With the help of a special instrument (laparoscope), after small incisions on the abdominal cavity, it is possible to carry out both its diagnostic examination in gynecology (diagnostic laparoscopy) and small surgical interventions in gynecology (surgical or operative laparoscopy).
Indications for laparoscopy in gynecology
The main indications for laparoscopy:
- infertility in women (for diagnosis of violations of patency of the fallopian tubes and their elimination, dissection of adhesions);
- acute surgical diseases in gynecology (ectopic pregnancy, acute appendicitis, ovarian apoplexy);
- removal of ovarian cysts, tumors of the uterus and ovaries, polyps, fibroids of the uterus;
- ligation of the fallopian tubes during sterilization;
- removal of the uterus and ovaries;
- diagnosis and treatment of endometriosis of the ovaries and peritoneum;
- diagnosis and treatment of polycystic ovaries, anomalies of the development of the uterus , ovulation of the uterus;
- preparation for IVF.
There are also certain contraindications to laparoscopy in gynecology:
- tendency to bleeding (with hemophilia, hemorrhagic diathesis);
- decompensated diseases of the cardiovascular system, respiratory system, liver and kidneys;
- acute infectious diseases;
- purulent peritonitis;
- diaphragmatic hernia;
- shock or coma;
- malignant tumors in gynecology;
- excessive obesity;
- condition after a cavitary operation or adhesive process in the abdominal cavity.
Preparation for laparoscopy in gynecology
In addition to direct training, there are a number of tests and examinations that must be carried out on the eve of laparoscopy. These include general blood and urine tests, feces analysis for eggs of worms, biochemical blood test (necessarily blood sugar), tests for syphilis, HIV, viral hepatitis, a general gynecological examination with a smear on the flora, pelvic floor ultrasound, ECG, fluorography and conclusion of the therapist.
Peredoperatsionnaya preparation is a diet before laparoscopy in gynecology, poor in fiber, not causing bloating. On the eve of the operation, a cleansing enema is made, and on the day of surgery it is forbidden to take food and drink water, prescribe premedication.
Operative laparoscopy in gynecology
With laparoscopy, a trocar is inserted through the incision in the navel region d 10 mm (through it, a laparoscope with a video camera is inserted), and in the pelvic region - two trocar d 5 mm for instruments. Enter the abdominal cavity carbon dioxide for easy access to the organs. With the help of surgical instruments, the necessary surgical intervention is performed. After it, stop the bleeding and apply seams to the wounds.
Laparoscopy in gynecology: postoperative period
After surgery, a patient's day should be under the supervision of doctors to prevent the development of possible complications. After laparoscopy, severe internal bleeding may develop, during operation, abdominal organs or blood vessels may be damaged, the work of the heart or lungs may be disrupted by insertion of carbon dioxide into the abdominal cavity. Of the later complications, the development of subcutaneous emphysema is possible in the case of gas falling under the skin, thrombosis of the vessels of the abdominal cavity.
The advantages of laparoscopy
The advantage of this intervention is a small postoperative wound, a small traumatic operation, the absence of scars and pain in the postoperative period, a small blood loss with intervention, a short postoperative period, the possibility of simultaneous diagnosis and treatment during the intervention. The disadvantage is general anesthesia during the intervention, and with incorrect determination of the indications or development of complications, it is possible to develop the need for translating the laparoscopic operation into a common cavity.