Laparoscopy

Laparoscopy

Laparoscopy (Gr. lapara – abdomen, scopeo – see) – a method of surgery, when the necessary operational actions in the abdominal cavity are made through a few small incisions in the abdominal wall using an optical system and fine manipulators. A special Veres needle is used through a small incision in the abdominal wall, it doesn’t damage organs underneath it and gives the possibility to inject carbon dioxide gas, which lift the abdominal wall and separates it from the organs. This operation gives the doctor a possibility to inspect abdominal organs and gives enough space to perform diagnostic and surgical procedures. Later, special surgical instruments are inserted through small (from 1 cm to 2.5 cm) incisions (incision length and number depends on the complexity and size of the available instruments) in the abdominal cavity, these instrument’s  working parts are similar to conventional surgical instruments, but they are managed by the surgeon from outside the abdominal cavity. The surgeon sees what’s happening in the abdomen through a monitor, the picture is transmitted by a small camera, which lens is also injected into the abdominal cavity. Laparoscopy is a unique approach to the use of technical optics, television, electrical appliances, mechanical possibilities, surgical experience, skills and knowledge to open up huge opportunities for diagnosis and treatment. The patients suffer a lot less surgery, small incisions are responsible for easier post-operative period and a shorter recovery time. It may be a an “easy” surgery for the patient, but it is a difficult major surgery for the endoscopist, because even the smallest intervention requires a lot of specific knowledge, skills and experience.

Why do you need a laparoscopy?

Gynecological diagnostic laparoscopy is performed mostly in cases of:

• Unexplained acute or chronic abdominal pain in the lower abdomen or lumbar area;
• Suspicion for gynecological inflammation;
• Ectopic  pregnancy;
• Endometriosis;
• Ovarian tumors (cysts);
• Excision myomas uteri;
• Infertility, because fallopian tube possability, and other important factors relating to infertility (adhesions, endometriosis), can be assessed.

When a disease is found during the diagnostic laparoscopy, surgical treatment – surgical laparoscopy, can be immediately applied.

What are the advantages of laparoscopy?

It is confirmed that laparoscopic surgery is safe and effective. It has the following advantages compared with traditional surgery: the patient is recovering faster, the amount of time the patient needs to stay in hospital is reduced, decreased cost of treatment, better cosmetic results .
It has been proven, that the size of abdominal incision is directly related with the patient’s postoperative activity. It is very important to older people and people suffering from overweight, because large incisions are required to reach the desired organ. In such a case, a lot of muscle, fascia, nerves and blood vessels are damaged. This leads to more pain during the early postoperative period, especially when the patient needs to move, so he is forced to lie in bed for a longer period of time. During the late postoperative period, the surgical wound may be harder to heal because of the nerve and vascular damage, the abdominal wall is usually atrophied, fascias heal poorly and there is a higher risk of postoperative hernia. Meanwhile, if the patient’s abdominal surgery is done with the help of laparoscope, abdominal wall thickness does not affect the operating incision size. The patient is able to get out of bed the next day after the surgery, the patient is more active so there are less postoperative complications, he can be sent home in a shorter term, he needs less pain-relieving drugs, and can return to active work and social life faster.

What kind of gynecological diseases can be diagnosed and treated by laparoscopy?

Endometriosis – a disease which occurs when tissue similar to the endometrium (uterine mucous) flourishes outside the uterine cavity. Endometriosis affects about 10 percent of fertile age women, and is diagnosed in 20-40 percent cases of infertility. This is the most common fertile age women gynecological pathology after the uterus myoma. Endometriosis symptoms and progress are diverse, depending on the place of the damage. Correlation between the intensity of symptoms and disease stage is not always observed. The disease is characterized by symptoms of painful menstruation, pelvic pain, painful  sexual  intercourse, infertility and so on.
These days, there can be no diagnosis and treatment of endometriosis without laparoscopy. The most common laparoscopic surgical intervention is localizing the endometriosis, it’s coagulation and cutting it out by using a variety of electric instruments. This has proven to reduce pelvic pain and improve fertility treatment outcome.

Ovarian cysts. Women’s functional ovarian cyst is a benign ovarian cavity formation with a thin peel, filled with liquid without any fabric inserts. It’s not a tumor and should be treated as a normal physiological process variation, especially during puberty. The cysts are often formed because of the menstrual cycle disorders or endocrine system pathology. In the absence of ovulation, the follicle stays in the cavity to form a functional  follicular cyst. Corpus luteum cysts are a more rare. The cysts can be either in one ovary or both, at the same time. This is a relatively common disease for women of childbearing age, accounting for 30-40% of women of ovarian pathology. If there are no clinical symptoms, monitoring  and gynecological and ultrasound examination are recommended. Very often functional cysts disappear spontaneously by themselves. If the cyst is growing and enlarging, or in cases of acute abdominal pain, operational treatment – surgical laparoscopy is applied.

