations on internal organs are performed through small (usually 0.5-1.5 centimeters) holes, while in traditional surgery Large incisions are required. Laparoscopy is usually performed on the abdominal or pelvic cavities.
The main instrument in laparoscopic surgery is the laparoscope: a telescopic tube containing a lens system and usually attached to a video camera. An optical cable illuminated by a “cold” light source (halogen or xenon lamp) is also attached to the tube. The abdominal cavity is usually filled with carbon dioxide to create an operating space. In fact, the stomach inflates like balloon, the wall of the abdominal cavity rises above the internal organs like a dome.
Carrying out laparoscopy
Laparoscopy is usually performed under general anesthesia. A harmless gas is used to clear potential space in the abdomen and dislodge the intestines. The endoscope is then inserted through a small incision and various instruments are inserted through it.
Tissue can be lasered or excised without bleeding using a wire loop cautery device.
Areas of damaged tissue can be destroyed using a cauterization device in the form of a wire loop or a laser.
Tissue can be biopsied from any organ using biopsy forceps, which pinch off a tiny piece of tissue from the organ.
The patient may feel that the gas pressure causes discomfort for 1-2 days, but the gas will soon be absorbed by the body.
During video-laparoscopy, a video camera is attached to the laparoscope, and inner part abdominal cavity is displayed on a video monitor. This allows the surgeon to perform surgery while looking at the screen, a much more comfortable way than looking through a small eyepiece for a long time. This method also allows for video recording.
General indications for the use of laparoscopy.
During planned treatment
1. Infertility.
2. Suspicion of the presence of a tumor of the uterus or uterine appendages.
3. Chronic pelvic pain in the absence of treatment effect.
Laparoscopy in extreme situations
1. Suspicion of tubal pregnancy.
2. Suspicion of ovarian apoplexy.
3. Suspicion of uterine perforation.
4. Suspicion of torsion of the pedicle of the ovarian tumor.
5. Suspicion of rupture of an ovarian cyst or pyosalpinx.
6. Acute inflammation uterine appendages in the absence of effect from complex conservative therapy within 12-48 hours.
7. Loss of the Navy.
Contraindications to diagnostic and therapeutic laparoscopy.
Laparoscopy is contraindicated for diseases that can, at any stage of the study, aggravate the general condition of the patient and be life-threatening:
Diseases of the cardiovascular and respiratory systems in the stage of decompensation;
Hemophilia and severe hemorrhagic diathesis;
Acute and chronic hepatic-renal failure.
The listed contraindications are general contraindications for laparoscopy.
In the female infertility clinic, patients who might encounter such contraindications, as a rule, are not encountered, since patients suffering from severe chronic extragenital diseases are not recommended to continue examination and treatment for infertility at the first, outpatient stage.
Due to the specific tasks solved using endoscopy, the following are contraindications to laparoscopy:
1. Inadequate examination and treatment of the couple at the time of the proposed endoscopic examination (see indications for laparoscopy).
2. Acute and chronic infectious and cold diseases existing or suffered less than 6 weeks ago.
3. Subacute or chronic inflammation uterine appendages (is a contraindication for the surgical stage of laparoscopy).
4. Deviations in the indicators of clinical, biochemical and special research methods (clinical blood test, urine test, biochemical blood test, hemostasiogram, ECG).
5. III-IV degree of vaginal cleanliness.
6. Obesity.
Pros and cons of laparoscopy
In modern gynecology, laparoscopy is perhaps the most advanced method for diagnosing and treating a number of diseases. Among its positive aspects is the absence postoperative scars and postoperative pain, which is largely due to the small size of the incision. Also, the patient usually does not need to comply with strict bed rest, and normal well-being and performance are restored very quickly. In this case, the period of hospitalization after laparoscopy does not exceed 2 - 3 days.
During this operation, there is very little blood loss and extremely little trauma to body tissue. In this case, the tissues do not come into contact with the surgeon’s gloves, gauze napkins and other means that are inevitable in a number of other operations. As a result, the possibility of the formation of the so-called adhesive process, which can cause various complications, is minimized. In addition, an undoubted advantage of laparoscopy is the ability to simultaneously diagnose and eliminate certain pathologies. At the same time, as mentioned above, organs such as the uterus, fallopian tubes, ovaries, despite surgical intervention, remain in their normal state and function in the same way as before the operation.
The disadvantages of laparoscopy, as a rule, come down to the use of general anesthesia, which is inevitable for any surgical operation. The effect of anesthesia on the body is largely individual, but it is worth remembering that various contraindications to it are being clarified during the process. preoperative preparation. Based on this, the specialist concludes how safe general anesthesia is for the patient. In cases where there are no other contraindications to laparoscopy, the operation can also be performed under local anesthesia.
