How is laparoscopy performed? Diagnostic laparoscopy. Laparoscopy - is it a danger or benefit?

It is very strange to see how many women still do not know that now most operations can be performed in a gentle way, without an incision, with a short recovery period and with a minimal likelihood of adhesions and relapses. Currently, most operations are performed using a (minimally invasive) laparoscopic approach.

In this section we will be able to answer some questions:

So, what is laparoscopy?

- this is an inspection abdominal cavity through an opening in the abdominal wall using the optical system of a laparoscope. The operation is carried out under the control of an endovideo camera, the image from which is transmitted to a color monitor with sixfold magnification, using special instruments inserted inside through small holes - punctures with a diameter of about 5 mm.

A laparoscope is a metal tube with a diameter of 10 or 5 mm with a complex system of lenses and a light guide. The laparoscope is designed to transmit images from cavities human body using lens or rod optics and having a rigid outer tube. The laparoscope is the first link in the image transmission chain. In general, a laparoscope consists of an outer and an inner tube, between which an optical fiber is laid to transmit light from the illuminator into the body cavity. The inner tube contains an optical system of miniature lenses and rods.

Endovideo camera designed to display a color image of the surgical field from various endoscopic devices - laparoscopes, cystourethroscopes, rectoscopes, hysteroscopes, flexible endoscopes, etc. during surgical operations and diagnostic procedures.

A little about the history of the development of laparoscopy

In our country, as well as throughout the world, the development of laparoscopy continues. Unfortunately, in the outback, such operations still remain the exception and not the rule, although laparoscopy has existed in the world for more than 100 years.

The first experience of laparoscopy was described back in 1910, and until the mid-twentieth century, laparoscopy was of a diagnostic nature, it developed, more and more complex equipment was created, and safe lighting systems were developed.

• Consultation with MD, professor of obstetrician-gynecologist
• Preoperative examination in 1 day!
• Expert ultrasound of the pelvic organs with Doppler ultrasound
• Carrying out simultaneous operations by combined teams if necessary (gynecologists, urologists, surgeons)
• Postoperative management
• Histological examination in leading institutions of Russia
• Consultation on results and selection of preventive measures
• Preconception preparation

If you need to make a diagnosis or minimally traumatic treatment, a laparoscopy of the uterus is performed in gynecology. The choice of procedure depends on the type of disease and the severity of its course. For everything to go smoothly, the operation must be performed by an experienced specialist using proper equipment. Is it possible to do laparoscopy during menstruation and how it is performed, you will find out below.

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What is uterine laparoscopy?

Laparoscopy of the uterus is a safe and gentle technique that allows not only diagnostics of the organ, but also successful operations. In this case, the surgeon makes the required number of punctures in the peritoneum. This type of access is advisable for neoplasms that are present in the area of ​​the organ, or for anomalies of its development.

With the help of laparoscopy, endometriosis can be diagnosed, microcysts can be detected and a definitive answer can be given as to why a woman is infertile.

After this method the woman comes to her senses completely within 1-2 weeks.

In what cases is surgery performed?

The operation may be prescribed for:

• fibroids;
• fibromas;
• cysts;
• cancer;
• regular bleeding from the uterus of unknown nature;
• prolapse of the uterus and its prolapse;
• endometriosis;
• congenital defects;
• ineffective hormone therapy;
• unknown nature of infertility;
• adhesions;
• pregnancy outside the uterus.

If a woman has any of the above pathologies, it is not a fact that the doctor will opt for laparoscopy. Everything is purely individual, taking into account the patient’s age, presenting symptoms, etc.

Kinds

Laparoscopy can be diagnostic, operative and control.

Diagnostic

Its purpose is to confirm or refute the established diagnosis. They resort to such diagnostics in a hopeless situation, when other methods could not provide answers to the questions of interest. There are cases when this type smoothly turns into operational.

Operational

This is done after receiving all the tests, in the case when conservative treatment did not help. This includes the removal of various neoplasms, both malignant and benign (fibroids, fibroids, cysts, tumors, etc.) and the removal of the organ itself.

