Laparoscopy is a method of examining the organs of the abdominal cavity, using a special medical device, an endoscope, inserted through the anterior abdominal wall. This method is widely applicable in gynecology and is one of the most common modern diagnostic and, in some cases, therapeutic tactics. In essence, this is a small surgical operation, during which the patient has very little blood loss and minimal tissue injury. Also, during this diagnosis, the doctor has the opportunity to eliminate some defects and pathologies.
Preparation and technique
Before laparoscopy , a general examination is usually carried out to determine if there are any contraindications to its implementation. The gynecologist conducts a long conversation with the patient, informing her about all the features of the study and the possible consequences. On the eve of a planned operation, a woman should limit herself to liquid food intake and make a cleansing enema.
This operation is usually performed under general anesthesia. Several small incisions are made in the abdomen. To raise the abdominal wall, gas (carbon dioxide, helium, nitrous oxide, argon) is injected into the abdominal cavity by direct puncture of the anterior abdominal wall with a Veress needle . After that, a laparoscope is inserted through the first incision – a device with a lens at one end and an eyepiece at the other, or built using such technology so that the image from one end, which is inserted inside, is transmitted to the screen. Through the second incision, a manipulator device is inserted to help the doctor carefully examine the internal organs. With the help of this device, if necessary, some adjustments are made: alignment or laser spraying of tissues for cauterization, some areas of damaged tissues can be destroyed for cauterization in the form of a wire loop or laser, as well as the ability to take tissue from any organ for microscopic examination.
Indications for laparoscopy
Laparoscopy is one of the best methods for diagnosing and treating many diseases in gynecology, which is prescribed in case of the following indications:
– tubal- peritoneal infertility;
– malformations of the internal genital organs;
– to create artificial obstruction of the fallopian tubes;
– genital endometriosis;
– pain in the lower abdomen of unknown etiology;
– malformations of the internal genital organs;
– ectopic pregnancy;
– inflammatory diseases of the pelvic organs;
– differential diagnosis between gynecological and acute surgical pathology;
– tumors, tumor-like formations of the ovaries;
– suspicion of twisting subserous myoma.
Contraindications
However, laparoscopy, like all other surgical interventions, has a number of contraindications, which are divided into absolute, temporary and relative. Absolute contraindications include the following:
– hemorrhagic shock;
– uncorrected coagulopathy ;
– diseases of the cardiovascular and respiratory systems in the stage of decompensation;
– acute and chronic liver and kidney failure;
– Consequences of a brain injury, damage to the cerebral vessels and other similar ones that do not allow the patient to be placed in the Trendelenburg position ;
– ovarian cancer and RMT (with the exception of laparoscopy during chemotherapy or radiation therapy).
Temporary contraindications:
– degree III-IV of the purity of the vaginal contents;
– existing or transferred less than 4 weeks ago acute viral and colds;
– incorrectly conducted examination and treatment of a couple for infertility, by the time of the proposed endoscopic examination.
Relative contraindications, in which laparoscopy is considered highly undesirable, but in emergency cases it remains possible:
– late pregnancy;
– diffuse peritonitis;
– polyvalent allergy;
– suspicion of malignant tumors of the uterine appendages;
– adhesive process after previously undergone operations on the abdominal organs.