What tests need to be taken before laparoscopy?
The doctor has no right to accept you for laparoscopy without the results of the following tests:
- clinical blood test;
- blood chemistry;
- coagulogram (blood clotting);
- blood type + Rh factor;
- analysis for HIV, syphilis, hepatitis B and C;
- general urine analysis;
- general smear;
- electrocardiogram.
In case of cardiovascular pathology, respiratory system, gastrointestinal tract, endocrine disorders It is necessary to consult other specialists to develop tactics for managing the patient in the pre- and postoperative periods, as well as to assess the presence of contraindications for laparoscopy.
Remember that all tests are valid for no more than 2 weeks! In some clinics, it is customary for the patient to undergo an examination where she will be operated on, since the standards for different laboratories are different and it is more convenient for the doctor to be guided by the results of his laboratory.
On what day of the cycle should laparoscopy be done?
As a rule, laparoscopy can be performed on any day of the cycle, just not during menstruation. This is due to the fact that bleeding increases during menstruation and there is a risk of increased blood loss during surgery.
Are obesity and diabetes a contraindication to laparoscopy?
Obesity is a relative contraindication to laparoscopy.
With sufficient skill of the surgeon, for obesity of 2-3 degrees, laparoscopy may well be technically feasible.
In patients with diabetes mellitus Laparoscopy is the operation of choice. Healing of a skin wound in patients with diabetes mellitus takes much longer, and the likelihood purulent complications reliably higher. With laparoscopy, trauma is minimal and the wound is much smaller than with other operations.
How is pain relieved during laparoscopy?
Laparoscopy is performed under general anesthesia, the patient sleeps and does not feel anything. During laparoscopy, only endotracheal anesthesia is used: during the operation, the patient’s lungs breathe through a tube using a special breathing apparatus.
The use of other types of anesthesia during laparoscopy is impossible, since during the operation gas is introduced into the abdominal cavity, which “presses” on the diaphragm from below, which leads to the fact that the lungs cannot breathe on their own. As soon as the operation is over, the tube is removed, the anesthesiologist “wakes up” the patient, and the anesthesia ends.
How long does laparoscopy take?
This depends on the pathology for which the operation is performed and the qualifications of the doctor. If this is the separation of adhesions or coagulation of endometriosis foci medium degree complexity, laparoscopy lasts on average 40 minutes.
If the patient multiple fibroids uterus, and it is necessary to remove all myomatous nodes, then the duration of the operation can be 1.5-2 hours.
When can you get out of bed and eat after laparoscopy?
As a rule, after laparoscopy you can get up in the evening on the day of the operation.
The next day, a fairly active lifestyle is recommended: the patient should move and eat smaller meals in order to recover faster. Discomfort after surgery is mainly due to the fact that a small amount of gas remains in the abdominal cavity and is then gradually absorbed. The gas that remains can cause pain in the muscles of the neck, abdomen, and legs. To speed up the absorption process, movement and normal bowel function are necessary.
When are sutures removed after laparoscopy?
Sutures are removed 7-9 days after surgery.
When can you start having sex after laparoscopy?
Sexual activity is permitted one month after laparoscopy. Physical activity should be limited in the first 2-3 weeks after surgery.
When can you start trying to get pregnant after laparoscopy? How quickly can you start trying to get pregnant after laparoscopy:
If laparoscopy was performed for adhesions in the pelvis, which was the cause of infertility, then you can start trying to get pregnant a month after the first menstruation.
If laparoscopy is performed for endometriosis and is required in the postoperative period additional treatment, then you need to wait until the end of treatment and only then plan a pregnancy.
After conservative myomectomy, pregnancy is prohibited for 6-8 months, depending on the size of the myomatous node, which was removed during laparoscopy. During this period of time, it will not hurt to take contraceptive medications, since pregnancy during this period is very dangerous and threatens uterine rupture. For such patients, strict contraception from pregnancy is recommended after laparoscopy.
When can I return to work after laparoscopy?
According to standards, sick leave on average after laparoscopy is given for 7 days. As a rule, by this time patients can already work calmly, if their work does not involve heavy physical labor. After a simple operation, the patient is ready to work within 3-4 days.
Content
The laparoscopy operation has relatively recently become widely practiced among gynecologists involved in surgery, so many women are afraid when they are prescribed this operational research, do not understand what this means, fearing pain and serious complications. However, laparoscopy in gynecology is considered one of the most gentle methods of surgical intervention; it has a minimum unpleasant consequences and complications after use.