Control

This is done to check a previous surgical intervention.

Contraindications for surgery

Before laparoscopy, the doctor must exclude all contraindications. These include:

• the presence of a hernia;
• poor blood clotting;
• exhaustion of the body;
• serious lung pathology;
• the presence of diseases that are associated with the heart and blood vessels.

If the above is not taken into account, complications may arise after the operation.

There is also a risk of negative consequences after radical treatment if a woman has:

• there is obesity;
• adhesions are present;
• infectious diseases;
• there is more than 1 liter of liquid inclusions in the peritoneum.

In order for everything to go smoothly, you must first carry out preparatory procedures or treatment (if necessary).

How to prepare for the procedure?

If laparoscopy is planned, then preparation will take a week, sometimes more. During an emergency operation, a woman is prepared in a few minutes, sometimes it takes up to half an hour. The countdown is in seconds, because we are talking about human life.

If there is no need for emergency surgery, the doctor gives a referral to the patient for tests:

• general (urine and blood);
• checking blood glucose;
• exclusion of STIs, HIV, hepatitis and syphilis;
• biochemical;
• determination of the Rh factor and blood group;
• A swab is taken from the vagina.

First, the doctor must familiarize himself with the medical history and find out why the woman is experiencing allergic reactions. A gynecological examination is performed using speculum.

In addition to laboratory tests, you need to undergo instrumental diagnostics. This is an electrocardiogram, ultrasound examination, fluorographic examination. All this is necessary for selecting an anesthetic drug and type of anesthesia.

Sometimes a woman is referred to a psychotherapist who provides psychological training. Conversations with a doctor help you come to your senses and calm down emotionally.

Is it possible to do laparoscopy during menstruation? During menstruation, surgery is usually not performed. The exception is emergency surgery when life or death is involved. Best time– the period after critical days, in the first phase of the cycle.

If we talk about immediate preparation the day before the operation, this includes:

• refusal to eat in the evening;
• using an enema before bedtime;
• conversation with an anesthesiologist and choice of anesthesia;
• acquisition of special compression stockings or tights that will prevent blood clots (it’s better to do this in advance).

Technique of the procedure

Laparoscopic surgery to remove the uterus or tumors in its cavity occurs through minor punctures in the peritoneum. Trocars are installed in them, which will hold the endovideo camera and other instruments that will be used during laparoscopy.

The entire area is pre-treated with an antiseptic. After punctures and insertion of instrumental equipment, the peritoneal cavity is inflated with a special harmless gas. It does not cause allergies and dissolves quickly. This is necessary for:

• increasing abdominal space;
• visualization improvements;
• freedom of action.

There can be 2, 3 or 4 punctures. It all depends on the purpose of laparoscopy. Their purpose is as follows:

1. The navel area is for a Veress needle. Gas will be supplied through it.
2. The next mini-incision is made to insert a trocar with a camera.
3. If laparoscopic removal of the uterus or any formations is performed, then a third (if absolutely necessary, a fourth) puncture is performed. The 3rd will be in the area above the pubis. A laser, scissors and other instruments are introduced there.

The monitor screen will show an image of what is happening inside. In this case, the image is enlarged several times. Laparoscopy lasts from 45 minutes to two hours. It all depends on the severity of the intervention. The diagnostic procedure will take the least time, no more than half an hour.

During the operation, the woman does not feel any discomfort or pain, since the anesthesia is general and the patient is in a medicated sleep.

Recovery period

After the operation, the woman needs a little time to recover. Since the violation of tissue integrity is insignificant, the healing process is rapid. You can get out of bed after 7-8 hours. They are discharged home after three to five days. It all depends on the woman’s condition.

At first, painkillers are prescribed to eliminate pain. Antibiotics may be prescribed to prevent infections. Equally important proper nutrition and exclusion of physical activity.

Sometimes a woman needs 10 days for everything to return to normal, while others will have to wait 20-30 days.

