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Diagnostic laparoscopy is a modern diagnostic method, which is considered one of the most informative and reliable. As a rule, laparoscopy is performed on the organs of the abdominal cavity and pelvis, which is reflected in the very name of the procedure: the term “laparoscopy” is a derivative of the Greek words “womb” and “look”. Synonyms for the concept of “laparoscopy” are “peritoneoscopy” and “ventroscopy”. This procedure involves examining the internal organs through small openings using a special instrument called a laparoscope.
Laparoscopic diagnostics is carried out if other types of examination were not informative enough.
Historical information
Before the advent of laparoscopy, the only way to view the abdominal organs was laparotomy. In other words, the patient’s stomach was cut open, and examination and operations were carried out through this cut. 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.
For the first time, they started talking about diagnostic laparoscopy at the beginning of the 1960th century, but the technique remained practically in its “rudimentary” state until the XNUMXs.
The pioneer of laparoscopy is the Russian obstetrician-gynecologist Dr. Ott. It was he who, in 1901, first conducted an endoscopic examination of the patient’s abdominal cavity using a forehead reflector, an electric lamp and a mirror. He called his method ventroscopy. In the same year, in Germany, Professor Kelling was the first to conduct an endoscopic examination of the abdominal organs in animals.
During the 1920s and 1930s, a large number of publications devoted to endoscopic studies appeared. Their authors were scientists from Switzerland, Denmark, Sweden and the USA. They praise laparoscopy as a highly effective method for diagnosing liver disease. In the same period, the first, still extremely imperfect, laparoscopes appeared. In the 1940s, the design of laparoscopy devices improved, laparoscopes equipped with biopsy devices appeared. In 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 under 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 of the abdominal cavity. So, with ascites, this diagnosis makes it possible to identify the root causes of the appearance of fluid in the abdominal cavity. With tumor-like formations of the abdominal cavity, the doctor during the diagnostic laparoscopy gets the opportunity to carefully examine the formation and conduct a biopsy. For patients suffering from liver diseases, laparoscopy is one of the safest methods that allow you to get 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 a diagnosis for unknown etiology of pain in the abdomen and pelvis.
Contraindications for diagnosis
Since diagnostic laparoscopy is a minimally invasive but surgical intervention, the list of contraindications for this procedure should be taken very seriously.
So, there are absolute and relative contraindications for this research method. Laparoscopy is strictly prohibited in hemorrhagic shock caused by severe blood loss, and in the presence of adhesions in the abdominal cavity. Also, the reason for refusing the procedure is liver and kidney failure, an acute form of cardiovascular disease, and lung disease. Laparoscopy is contraindicated with severe bloating and intestinal colic, as well as with ovarian cancer.
Относительными противопоказаниями для проведения диагностики считаются аллергия на несколько видов лекарственных препаратов, наличие миомы больших размеров, срок беременности, превышающий шестнадцать недель, разлитой перитонит. Не рекомендуется проведение процедуры, если пациент менее четырех недель назад перенес ОРВИ или простудное заболевание.
Diagnostic Benefits
Compared to laparotomy, laparoscopy has many advantages:
- First of all, this method is minimally invasive. In other words, the surgical effect is very sparing, the risk of infection is minimal, and there is practically no blood loss. 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 stitches applied to the incision. The cosmetic effect is also important – after laparoscopy, unaesthetic scars are not formed, 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 state of internal organs, find out the etiology of the disease and choose the best method of therapy. Due to the display of a multiply enlarged image of the internal organs on the screen, the doctor gets the opportunity to examine the tissues in detail from different angles.
Disadvantages of the procedure
However, like all medical procedures, diagnostic laparoscopy has not only advantages, but also disadvantages.
First of all, it must be borne in mind that this diagnosis is carried out 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 all the necessary studies in order to avoid complications.
In addition, with insufficient qualifications of the doctor who conducts the diagnosis, there is a risk of injury to organs during the introduction of instruments. Due to the fact that the doctor operates with tools “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 can conduct a detailed examination of the internal genital organs of a woman: the ovaries, uterus and fallopian tubes.
Gynecological laparoscopy is performed either under general anesthesia or local anesthesia combined with sedation. The method of its implementation 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 rises with a dome. A small incision is then made through which the trocar is inserted. The latter is used to introduce 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 course of diagnostic laparoscopy is recorded on an information carrier.
In gynecology, diagnostic laparoscopy is indicated when the cause of diseases of the reproductive system cannot be identified using ultrasound and radiological methods. In particular, diagnostic laparoscopy can be used in gynecology to identify the cause of pain, clarify the nature of tumor formations in the pelvis, confirm previously diagnosed endometriosis and inflammatory diseases. Also, this procedure helps to check the fallopian tubes and identify the cause of their obstruction.
Preparation for diagnostics
Чтобы процедура диагностической лапароскопии прошла без осложнений и оказалась максимально информативной, необходимо предварительное проведение ряда обследований и соблюдение рекомендаций медиков.
Preparation for a planned diagnostic laparoscopy is recommended to begin approximately one month before the procedure. During this period, the patient must undergo the most thorough examination, which includes a complete history taking, as well as laboratory diagnostics and consultations of narrow specialists. Doctors must find out what diseases the patient had previously suffered, whether he had serious injuries, whether he was subjected to surgical interventions. It is mandatory to check for an allergic reaction to medications.
Чтобы выяснить, не страдает ли пациент заболеваниями, которые могут рассматриваться в качестве противопоказаний для проведения диагностики, обязательно посещение кардиолога, терапевта и гинеколога и других специалистов. Также проводятся УЗИ, флюорография и стандартный анализ крови, а также коагулограмма, исследования на ВИЧ, гепатиты и сифилис. Определяется группа крови и резус-фактор на случай возникновении осложнений.
Despite the fact that this surgical intervention is considered relatively safe, patients should be informed about all the details of the procedure and possible “pitfalls”.
Two weeks before the diagnosis, it is usually recommended to stop taking blood thinners. In addition, the diet is adjusted. It is usually recommended to minimize or completely exclude spicy and fried foods, smoked meats, as well as 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 – to minimize it.
Dinner on the eve of the procedure should be very light. Doctors usually recommend a cleansing enema in the evening.
Diagnostic laparoscopy is performed exclusively on an empty stomach. An anesthesiologist is consulted immediately before the operation.
Diagnostic laparoscopy technique
As noted above, laparoscopic diagnostics is most often performed under general anesthesia. It begins with the fact that a puncture of the abdominal cavity is performed, after which heated carbon dioxide is introduced into it. This is necessary in order to increase the volume of the internal space – so the doctor can more easily manipulate the instruments and the examination of the organs will not be difficult.
After that, small incisions are made at certain points in the abdomen, into which a laparoscope is inserted – an instrument with which the 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 introduced, allowing, for example, a biopsy or dissection of adhesions. After the introduction of the laparoscope, the doctor begins to examine the upper sections of the abdominal cavity, assesses the condition of the organs.
After the operation is completed, the instruments are removed, gas is removed from the abdominal cavity, and small incisions are treated with an antiseptic and stitched.
Mode 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, one 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 manipulation, patients are allowed to walk. Moreover, walking is even welcomed, since physical activity avoids the adhesive process and the occurrence of blood clots.
However, you should not be particularly zealous – it is 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. The doctor may recommend temporarily eliminating foods that stimulate gas formation from the diet: brown bread, legumes, raw vegetables, milk.
Painkillers may be prescribed to relieve discomfort in the puncture area.