Laparoscopy

Laparoscopy (peritoneoscope) (from the Greek. peritonaion - peritoneum and skopeo - examine, investigate; synonym: introscope, peritoneoscopy, celioscopy, abdominoscopy, celioscopy and others) - endoscopic examination of the abdominal cavity through an incision in the abdominal wall.
Laparoscopy can sometimes replace trial laparotomy.
Contraindications - acute inflammatory diseases of the abdominal cavity, extensive adhesions, especially the seam of the intestine with the anterior abdominal wall, flatulence, lung-heart failure of any origin, severe neurosis.
Equipment. Calling (G. Kelling), Bernheim (Century Bernheim) and others, have developed an original system of peritoneoscope, but usually are thoracoscope.
The technique. Preparation of the patient before laparotomy (see). After injection of morphine or pantopon, sometimes chlorpromazine and muscle relaxants patient is placed on the table. The puncture site define the intended localization process.
More convenient and safe for puncture anterolateral departments of mathetria outwards from direct stomach muscles and white line below the navel (Fig. 1). The operating field and hand surgeon process as usual. Peritoneoscopy sterilized by common rules. Under local anesthesia (children under General anesthesia) pointed scalpel an incision of the skin in 1 cm, through it a shot! peritoneoscope.


Fig. 1. The field for the puncture of the abdominal wall by peritoneoscopy (shaded).
laparoscopy
Fig. 2. Laparoscopy (schematically). The abdominal wall is raised in the navel; through the cone of trocar entered the optical system.

For greater security, you can pre-enter into the abdominal cavity stupidly beveled needle 1,5-2 liters of filtered through a sterile cotton wool air or anastasiaweb the skin in the navel, grab her bullet forceps and to lift the abdominal wall, or the edges of the skin incision to capture clips Kocher and withdraw.
Ukolov trocar, stiletto extract. When ascites release the fluid. If the air is not implemented yet, it is blown into through the trocar; the lifting of the abdominal wall for skin prevents reverse vihodnie air.
Through the cone of trocar enter the optical system (Fig. 2). For exploring the area blind gut patient turn on your left side. For exploring the upper abdomen, lower the foot end of the table.
Data laparoscopy can be supplemented by typing the light source into the stomach through the mouth and into the sigmoid colon (through the anus), and by paying off the illuminator of peritoneoscope, to consider the walls of these bodies against the light.


Fig. 3. The front edge of the liver (metastatic cancer).

Laparoscopy pelvic cavity produce, giving the patient the Trendelenburg position. After laparoscopy air out the rest it is absorbed through 4-7 days) and extract trocar. Skin impose a seam.
When laparoscopy available to the inspection of the front edge of the liver (Fig. 3), the bottom of the gallbladder, the front wall of the stomach, the greater omentum, thick and thin intestines, pelvic organs. Unaugmented spleen is not visible.
Tip peritoneoscope may be determined by the density of the subject of education and biopsy forceps, you can take a piece of cloth.
When laparoscopy can dissect adhesions (strands) electrocautery, to find and remove small foreign bodies, to introduce medicines.
Complications. Emphysema of the abdominal wall is observed more often in obese people in cases when injection of air is taken short needle. Possible (accident) bleeding wounds parenchymatous and hollow organs. In the last case you need an urgent chrevosechenie, so to laparoscopy outpatient impossible.
Laparoscopy in gynecology. Besides the described method of laparoscopy in gynecology applied also modified L - culdoscopy. This method is called by googlecolombia and pelviscopy. An endoscope (a special peritoneoscopy or thoracoscopy) is introduced into the abdominal cavity through the anterior abdominal wall, as if peritoneoscopy (laparoscopy), and through an incision in the posterior vaginal fornix.
Evidence - various gynecological diseases, when a thorough study of the usual methods failed to establish the diagnosis. Culdoscopy shown by tumors of the ovaries in the initial stage, the differential diagnosis between ovarian tumors and tumors of the uterus or inflammatory diseases of appendages between genital and extra genital swelling, difficulty in diagnosis of ectopic pregnancy, various dysfunctions ovarian syndrome Stein - Leventhal and others), when abnormalities and malformations of the genitals, tuberculosis and endometriosis genitalia, and to clarify some of the causes of infertility in women. Culdoscopy is preferable to use in the diagnosis of ectopic pregnancy, suspected ovarian cancer in early stages, and when there are contraindications to laparoscopy.
Laparoscopy is advisable to use when mass formations of considerable size to determine the stage of tumor spread to women, not lived sex life, and in those cases, when there are contraindications to moldoscopie.
Some authors during L. produce a biopsy, puncture tumors and other manipulations. The majority of domestic authors speaks against this, because such interventions are often not effective and is contrary to the principle of elastichnost.
Contraindications to the use of moldoscopie and L. in General: General poor condition of the patient, heart diseases in the stage of decompensation, angina, recent myocardial infarction, has expressed sclerotic changes of vessels of a brain and heart disease among the elderly (especially in the presence of hypertension), severe lung disease with a violation of their functions.
Especially it is necessary to take into account inflammatory processes and adhesions in the lower abdomen. Culdoscopy contraindicated also virgins, if dopasowa pocket tumors, inflammatory infiltrates or massive adhesions, at a fixed bend of the uterus back, long and narrow vagina. Excessive obesity anterior abdominal wall is not a barrier for the laparoscopy.
Peritoneoscopy gynecological patients produce in the Trendelenburg position, technique (see above) has no singularities. When laparoscopy are clearly visible uterus, uterine tubes, ovaries, intestines and other organs of the abdominal cavity (Fig. 5).

examination of small pelvis organs Fig. 5. Examination of small pelvis organs with the help of peritoneoscope (schematically). Right there in the corner - a view of internal genital organs of the female:
1 - fallopian tube;
2 - ovary;
3 - uterus.

Complications when endoscopy is very rare. The most dangerous of them - air embolism due to creation of artificial pneumoperitoneum. If properly create pneumoperitoneum and to use carbon dioxide or nitrous oxide, and not air or oxygen, this complication can be avoided. Sometimes when you create pneumoperitoneum forms of subcutaneous or intramuscular emphysema, which passes quickly. Other rare complications described injured intestines and other internal organs, acute inflammatory processes in the small pelvis. The correct selection of patients, taking into account contraindications prevent these complications. After endoscopic examinations in 2-3 days the patients menicus - symptom is that usually gets better without any treatment.