To recovery period decreased, you should listen to the recommendations of a specialist, avoid visiting baths, saunas, baths. You can't exercise, have sex, or lift heavy objects.

Possible consequences and complications

Usually after this technique there are the least number of complications, but they can also occur. This:

• soreness;
• bleeding (external and internal);
• difficulty emptying the urethra.

Such consequences do not need to be treated, everything will go away on its own. Sometimes a woman may develop a fever, weakness, increasing pain and discharge from the genitals. This indicates the development of an infection. To prevent this from happening, the patient should not neglect taking antiseptic drugs and antibiotics. During laparoscopy of an ovarian cyst or removal of the uterus, symptoms may persist longer.

Is pregnancy possible after this operation?

It is possible to get pregnant after laparoscopy, but it is not advisable to rush. It is recommended to plan pregnancy after 3-6 months. Sometimes you have to wait 8-10 months. It all depends on the diagnosis and the individual characteristics of the patient. You must first consult with a gynecologist who will examine the patient, prescribe tests and some instrumental types. diagnostic examination. Only after receiving the results can something clearly be said about further actions.

If the uterus was removed using this method, pregnancy is impossible.

Cost of laparoscopy

The cost of a particular operation may vary. In each case everything is individual.

Conclusion and Conclusion

Laparoscopy of the uterus is distinguished by its gentle technique. Recovery is quick and not very painful. Surgeries performed on the body of the organ can not only restore reproductive function, but also extend the years of life for patients who have been diagnosed with malignant tumors. Now, a clear answer has been found to the question of whether it is possible to remove the uterus by laparoscopy.

In this way, you can determine why a woman cannot get pregnant and immediately eliminate the defect present. But, before resorting to laparoscopy, you need to undergo a complete diagnosis, which will eliminate all contraindications.

Content

For a thorough diagnosis of the pelvic organs and peritoneum, there are a number of invasive methods. Among them is laparoscopy, which is prescribed for suspected fibroids, cysts, adhesions, endometriosis, infectious processes of the abdominal cavity, pathologies fallopian tubes and ovaries. The method and operation are informative and are often used by modern gynecology.

What is laparoscopy

Before treating the source of pathology, it must be detected and examined in detail. In this case, patients will learn what laparoscopic surgery is, to whom it is recommended, and for what therapeutic purposes it is performed. In essence, this is a surgical intervention, since all the specialist’s actions take place under general anesthesia with making incisions in the peritoneum. During the operation, a special instrument is used, after which rehabilitation is required, complications are possible. If laparoscopy is necessary, an experienced doctor will tell you what it is.

Diagnostic laparoscopy

In most clinical cases this is informative method diagnostics, however, some experts associate the procedure with a full-fledged operation. This is an alternative to abdominal surgery, which requires a deep incision in the abdomen. Diagnostic laparoscopy involves only small incisions in the peritoneal area for further insertion of thin tubes into the cavity. This is necessary for research general condition peritoneal organs, identifying affected areas and their characteristics, performing surgery.

How is laparoscopy done?

Before proceeding with the implementation of the method, the doctor selects the anesthesia that will be used for the operation. More often this is general anesthesia during laparoscopy, when during surgical procedures the patient remains unconscious, all his reflexes are temporarily disabled. In gynecology, the operation is performed by a gynecologist, in surgery - by an experienced surgeon; for other areas of medicine, this diagnostic method is used extremely rarely. The sequence of actions during laparoscopy is as follows:

1. First of all, the patient is given special medications to prevent complications in the rehabilitation period after operation.
2. In the operating room, a drip is installed for future administration of anesthesia and electrodes for monitoring cardiac activity.
3. Before the operation, anesthesia is administered to relax the muscles and make the operation painless.
4. An endotracheal tube is installed in the trachea to increase the information content of the selected diagnostic method and maintain natural ventilation of the lungs.
5. During surgery, gas is injected into the abdominal cavity to improve visibility of suspected foci of pathology and reduce the risk of complications in relation to neighboring organs.
6. Hollow tubes are inserted through small incisions in the abdomen to allow passage of endoscopic instruments.
7. In case of obstruction of the fallopian tubes, their plastic surgery is indicated.
8. For normalization menstrual cycle and restoration of ovulation, incisions are made on the ovaries, and in case of polycystic disease, a wedge-shaped resection is performed.
9. The pelvic adhesions are separated, cysts and fibroids must be immediately removed from the pelvic organs.