What is laparoscopy in gynecology
A method that causes the least amount of trauma and damage during diagnosis or surgery, with the smallest number of invasive penetrations - this is what laparoscopy of the uterus and ovaries is in gynecology. To reach the female genital organs without a large incision, three or four punctures are made in the abdominal wall, after which special instruments called laparoscopes are inserted. These instruments are equipped with sensors and lighting, and the gynecologist “with his own eyes” evaluates the process occurring inside, coupled with the diagnosis of the female genital organs.
Indications
Laparoscopy is widely used, since it is considered the most in a convenient way simultaneous diagnostics and surgical intervention for the treatment of pathological processes unknown etiology. Gynecologists evaluate “live” the condition of a woman’s genital organs if other research methods have not proven effective for an accurate diagnosis. Laparoscopy is used for the following gynecological pathologies:
- if a woman is diagnosed with infertility, the exact cause of which gynecologists cannot identify;
- when gynecological therapy with hormonal drugs was ineffective for conceiving a child;
- if you need to perform surgery on the ovaries;
- with endometriosis of the cervix, adhesions;
- at constant pain in the lower abdomen;
- if you suspect myoma or fibroma;
- for ligation of uterine tubes;
- in case of ectopic pregnancy, tubal ruptures, breakthrough bleeding and other dangerous pathological processes in gynecology, when emergency intracavitary gynecological surgery is necessary;
- when the pedicle of an ovarian cyst is twisted;
- with severe dysmenorrhea;
- for infections of the genital organs accompanied by the discharge of pus.
On what day of the cycle is it done?
Many women do not attach importance to what day menstrual cycle an operation will be scheduled, and they are surprised by the questions of the gynecologist, inquiring about when the last menstruation was. However, preparation for laparoscopy in gynecology begins with clarifying this issue, since the effectiveness of the procedure itself will directly depend on the day of the cycle at the time of the operation. If a woman has her period, there is a high probability of infection in the upper layers of the uterine tissue, in addition, there is a risk of causing internal bleeding.
Gynecologists recommend doing laparoscopy immediately after ovulation, in the middle monthly cycle. With a 30-day cycle, this will be the fifteenth day from the start of menstruation, with a shorter one - the tenth or twelfth. Such indications are due to the fact that after ovulation, the gynecologist can look at what reasons prevent the egg from leaving the ovary for fertilization; we are talking about diagnosing infertility.
Preparation
In gynecology, laparoscopy can be prescribed routinely or performed urgently. In the latter case, there will be practically no preparation, because gynecologists will strive to save the patient’s life, and this situation does not involve a long collection of tests. Immediately before the operation, the patient's blood and urine are collected, if possible, and studies are carried out after the fact, after laparoscopy. When performing laparoscopy as planned, preparation includes collecting data on the patient’s current condition and restricting the diet.
Analyzes
Patients are surprised by the extensive list necessary tests before performing laparoscopy, however, before any abdominal gynecological operation it is necessary to do the following studies:
- take a blood test, as well as conduct blood tests for sexually transmitted diseases, syphilis, AIDS, hepatitis, ALT, AST, the presence of bilirubin, glucose, assess the degree of blood coagulation, establish the blood group and Rh factor;
- pass OAM;
- make a general smear from the walls of the cervix;
- conduct an ultrasound of the pelvic organs, take a fluorogram;
- provide the gynecologist with a statement about the presence of chronic ailments, if any, and notify about the medications you are constantly taking;
- do a cardiogram.
When the gynecologist receives all the research results, he checks the possibility of performing laparoscopy on a predetermined day, specifying the scope of the future gynecological operation or diagnostic examination. If the gynecologist gives the go-ahead, then the anesthesiologist talks with the patient, finding out if she has an allergy to narcotic drugs or contraindications to general anesthesia during the procedure.
Diet before laparoscopy in gynecology
In gynecology, there are the following dietary rules before laparoscopy:
- 7 days before laparoscopy, you should abstain from any foods that stimulate gas formation in the stomach and intestines - legumes, milk, some vegetables and fruits. The intake of lean meat, boiled eggs, porridge, and fermented milk products is indicated.
- For 5 days, the gynecologist prescribes the use of enzymatic agents, activated carbon, to normalize digestion.
- The day before the procedure, you can only eat pureed soups or liquid porridges; you cannot have dinner. You need to do a cleansing enema in the evening if the gynecologist prescribed it.
