Laparoscopy

introduction

During the laparoscopy (laparoscopy) is an operative surgical procedure in which various surgical instruments and a video camera are inserted into the abdomen through a small hole. This is a minimally invasive technique (see also: minimally invasive surgery) which, compared to open surgery, in which the patient is completely cut open, leaves much smaller scars and also offers a smaller area for infections.

Indications, advantages and disadvantages

The indications why a laparoscopy (laparoscopy) should be carried out are very diverse.
The most common indication for the use of laparoscopy is removal of the appendix (appendix) of the actual appendix (caecum). Ten years ago, to remove the inflamed appendix, a deep, open incision had to be made on the side of the abdomen, and then the appendix was removed in an open operation where the intestine could be seen directly. On the one hand, this had the disadvantage that the cosmetic result was not very nice in retrospect, on the other hand, an open abdominal cavity always offers a larger attack surface for germs such as bacteria. With the help of laparoscopic surgery, i.e. an operation using a laparoscopy, not only can a better cosmetic effect be achieved, but the risk of infection is also reduced.

It can also be used in laparoscopic surgery Local anesthetic which means that patients are fit again faster and can leave the hospital faster, with the Laparoscopy still on the general anesthetic is used. The is also very popular Laparoscopy in the surgical removal of the Gallbladder (Cholecystectomy).
Especially if the gallbladder is inflamed or if it is infected Samonella thyphia, the bacteria that cause typhoid, must be removed from the gallbladder. Since many patients do not want a transverse scar over the entire upper abdomen, which would inevitably arise with an open removal of the gallbladder, this is Laparoscopy together with the minimally invasive surgery here the means of choice (so-called Gold standard).
Depending on the severity and type of cause, various diseases of the intestine can also mean Laparoscopy and minimally invasive surgery be treated. For example be Intestinal polyps often using the Laparoscopy under general anesthetic away. Nevertheless, it should be said at this point that the laparoscopy together with minimally invasive surgery not only brings advantages. Because the doctor brings the instruments and the camera through a small hole in the abdominal wall, he cannot spontaneously enlarge the operating area should this be necessary. In addition, he cannot detect any abnormalities by touching the section of intestine to be examined. This means that the doctor loses an important tool, namely his sense of touch and feel. Therefore there are many areas, for example one Tumor removalin which open surgery is clearly the Laparoscopy (laparoscopy) is preferable. Adhesions in the abdomen can also only be performed laparoscopically to a certain extent, i.e. by means of Laparoscopyto be removed. The laparoscopy is of particular importance in the field of gynecology. Here is the Laparoscopy a very frequently used method, for example for the removal of cysts but also diagnostically for example in chronic Abdominal pain to find the cause. Another disadvantage of the Laparoscopy for one is that they are taking general anesthetic must be carried out and thus higher operational risks arise, such as with a Local anesthesia. In addition, there can be more complications in very overweight patients, it can even be that one Laparoscopy is impossible. Even if the patient has already had frequent abdominal surgery and therefore has many scars, it is possible that one Laparoscopy leads to an increased risk and therefore a cross-section is preferred. A Laparoscopy should not be performed on patients with certain Pre-existing illness, such as a Heart attack, one Angina pectoris, one chronic lung disease (COPD) or in patients with suspected malignant disease (Tumor, cancer). In general, however, it should be said that the risk of a laparoscopy in healthy patients is extremely low and the laparoscopy therefore has few disadvantages.

Action

Before the actual laparoscopy can start, the patient must be informed by the respective doctor (Anesthetist, surgeon) be instructed. Since this is an operation under general anesthesia, blood-thinning medication such as aspirin or marcumar, for example, must be discontinued as otherwise unwanted massive bleeding can occur during the operation. During the laparoscopy, access to the abdominal area must then be created. To do this, the abdominal wall, which consists of muscles, skin and fatty tissue, has to be pierced. The hole must be large enough so that all instruments and the camera can later fit through the opening. The doctor uses a kind of thick needle, which he pierces through the abdominal wall. In order to pierce as thin a part of the abdominal wall as possible, the doctor usually chooses a point below the navel. However, it can also be the case that the puncture site has to be chosen at a different location due to organs that may be in the way (for example if the intestine has slipped down too far). The principle is always the same for a laparoscopy, no matter which organ is to be examined or removed. First, the doctor has to "inflate" the patient's abdomen in order to get a better overview. CO2 is chosen for this because it is absorbed through the abdomen and can then be easily exhaled through the lungs without causing allergic reactions or the like. In the end, you have an inflated belly that looks a bit like the patient is 9 months pregnant. Since the abdominal wall is very elastic and the pressure in the abdominal cavity is constantly controlled, there is no need to worry about the stomach being inflated too far or even bursting. Depending on the size and scope of the patient, the doctor pumps up to 7l of CO2 into the abdomen and now has a very good overview of the area to be examined. The needle that pierced the abdomen can now be replaced by the so-called trocar. This is a kind of tube through which the various instruments and a small camera for orientation, the laparoscope, can be inserted. With the help of this lumbar mirror, the doctor can now get an overview and look at the stomach, liver, spleen, intestines, but above all the (female) genital organs and determine any changes. The laparoscopy is often used, especially in gynecology. So that the doctor can really look primarily at the female genital organs without the intestines covering them, the patient is tilted back on the couch so that her head hangs down. This also causes the entire organs of the gastrointestinal tract to slip (Gastrointestinal tract) down and the doctor has a perfect overview of the female genital organs that interest him.

Laparoscopy in gynecology

In gynecology, the laparoscopy is particularly popular because it is equally efficient for diagnosis and therapy without having any cosmetic disadvantages. The laparoscopy is used, for example, in the event of involuntary childlessness. Samples can be taken from the patient with the help of the laparoscopy or contrast media can be given into the ovaries through the laparoscopy and thus determine whether the fallopian tubes are open. By introducing the contrast agent into the fallopian tubes, you can now use a magnetic resonance (MRT) or computerized tomograph (CT) to determine whether the fallopian tube is completely pervious and is therefore able to transport the egg into the uterus so that a baby is there can grow up. Especially for women who want to have children and who have already been diagnosed with an ectopic pregnancy, the laparoscopy can provide information about their fallopian tubes and thus their ability to give birth. The laparoscopy can not only test the permeability of the fallopian tubes, but also cut them (sterilization) if the woman no longer wants to have children. Ectopic pregnancies can also be removed using a laparoscopy. Even with chronic abdominal pain, the doctor can choose the laparoscopy as the last diagnostic option if previous examinations such as palpation and ultrasound have not shown anything. For example, endometriosis can be diagnosed with the help of a laparoscopy, which can lead to severe abdominal pain and bleeding. If endometriosis is suspected, a laparoscopy is often used to confirm the diagnosis. Endometriosis is a benign spread of uterine tissue in other areas of the body, for example in areas of the intestines. This is not bad in itself, but, as already mentioned, it can lead to chronic abdominal pain and also to spotting, i.e. bleeding that is not caused by the normal period. The laparoscopy is also used for direct therapy, for example the removal of benign tumors in the uterus (myoma). In addition, cysts on the ovaries are removed using a laparoscopy. Cysts are also benign, fluid-filled hollow bodies, but they can cause pain and should therefore be removed.