Where is laparoscopy performed?

You can get a free service at a district clinic or gynecological departments of city hospitals, subject to the provision of standard documents. Specialists monitor not only the operation itself, but also the postoperative period. Many patients choose the services of private clinics and medical centers, agree to the high cost of the session. The laparoscopy operation should be performed exclusively by a gynecologist or surgeon, and it is advisable to trust your health only to experienced doctors.

Price for laparoscopy

This is one of the most expensive diagnostic methods not only in gynecology. The answer to the question of how much laparoscopy costs sometimes shocks patients, but there is nothing left - they have to agree to the operation. The price of the procedure depends on the city, the rating of the clinic and the professionalism of the specialist who will perform such surgical procedures. Prices vary, but in the provinces they start from 8,000 rubles. Prices in the capital are higher, starting from 12,000 rubles, depending on the characteristics of the pathology.

Preparation for laparoscopy

During pregnancy, such an invasive diagnostic method is carried out in exceptional cases when the life of the mother and child is threatened. This is not the only contraindication; for some patients, surgery is simply not suitable. Therefore, it is necessary to undergo tests before laparoscopy to eliminate the risk of complications. Necessarily laboratory test blood to determine compatibility with anesthesia and collecting medical history to study general health.

Recovery after laparoscopy

After a careful study of the internal organs and systems, a short-term restoration of the body is required. Rehabilitation after laparoscopy involves proper nutrition, a minimum of physical activity muscle mass first 2-3 hours. Then physical therapy in a hospital setting or walking in the fresh air will not hurt. Already 7 hours after surgery general health will come back to normal. As for pregnancy, after laparoscopy it can be planned after 2-3 months.

Nutrition after laparoscopy

A special diet after surgery is not required, but doctors still recommend somewhat limiting the diet. For the first 2 weeks, nutrition after laparoscopy should exclude spicy, fatty and salty foods so as not to overload the stomach and intestines. Be sure to drink more fluid - at least 2 liters per day; otherwise, act according to the indications of a specialist.

Consequences of laparoscopy

If a cyst was removed using such a progressive method, the patient may face unpleasant consequences in the postoperative period. Doctors warn in advance that complications after laparoscopy are possible, which require additional conservative therapy. Therefore, it is important to know not only the cost of the operation, but also the consequences it can cause. This:

• formation of adhesions with subsequent infertility;
• massive uterine bleeding from the peritoneal organs;
• injury to large vessels;
• injury to internal organs and systems;
• subcutaneous emphysema.

– Yan Evgenievich, what caused the creation of the Pain Treatment Clinic? What are its features?

– Multidisciplinary clinic "Health 365" has been operating in Yekaterinburg since 2008. Today it consists of five divisions in different areas of the city, including our Pain Treatment Clinic. This is a complex that brings together expert doctors with special training in the field of pain treatment. We use special techniques laboratory methods and equipment, our activities are regulated general rules and approaches to the diagnosis and treatment of pain, and internal management.

There are many manifestations of pain, for her effective treatment a systematic multidisciplinary approach is required. Chronic pain is dangerous because the longer it exists, the more difficult it is to treat; over time, it leads to the development of very complex structural changes in the central nervous system.