- Immediately before laparoscopy, you should not eat or drink anything to keep your bladder empty.
Does it hurt to do
Women who are afraid of pain often ask gynecologists whether they will feel pain during laparoscopy. However, in gynecology this method is considered the most painless and fastest invasion. Laparoscopy is done under general anesthesia, so you will simply fall asleep and not feel anything. Before the operation, gynecologists prescribe sedatives and painkillers to the most emotional patients and conduct preliminary conversations, telling them what gynecological procedures will be performed.
How they do it
Laparoscopy begins with general intravenous anesthesia. Then gynecologists treat the entire abdomen antiseptic solutions, after which incisions are made in the skin in the navel area and around it, into which trocars are inserted, which serve to pump carbon dioxide into the abdominal cavity. Trocars are equipped with video cameras for visual control, allowing the gynecologist to see the condition of the internal organs on the monitor screen. After the manipulations, gynecologists apply small sutures.
Recovery after laparoscopy
Some gynecologists prefer that the patient regain consciousness after laparoscopy directly on the operating table. This way you can check the general condition of the patient and prevent complications. However, in most cases, the patient is transferred to a gurney and taken to the ward.
Gynecologists suggest getting out of bed 3-4 hours after laparoscopy so that the woman can walk to stimulate blood circulation. The patient is observed for another 2-3 days, after which she is discharged home for further rehabilitation. You can return to work in about a week, however physical activity must be limited.
Nutrition
Immediately after the operation, the patient is not allowed to eat anything - she can only drink clean water without gas. On the second day, you are allowed to drink low-fat broths and unsweetened tea. And only on the third day are you allowed to eat pureed foods, porridge, pureed meatballs or cutlets, pureed meat, and yoghurts. Since the intestines are very close to the genitals, during healing you need the most gentle diet that will not contribute to gas formation or increased peristalsis.
Sexual rest
Depending on the purpose for which the gynecologists performed the intervention, the doctor will determine the period of absolute sexual abstinence. If laparoscopy was performed to remove adhesions to conceive a baby, then gynecologists recommend starting sex life as early as possible in order to increase the likelihood of getting pregnant, because after a couple of months the fallopian tubes may become obstructed again. In all other cases, gynecologists may prohibit having sex for 2-3 weeks.
Contraindications
Laparoscopy has few contraindications. These include:
- intensive process of dying of the body - agony, coma, state clinical death;
- peritonitis and other serious inflammatory processes in the body;
- sudden stop heart or breathing problems;
- severe obesity;
- hernia;
- the last trimester of pregnancy with a threat to the mother and fetus;
- hemolytic chronic diseases;
- exacerbation of chronic gastrointestinal diseases;
- the course of ARVI and colds. We'll have to wait for a full recovery.
Consequences
Considering the low invasiveness gynecological procedure, the consequences of laparoscopy when performed correctly are small and include the body’s reaction to general anesthesia and the individual’s ability to restore previous functions. The entire system of female genital organs works as before, since penetration into the abdominal cavity is as gentle as possible and does not injure them. The laparoscopy diagram can be seen in the photo.
Complications
As with any penetration into the abdominal cavity, there are complications with laparoscopy. For example, after punctures during the insertion of a laparoscope, blood vessels may burst and a slight hemorrhage may begin, and carbon dioxide in the abdominal cavity can enter the tissue and contribute to subcutaneous emphysema. If the vessels are not sufficiently compressed, blood can enter the abdominal cavity. However, the professionalism of the gynecologist and a thorough examination of the abdominal cavity after the procedure will reduce the likelihood of such complications to zero.
Price
Since laparoscopy is an intervention under general anesthesia, the cost of this gynecological procedure is high. The price breakdown for Moscow is given in the table below:
Video
Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.
Found an error in the text? Select it, press Ctrl + Enter and we will fix everything!Today, approximately ten percent of all women of reproductive age face the problem infertility.
Note: Infertility is a condition that is caused by the inability to conceive a child within one year while having regular sexual activity.
The following types of infertility exist:
- primary infertility– this infertility can only occur in those women who have never been pregnant before;
- secondary infertility– this type of infertility can only be observed in those women who have previously had a pregnancy.
Pathologies of the uterus can be:
- congenital (e.g. bicornuate uterus, intrauterine septum, duplex uterus);
- acquired (For example, postoperative scars, endometrial hyperplasia, uterine fibroids).
What is laparoscopy?