Ovarian tumors. Ovarian tumors are classified into benign and malignant. Ovarian cystoma – is a rapidly growing, consisting of one or more chambers filled with fluid and surrounded by a thick membrane, epithelium tissue tumor. Ovarian cystoms can be benign, malignant and boundary (low-malicious). Ovarian cystoma causes are unclear. Cystoma’s symptoms: heaviness in the lower abdomen, bloating, abdominal volume increase, dull pain in lower abdomen, body side, painful irregular menstruation, urination, defecation disorders. Cystoms may split: their contents spill in the abdominal cavity, bleeding begins, cystom peduncle may turn around,  cystom may necrose, infections may contribute to purulence, “acute abdomen” syndrome may develop quickly. Cystom may turn malignant. Cystoms do not disappear by themselves, they are only surgically treated. Depending on the size of the tumor and it’s possibility of it becoming malignant, doctors decide whether to remove it with  laparoscopic technique or a surgical intervention.

Myoma uteri – is an uterine smooth muscle and connective tissue cell tumor. According to histological structure they are divided to: leiomyoma, fibromyoma, fibroma. According to the localization of the myom, they are divided to such groups: intramural (myom node is inside the muscle layer of the uterus), subserous (myom node is in uterine serous membrane and pushes it into the abdominal cavity) and submucosal (myom node is under the mucosal layer of the uterus and pushes it in to the uterine cavity). They are diagnosed to about 30 percent of women older than 35 years. Myom symptoms: bleeding from the uterus, heavy and long menstrual periods, different types of abdominal pain, frequent urination, constipation. Myoms can cause infertility. Myoms are treated with uterine surgery, laparoscopy, hysteroscopy or laparotomy, depending on the size and location of myoms.

One of the first laparoscopic diagnostics application areas is diagnosis and treatment of gynecological inflammation. Early diagnosis helps initiate timely and adequate treatment to prevent worse consequences (pelvic pain, infertility). Currently, surgical gynecological laparoscopy is applied to treat infections (opening  of abscesses, cleaning, drainage, removal of adhesions).. Adhesions  form due to pelvic inflammatory disease, endometriosis, burst appendix,or previous operations. Adhesions may be the cause of infertility or chronic pelvic pain.

Ectopic pregnancy diagnosis and treatment is unimaginable today without laparoscopy, except when the patient is in a state of haemorrhagic shock. Organ-saving operations are performed: chorionic tissue removal from the fallopian tubes or ovaries, stopping bleeding. In case of obvious changes in the tubal anatomy, fallopian tube removal operation is performed.

How do You prepare for laparoscopy?

It is advised not to eat anything for 12 hours, and not to drink anything for 6 hours prior to planned surgery. This helps to prevent aspiration of gastric contents during anesthesia. Laboratory tests are recommended before laparoscopy: a common blood test, urine test, coagulio-gram, blood group test, ECG  for women older than 30 years, other studies are carried out in accordance with the clinical situation.

Can all women use this method?

Contraindications to laparoscopy are still debatable. One of the former contraindication was the patients state after abdominal surgery, especially in cases of bowel obstruction, it has become relative. Although the risk of intestinal infringement is  increased, clinical studies have shown that in this situation, morbidity after laparoscopic surgery is less than after laparotomy. Former abdominal surgery is a risk factor for laparoscopic surgery because the possibility of intestinal damage is increased. In 20 percent. of cases, the bowel is connected with the anterior abdominal wall . Nevertheless, cases of the intestinal damage are rare (about three cases out of 10,000 laparoscopies).

A frequent contraindication – circulatory instability because of disrupted ectopic pregnancy. However, laparoscopy can be done quite safely with sufficient amount of fluid infusion, in the majority of clinical situations. Pregnancy is not a contraindication for laparoscopy. It was found that it can be safely performed even on 12-16 weeks of pregnancy. One of the main contraindications for laparoscopy is a high degree of pulmonary heart failure, liver failure, diffuse peritonitis.

What are the possible complications of laparoscopy?

The overall complication rate of laparoscopic operations is about 2 percent. All complications are divided into surgical: bleeding, infection, organ damage and anesthetic: aspiration of gastric contents, allergic reactions, cardiovascular problems and others. Severe bleeding during surgery is often associated with major vascular injuries. This is the least common but a life-threatening complication.

What you should know after laparoscopy?

You may feel pain in the lower abdomen after gynecological laparoscopic surgery. The pain is usually more intensive and exhausting during the first 4-6 hours after surgery, during that time pain-relieving drugs are taken. You may experience discomfort in the abdomen, under the rib arc or at the collarbone, particularly when you take a deep breath, during the first three days after surgery. The wound heals, and the pain disappears within a week. After laparoscopy, the patient feels well after 72 hours if there are no complications. Since the abdominal fascial defects heal for several weeks, the patient should avoid lifting objects heavier than 7 kg during the first month after surgery.

If you have any questions, please contact our GK Clinic by phone at (+370) 5 255 33 53 and arrange a private consultation.