Often, patients turn to specialized specialists to get rid of pain, and they begin to walk in circles: from a therapist to a neurologist, from him to a surgeon, then to a neurosurgeon, a psychologist, and again to a therapist. A multisystem approach disproportionately increases cure and remission rates for various diseases

Our clinic is focused on the diagnosis and treatment of syndromes such as headaches and back pain, pain in the limbs, joints, as well as in the coccyx, sacrum and pelvis - a total of five basic areas. Our Clinic staff includes neurologists, therapists, neurosurgeons, ultrasound doctors, chiropractors, and massage specialists. Including three candidates of medical sciences, which once again confirms the level of qualifications of the staff.

– How is pain treated in your clinic? What innovative techniques and equipment are used?

– It all starts with an appointment with a doctor who provides assistance in removing acute symptoms pain and recommends to the patient diagnostic studies, laboratory and instrumental, necessary for an accurate diagnosis of the cause of pain. After which it is appointed complex treatment– from the use of drug therapy and physiotherapy to invasive treatment– various blockades under ultrasound control, neurosurgical operations. Chronic pain disorder is often accompanied by anxiety and depressive disorders, so psychotherapy and psychopharmacotherapy may be included in the structure of our care.

Treatment also includes various non-drug methods. For common causes of pain (consequences of sports injuries, diseases of the musculoskeletal system), an innovative method such as kinesio taping is used. On the patient’s skin, in accordance with certain anatomical rules, dense adhesive-based tapes are placed, which support the skin, fiber, muscles, relieve certain areas of the body, improve blood supply and lymphatic drainage, thereby significantly reducing painful sensations. Another innovative method is plasma lifting. Plasma, which is obtained in concentrated form from the patient’s own blood, is separated from the blood, enriched with platelets and biologically active substances and injected, for example, into the tissue around a diseased joint. This plasma has good restorative and anti-inflammatory properties. In our clinic, both traditional devices, such as magnetic therapy devices, magnetic laser, ultrasound, amplipulse, and innovative equipment are actively used for physical procedures. For example, the Sympatocor-1 device is used to relieve migraine attacks and preventive treatment of headaches. It successfully and permanently relieves a person from repeated attacks of pain, subsequently reducing their frequency and intensity.

– What kind of pain do patients come to you with most often?

– Headaches and back pain are more common, closely followed by joint pain. If necessary, we use MRI (magnetic resonance imaging) to accurately diagnose the causes of such pain. An accurate and timely diagnosis means a lot for the prescription. proper treatment, saves the patient from going through agony. Our diagnostic complex, in addition to MRI, includes different kinds Ultrasound. The clinic, the only one in the city, does ultrasound peripheral nerves. This is very important when diagnosing compression of nerves, the so-called “tunnel syndromes”, for example, carpal tunnel syndrome, cubital tunnel syndrome, it allows you to see the localization and cause of compression of the nerve trunk. We carry out expert ultrasound diagnostics of the condition of the vessels of the head and neck. Very often, such a study makes it possible to verify the causes of headaches, such as a violation venous outflow, vertebrogenic compression of the vertebral arteries, muscle tension, dysregulation of vascular tone. This provides a point of support for the general practitioner and neurologist. They gain a lever with which to solve a situation of severe, recurring pain, from which the patient sometimes despairs of finding relief and resigns himself. As a result of accurate diagnosis, we find this cause, which often responds well to treatment.

– What age patients predominate in your clinic?