Story laparoscopy dates back more than a hundred years. The first official experiments with this surgical intervention were recorded at the beginning of the twentieth century. At that time, laparoscopy was used only for diagnostic purposes. However, already in the mid-twentieth century, improved laparoscopy began to be used for therapeutic purposes. Today, this type of surgical intervention is the leading method of diagnosis and treatment. uterus.Laparoscopy is a diagnostic and treatment operation in which a surgeon makes three punctures in the anterior abdominal wall ( about five millimeters in size) for inserting special instruments and a video camera inside.
Laparoscopy has the following advantages:
- The operation is painless, since during surgery the patient arrives under general anesthesia.
- Has a short postoperative period. Often patients are discharged the next day after surgery.
- The physiological functions of the body are restored in a short period of time ( usually up to two days).
- Has a good cosmetic effect. Compared to other types of surgery, laparoscopy leaves behind only three subtle holes.
- Significantly reduces the risk of postoperative hernia.
- During the operation, minimal blood loss is observed.
- Allows the preservation of organs in various pathological conditions ( for example, the uterus in the presence of myomatous nodes).
Anatomy of the uterus
The uterus is an unpaired smooth muscle organ that is located in the pelvis between the bladder and rectum. The uterus has a pear-shaped shape, flattened in the anteroposterior direction. The main functions of the uterus are to create favorable conditions for the development of the fetus throughout pregnancy and ensure physiological delivery. The following parts are distinguished in the uterus:
- body of the uterus;
- isthmus of the uterus;
- Cervix.
The body of the uterus contains the following components:
- Fundus of the uterus. It is located above the origin of the fallopian tubes and is the convex part of the body of the uterus.
- Uterine cavity. It has triangular shape, wider at the top and gradually tapering at the bottom. It is in the uterine cavity that implantation and maturation of the fertilized egg occurs. In the two upper corners the uterine cavity communicates with fallopian tubes, which go to the sides. In the lower corner it turns into an isthmus ( narrowing that leads into the cavity of the cervical canal).
The walls of the uterus consist of the following layers:
- endometrium ( mucous membrane);
- myometrium ( muscularis propria);
- perimetry ( serosa).
The mucous membrane of the uterus tends to peel off physiologically. This process occurs monthly and is called menstruation. Due to the fact that the uterus has a good blood supply, menstruation is characterized by the release of blood. A significant delay in menstruation indicates a possible pregnancy or some pathological disorder.
Laparoscope and preparation for laparoscopy
Female infertility can be caused by various pathological conditions, some of which require surgical intervention. Currently, the most effective and gentle method of surgical diagnosis and treatment of female infertility is laparoscopy. The following types of laparoscopy are distinguished:
- diagnostic laparoscopy;
- operative laparoscopy;
- control laparoscopy.
| Diagnostic laparoscopy | Operative laparoscopy | Control laparoscopy |
| Performed for the purpose of confirming or refuting the diagnosis. This type of surgical intervention is performed in cases where other diagnostic methods have failed to provide adequate information. Often diagnostic laparoscopy turns into operative laparoscopy. | It is carried out after an accurate diagnosis has been established in order to remove or correct existing pathological changes. Surgical laparoscopy is effective in treating diseases that have led to the development of infertility in a woman ( for example, with adenomyosis or uterine fibroids). | It is used only in cases where it is necessary to check the effectiveness of a previously performed operation. |
Note: Laparoscopy can be performed routinely or urgently.
Laparoscopy is the newest and high-tech method of surgical intervention. To perform this type of operation, surgeons must undergo additional training.
Laparoscopy uses:
- laparoscopic instruments;
- endoscopic equipment.
- stylets for cutting tissue;
- trocars - special tubes that can maintain tightness during surgery;
- Veress needle - delivers carbon dioxide into the abdominal cavity;
- scissors - for cutting tissue;
- electrodes - for coagulation ( cauterization) fabrics;
- clamps - for clamping blood vessels;
- retractors - for tissue dilution;
- tool that applies clips;
- clips - to stop bleeding;
- needle holder - guides the needle through the tissue when suturing;
- needles - for joining fabrics.
The set of endoscopic equipment includes:
- endovideo camera;
- Light source;
- monitor;
- aspirator-irrigator - delivers physiological solution into the abdominal cavity for the purpose of washing;
- insufflator - automatically supplies carbon dioxide.
During laparoscopy, the abdominal cavity is inflated with carbon dioxide during the operation.
Gas is administered into the abdominal cavity for the following purposes:
- increase abdominal space;
- improve visualization of organs;
- provide the ability to manipulate tools more freely.
- First cut is performed in the navel area, where a Veress needle is subsequently inserted, through which gas is introduced into the abdominal cavity.
- Second cut made with a diameter of ten millimeters for inserting a trocar with a video camera.
- Third and, if necessary, fourth incisions with a diameter of five millimeters are produced in the suprapubic region and are necessary for the introduction of instruments such as a laser ( for electrocoagulation), scissors, clamps, forceps and others. The diameter of the inserted instruments does not exceed five millimeters.
Diagnostic and surgical laparoscopy can be performed at any period of the menstrual cycle, with the exception of the menstrual period itself.
Recently, medicine has seen the introduction of the most advanced robot in the world today, “Da Vinci”. This system contains a control unit, a unit consisting of three robotic arms, and another arm with a camera, which are controlled by the surgeon. The mechanical arms are inserted into the patient's body using standard laparoscopic techniques. During the operation, the surgeon is located at the control unit, controlling the robot and observing what is happening in the abdominal cavity in a three-dimensional HD image ( high image quality).
The Da Vinci robotic system has a number of advantages:
- the surgeon is provided with a comfortable working environment;
- three-dimensional image allows you to see a high-quality picture of the surgical site;
- robot cameras show images at tenfold magnification;
- The robot's hands feature seven-degree-of-freedom robotic wrist movements that closely mimic human wrist movements and also suppress hand tremors;
- During the operation, only minor blood loss is observed.
Preparing the patient for laparoscopy
Preparation for laparoscopy can be divided into the following stages:
- prehospital preparation;
- preoperative examination;
- preoperative preparation;
- preparation for surgery.
On at this stage the patient together with relatives ( optional) complete information about upcoming surgery, and also justifies the feasibility of its implementation. During the conversation, the woman should receive from the doctor detailed information about the expected effect of the operation, as well as about complications that may arise after laparoscopy.
After the patient has received all the answers to her questions, she needs ( in case of consent) sign a voluntary consent for this surgical intervention. The proposed written form also contains information that the patient was explained the full meaning of the surgical intervention, and at the same time provided information about other treatment methods.
During pre-hospital preparation, the doctor psychologically prepares the patient in such a way that she develops a calm, balanced attitude towards the upcoming operation.
Preoperative examination
At this stage, certain tests are taken, and additional research. Preoperative examinations can reveal possible violations from other organs and systems, which for one reason or another may be a contraindication to laparoscopy.
The obtained results of the studies allow us to develop tactics for managing the patient in her subsequent preparation for surgery.
Before undergoing laparoscopy, a woman will need to undergo the following laboratory and instrumental tests:
- blood to determine blood group and Rh factor;
- blood test for HIV ( AIDS virus), syphilis, viral hepatitis B, C;
- coagulogram ( for blood clotting testing);
- urogenital smear ( to determine the microflora of the urethra, vagina and cervix);
- ECG ( electrocardiogram).
Preoperative preparation
At this stage, it is necessary to prepare your body as much as possible for the upcoming laparoscopy.
- Before laparoscopy, it is recommended to perform simple gymnastic exercises.
- Five days before laparoscopy, it is recommended to take activated charcoal to reduce bloating ( two tablets orally three times a day).
- On the eve of the operation, the woman needs to take a bath and also remove pubic and abdominal hair ( navel area and lower abdomen).
- Psycho-emotional preparation is recommended, in which herbal sedatives are taken a few days before the operation ( sedatives) drugs ( for example, motherwort, valerian).
- The patient must follow a certain diet. Three to four days before surgery, gas-forming foods and carbonated drinks should be excluded from the diet. The day before laparoscopy, the last meal should take place no later than seven o'clock in the evening.
- legumes ( e.g. peas, beans);
- cabbage;
- eggs;
- plums;
- apples;
- fatty meats;
- unleavened milk;
- black bread;
- potato.
- lean meats ( for example, chicken);
- fish;
- cottage cheese;
- kefir;
- porridge;
- broths.
- Before laparoscopy, bowel cleansing is performed. To do this, the woman is given an enema before going to bed on the eve of the operation. An additional cleansing enema is given on the morning of the operation.
- For ease of insertion during surgery medications the patient is installed venous catheter.
- Immediately before transport to the operating room, the patient should go to the toilet and empty her bladder.
- To prepare the body for surgery and general anesthesia, premedication is usually necessary. Its implementation will depend on general condition women, availability concomitant diseases, as well as the choice of type of anesthesia.
Premedication is carried out:
- to reduce the level of anxiety and excitement before surgery;
- to reduce the secretion of glands;
- to increase the effect of anesthetic drugs.
- Sedatives. This group of drugs provides sedative effect, reduces activity and emotional stress ( for example, valerian, validol, valocordin).