– Pain in the cities is getting younger: a person sits at the computer all week without straightening up, and on the weekend he abruptly switches to classes in the gym or on the ski slope. And then he goes to our clinic complaining of back pain. With age, the incidence of diseases of the musculoskeletal system increases, including spinal osteochondrosis, deforming osteoarthritis, and damage to muscles and ligaments. Simple general tips to prevent the development of such diseases: try to healthy image life and promptly seek advice from specialists. Regarding the type and intensity of necessary physical activity. Of course, movement is life, but it is very important that it does not cause pain, but joy. Patients often come to us with complaints of pain in the extremities, in particular in the wrists and wrist joints, where the nerves lie closely together with the tendons. Inflammation occurs due to stress from prolonged routine work, for example, when working with a wrench, driving for a long time in a chair and steering wheel that is not adjusted in height and depth, when playing the piano, or working at an inconveniently located computer keyboard.
Such pain can often make a person disabled. In this case, it is necessary to carry out a therapeutic and diagnostic blockade, treat the nerve directly, administer drugs that block pain, relieve inflammation and swelling, prevent further destruction of the nerve, and in some cases, perform neurosurgical intervention on the nerve. When performing pain blockades, our clinic uses high-tech methods: under the control of an ultrasound sensor (this is called ultrasound navigation) or an X-ray image in real time, a needle is brought exactly to the affected area, through which the necessary medicine is administered. The possibilities of such visualization during blockades practically eliminate the possibility of accidental damage to nerves and surrounding tissues and blood vessels and ensure increased safety of the procedure. Thanks to the pinpoint accuracy of administration, we are able to reduce the dose of injected medicinal product, thereby reducing the risks of developing undesirable reactions possible during the administration high doses drug.

– How financially accessible are the clinic’s services to patients?

– Our clinic operates in a mandatory system health insurance(compulsory medical insurance), because a large number of diseases accompanied by pain are included in the compulsory medical insurance system. The clinic also has a voluntary health insurance (VHI) department. According to current legislation, the possibility of receiving free medical services The patient must be oriented by the doctor. Medically special meaning is comprehensive and timely: if a patient undergoes an ultrasound today and an MRI six months later, this reduces the effectiveness of treatment to zero. We have developed special programs with significant discounts on complexes diagnostic procedures and pain treatment methods. At the same time, high-tech services, by definition, cannot be very cheap.

– In what directions will the clinic develop this year?

– In the coming years, our clinic will continue to introduce new types of medical services for the diagnosis and treatment of pain. These include various types of electrical neurostimulation, physiotherapy, new methods of neuroimaging, ultrasound, x-ray assistance, navigation in the treatment of pain syndromes. There will be a widespread introduction of minimally invasive operations, neurosurgical, low-traumatic procedures, which in 2-3 days will allow surgical treatment causes of pain. Further training of our doctors is planned; they will master related specialties, new treatment techniques, including diagnostic and invasive ones. We will also develop connections with other clinics and scientific schools specializing in the treatment of pain, both in our country and abroad. Our goal is to relieve our patients from any pain, from walking through torment: comprehensively, effectively and safely.

Thank you

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Laparoscopy of the gallbladder - definition, general characteristics, types of operations

That is, “gall bladder laparoscopy” is, first of all, a surgical operation during which either complete removal the entire organ, or removing the stones present in it. Distinctive feature operation is the access through which it is performed. This access is carried out using a special device - laparoscope, and therefore is called laparoscopic. Thus, laparoscopy of the gallbladder is a surgical operation performed using a laparoscope.

To clearly understand and imagine what the differences are between conventional and laparoscopic surgery, necessary in general outline present the progress and essence of both methods.

So, a usual operation on the abdominal organs, including the gallbladder, is carried out using an incision in the anterior abdominal wall, through which the doctor sees the organs with his eye and can perform various manipulations on them with instruments in his hands. That is, it is quite easy to imagine a regular operation to remove the gallbladder - the doctor cuts the stomach, cuts out the bladder and stitches the wound. After such a routine operation on skin a scar always remains in the form of a scar corresponding to the line of the incision made. This scar will never allow its owner to forget about the operation performed. Since the operation is performed using an incision in the tissue of the anterior abdominal wall, such access to the internal organs is traditionally called laparotomy .

The term "laparotomy" is formed from two words - "lapar-", which translates as belly, and "tomia", meaning to cut. That is, the general translation of the term “laparotomy” sounds like cutting the stomach. Since as a result of cutting the abdomen, the doctor is able to manipulate the gallbladder and other abdominal organs, the process of such cutting of the anterior abdominal wall is called laparotomy access. In this case, access refers to a technique that allows the doctor to perform any actions on internal organs.