- Sleeping pills. These drugs are used to produce a hypnotic effect ( for example, seduxen, midazolam, diazepam).
- Antihistamines ( antiallergic) drugs. These drugs block the activity of histamine receptors, as a result of which allergic reactions are reduced ( for example, tavegil, suprastin).
- Analgesics ( painkillers). This group of drugs is intended to reduce pain ( for example, baralgin, analgin, paracetamol).
- Anticholinergic drugs. The effect of these drugs is that they block the transmission of nerve impulses in various departments nervous system ( for example, atropine, platyphylline, metacin).
Research methodology
Indications for diagnostic laparoscopy of the uterus for infertility
There are the following indications for diagnostic laparoscopy of the uterus for infertility:- adenomyosis of the uterus;
- uterine fibroids;
- abnormalities of the uterus.
| Disease | Description | Symptoms |
| Adenomyosis of the uterus | It primarily affects women of reproductive age. Characterized by abnormal growth of the mucous layer of the uterus in its muscle layer (myometrium). The progression of the process over time leads to the fact that endometrial cells ( lining of the uterus), perforating the myometrium, reaching the abdominal region. To identify or confirm adenomyosis, diagnostic laparoscopy is performed. Once the diagnosis is made, it is necessary to begin treatment, since these lesions affect the process of conception. One of the main methods of treating uterine adenomyosis is surgery ( laparoscopy), in which pathological lesions are cauterized or removed. |
|
| Uterine fibroids | Is benign tumor muscular wall of the uterus. It manifests itself in the fact that nodules begin to grow in the myometrium, which subsequently grow and lead to an increase in the size of the uterus. Depending on the number of nodes, fibroids can be single or multiple. Both diagnosis and treatment of uterine fibroids can currently be carried out using laparoscopy, since this method is very informative and less traumatic ( in comparison with other surgical operations). During surgery, depending on clinical picture Myomatous nodes can be removed with preservation of the uterus or with its complete removal. | On early stages, as a rule, is asymptomatic. Later, a woman may experience symptoms such as pain in the lower abdomen, severe prolonged bleeding during menstruation. Deformation of the uterus with this disease can cause miscarriage. In some cases, uterine fibroids can lead to infertility in a woman. |
| Abnormalities of the uterus | During intrauterine development in the tenth to fourteenth week during the formation of the uterus, incomplete or complete fusion of the Müllerian ducts may occur. These changes lead to abnormal development of the organ, as a result of which a one-horned or two-horned uterus, duplication of the uterus, and others may be observed. pathological changes. If these pathologies are present, diagnostic laparoscopy is used to establish the diagnosis or degree of uterine bifurcation. If the uterine abnormality can be corrected, reconstructive surgical laparoscopy can subsequently be performed. | They may be asymptomatic. In most cases, these pathologies are detected only when diagnostic study. However, with conditions such as a double uterus or a bicornuate uterus, a woman may experience abundant menstrual bleeding. The main symptom of all the above pathologies is the presence of infertility in a woman or the inability to bear a child ( miscarriage). |
Contraindications to diagnostic laparoscopy of the uterus for infertility
There are absolute and relative contraindications for diagnostic laparoscopy.The following are absolute contraindications:
- severe cardiovascular diseases ( for example, acute myocardial infarction);
- poor blood clotting;
- acute period liver failure or kidney failure;
- states of shock (hemorrhagic shock);
- coma state;
- cachexia ( severe exhaustion of the body);
- hernia of the white line of the abdomen, as well as diaphragmatic hernia;
- ovarian cancer or cervical cancer.
- acute respiratory viral infections ( influenza, parainfluenza, adenovirus infection ), colds, herpetic rashes;
- arterial hypertension (high blood pressure);
- menstruation period;
- obesity ( third or fourth degree).
Choosing the type of anesthesia
When choosing anesthesia, the doctor approaches each patient individually. The first priority is to collect an anamnesis, assess the general condition of the patient, and analyze existing indications and contraindications.Also, before the anesthesiologist determines the optimal method and type of anesthesia used, the patient will need to undergo certain examinations. This is required for timely detection and subsequent treatment of concomitant diseases vitally important organs and systems.
In most cases, general anesthesia is used during laparoscopy, which is carried out in two ways:
- intravenous anesthesia;
- inhalation anesthesia.
Intravenous anesthesia
This type of anesthesia is carried out by intravenous administration narcotic drugs ( e.g. hexenal, sodium thiopental, fentanyl), bypassing Airways.
The advantages of this type of anesthesia are the following:
- ease of use;
- the speed of onset of the narcotic effect after administration of the drug.
Inhalation anesthesia is currently the most common type of anesthesia. It is achieved by introducing volatile or gaseous substances through the respiratory tract ( eg isoflurane, sevoflurane, halothane).
Inhalation anesthesia can be performed in the following ways:
- endotracheal method;
- mask method.
Most often, during laparoscopy, preference is given to the endotracheal method. This type of anesthesia involves inserting an endotracheal tube into the trachea, through which the necessary narcotic substances are delivered directly into the bronchi.
There are the following advantages of endotracheal anesthesia:
- possibility of application artificial ventilation lungs;
- significant reduction in the risk of aspiration ( entry of gastric contents into the respiratory tract);
- precise control of the incoming dose narcotic substance;
- ensuring free patency of the upper respiratory tract.
Mask method
The mask method for inhalation anesthesia is used less frequently and in the following cases:
- for simple and short operations;
- if the patient has anatomical features or diseases of the pharynx, larynx, and trachea that do not allow endotracheal anesthesia;
- for operations that do not require muscle relaxation ( decreased muscle tone), as well as artificial ventilation.
Rehabilitation after diagnosis
The quality of rehabilitation after diagnostic laparoscopy, as a rule, depends on what type of anesthesia was used during the operation. In connection with anesthesia, a woman may experience the following symptoms:
- sore throat ( due to insertion of an endotracheal tube);
- weakness, drowsiness;
- hallucinations, delusions.
However, it should be noted that since during laparoscopy the abdominal cavity is filled with gas, after the procedure a small amount remains inside. This can cause discomfort, a feeling of bloating, and painful sensations in area chest (the gas used is evacuated from the body through the lungs). In order for the process of absorption of the gas inside to accelerate, it is necessary to create favorable conditions for efficient work lungs and intestines. Therefore, the very next day after the operation, the woman is recommended to start moving more, as well as eat properly and in small portions ( five to six times a day) in order to speed up the healing process.
General principles of diet after diagnostic laparoscopy:
- In the first twelve hours after the procedure, you must drink a sufficient amount of water ( without gases);
- It is recommended to take food stewed, baked or boiled ( exclude fried and fatty foods);
- food taken should be in mushy form;
- in the first days after laparoscopy, the number of meals should be five to six times a day;
- food should include the consumption of proteins, carbohydrates ( especially fiber).
- salted, pickled and peppered products;
- gas-forming vegetables ( for example, cabbage, beets, corn);
- astringent fruit varieties ( for example, persimmon, quince);
- fatty meats ( for example pork), lard and smoked meats;
- confectionery
- alcohol, strong coffee, cocoa, carbonated drinks.
Fiber in large quantities found in the following products:
- vegetables ( carrots, broccoli, pumpkin, potatoes);
- fruits ( apples, pear, banana);
- porridge ( oatmeal, buckwheat, rice);
- bran or whole grain bread;
- nuts ( peanuts, almonds, walnuts).
- vegetable or chicken broths;
- mineral water no gases;
- weakly brewed tea;
- fruit or vegetable juices;
- jelly;
- fruit compotes.
Upon discharge, the attending physician will conduct an explanatory conversation regarding the following aspects:
- how the recovery process will proceed;
- how to care for postoperative wounds;
- what diet and diet should be followed.
On the seventh to tenth day after laparoscopy, the woman will need to come to the hospital to have postoperative sutures removed.
During the recovery period, the following recommendations should be followed:
- It is recommended to resume sexual life three to four weeks after surgery;
- should be limited physical exercise for about three weeks;
- if the work does not involve physical labor, then you can start working a week after laparoscopy.
Laparoscopy is a fairly safe type of surgical intervention, however, in 0.7–7 percent of cases, the following complications may be observed after it is performed:
- In case of careless insertion of the trocar into the abdominal cavity, internal organs may be damaged ( bladder, intestines);
- During the injection of gas into the abdominal cavity, subcutaneous emphysema may develop ( entry of air into the tissues of the anterior abdominal wall);
- with incomplete coagulation of the damaged vessel, internal bleeding may develop;
- due to improper preoperative preparation, the risk of blood clots may increase, therefore, for the purpose of prevention, before the operation, the woman’s legs are bandaged with an elastic bandage, and blood thinning drugs are also administered ( anticoagulants).
- hyperemia ( redness) and swelling of the wound and surrounding tissues;
- bleeding from the operated wound;
- increased local or general body temperature;
- strong pain in the abdominal area;
- hoarseness of the voice, which progresses over time.