Laparoscopic surgery on the abdominal and pelvic organs, including the gallbladder, is performed using special instruments - a laparoscope and trocar manipulators. A laparoscope is a video camera with a lighting device (flashlight), which is inserted into the abdominal cavity through a puncture on the anterior abdominal wall. Then the image from the video camera enters the screen on which the doctor sees internal organs. It is based on this image that he will carry out the operation. That is, during laparoscopy, the doctor sees the organs not through an incision in the abdomen, but through a video camera inserted into the abdominal cavity. The puncture through which the laparoscope is inserted has a length of 1.5 to 2 cm, so a small and almost invisible scar remains in its place.

In addition to the laparoscope, two more special hollow tubes called trocars or manipulators, which are designed to control surgical instruments. Through hollow holes inside the tubes, instruments are delivered into the abdominal cavity to the organ that will be operated on. After this, using special devices on the trocars, they begin to move the instruments and perform the necessary actions, for example, cutting adhesions, applying clamps, cauterizing blood vessels etc. Controlling instruments using trocars can be roughly compared to driving a car, airplane or other device.

Thus, laparoscopic surgery involves the insertion of three tubes into the abdominal cavity through small punctures 1.5–2 cm long, one of which is intended for obtaining an image, and the other two for performing the actual surgical procedure.

The technique, course and essence of the operations that are performed using laparoscopy and laparotomy are exactly the same. This means that the removal of the gallbladder will be performed according to the same rules and steps both using laparoscopy and during laparotomy.

That is, in addition to the classic laparotomy approach, laparoscopic access can be used to perform the same operations. In this case, the operation is called laparoscopic, or simply laparoscopy. After the words “laparoscopy” and “laparoscopic”, the name of the operation performed is usually added, for example, removal, after which the organ on which the intervention was performed is indicated. For example, the correct name for removing the gallbladder during laparoscopy would be “laparoscopic removal of the gallbladder.” However, in practice, the name of the operation (removal of part or the entire organ, enucleation of stones, etc.) is skipped, as a result of which only an indication of the laparoscopic approach and the name of the organ on which the intervention was performed remains.

Two types of gall bladder interventions can be performed using laparoscopic access:
1. Removal of the gallbladder.
2. Removing stones from the gallbladder.

Currently surgery to remove gallstones is almost never performed for two main reasons. Firstly, if there are a lot of stones, then the entire organ should be removed, which is already too much pathologically changed and therefore will never function normally. In this case, removing only the stones and leaving the gallbladder is unjustified, since the organ will constantly become inflamed and provoke other diseases.

And if there are few stones or they are small, then you can use other methods to remove them (for example, litholytic therapy with ursodeoxycholic acid preparations, such as Ursosan, Ursofalk, etc., or crushing stones with ultrasound, due to which they decrease in size and independently come out of the bladder into the intestine, from where with the food bolus and feces are removed from the body). For small stones, litholytic therapy with medications or ultrasound is also effective and avoids surgery.

In other words, the current situation is that when a person needs surgery for gallstones, it is advisable to remove the entire organ completely, rather than remove the stones. This is why surgeons most often resort to laparoscopic removal of the gallbladder, rather than stones from it.

Advantages of laparoscopy over laparotomy

• Little damage to the tissue of the anterior abdominal wall, since the operation uses four punctures rather than an incision;
• Minor pain after surgery, subsiding within 24 hours;
• A few hours after the end of the operation, the person can walk and perform simple actions;
• Short hospital stay (1 – 4 days);
• Rapid rehabilitation and restoration of working capacity;
• Low risk of postoperative hernia;
• Subtle or almost invisible scars.

Anesthesia for laparoscopy of the gallbladder

Laparoscopic removal of the gallbladder - the course of the operation

After a person is put under anesthesia, the anesthesiologist inserts a tube into the stomach to remove the liquid and gases present in it. This probe is necessary to prevent accidental vomiting and the entry of stomach contents into Airways followed by asphyxia. The gastric tube remains in the esophagus until the end of the operation. After the tube is installed, the mouth and nose are covered with a mask attached to a ventilator, with which the person will breathe during the entire operation. Mechanical ventilation during laparoscopy is absolutely necessary, since the gas used during the operation and pumped into the abdominal cavity puts pressure on the diaphragm, which, in turn, strongly compresses the lungs, as a result of which they cannot breathe on their own.

Only after the person has been put under anesthesia, gases and fluids have been removed from the stomach, and a ventilator has been successfully attached, the surgeon and his assistants begin to perform laparoscopic surgery to remove the gallbladder. To do this, a semicircular incision is made in the navel fold, through which a trocar with a camera and a flashlight is inserted. However, before the camera and flashlight are inserted, sterile gas, most often carbon dioxide, is pumped into the abdomen, which is necessary to straighten the organs and increase the volume of the abdominal cavity. Thanks to the gas bubble, the doctor is able to freely operate trocars in the abdominal cavity, minimally affecting neighboring organs.

Then, along the right hypochondrium, another 2 to 3 trocars are inserted, with which the surgeon will manipulate the instruments and remove the gallbladder. The puncture points on the abdominal skin through which trocars are inserted for laparoscopic removal of the gallbladder are shown in Figure 1.

Picture 1– Points at which a puncture is made and trocars are inserted for laparoscopic removal of the gallbladder.

The surgeon then first examines the location and appearance of the gallbladder. If the bladder is closed by adhesions due to chronic inflammatory process, then the doctor first dissects them, releasing the organ. Then the degree of its tension and fullness is determined. If the gallbladder is very tense, the doctor first cuts its wall and sucks out a small amount of fluid. Only after this a clamp is applied to the bladder, and the common bile duct is released from the tissues - bile duct, connecting it to the duodenum. The common bile duct is cut, after which the cystic artery is isolated from the tissue. Clamps are applied to the vessel, it is cut between them and the lumen of the artery is carefully sutured.

Only after the gallbladder is freed from the artery and common bile duct, the doctor begins to isolate it from the hepatic bed. The bubble is separated slowly and gradually, cauterizing along the way electric shock all bleeding vessels. When the bubble is separated from the surrounding tissue, it is removed through a special small cosmetic puncture in the navel.

After this, the doctor, using a laparoscope, carefully examines the abdominal cavity for bleeding vessels, bile and other pathologically altered structures. The vessels are coagulated, and all altered tissues are removed, after which an antiseptic solution is injected into the abdominal cavity, which is used to rinse it, after which it is sucked out.

This completes the laparoscopic operation to remove the gallbladder; the doctor removes all trocars and sutures or simply seals the punctures in the skin. However, a drainage tube is sometimes inserted into one of the punctures and left for 1 to 2 days so that the remaining antiseptic lavage fluid can flow freely from the abdominal cavity. But if during the operation practically no bile was poured out, and the bladder was not very inflamed, then the drainage may not be left.

It should be remembered that laparoscopic surgery can be converted to laparotomy if the bubble is too tightly fused with the surrounding tissues and cannot be removed using the available instruments. In principle, if any unsolvable difficulties arise, the doctor removes the trocars and performs a conventional extended laparotomy operation.

Laparoscopy of gallbladder stones - the course of the operation

After introducing gas and trocars into the abdominal cavity, the doctor, if necessary, cuts off adhesions between the gallbladder and surrounding organs and tissues, if any. Then the wall of the gallbladder is cut, the tip of the suction is inserted into the cavity of the organ, with the help of which all the contents are removed out. After this, the gallbladder wall is sutured, the abdominal cavity is washed with antiseptic solutions, the trocars are removed and sutures are applied to the punctures in the skin.

Laparoscopic removal of gallstones can also be converted to laparotomy at any time if the surgeon encounters any difficulties.

How long does gallbladder laparoscopy take?

Where to have the operation?

Laparoscopy of the gallbladder - contraindications and indications for surgery

• Chronic calculous and non-calculous cholecystitis;
• Polyps and cholesterosis of the gallbladder;
• Acute cholecystitis (in the first 2–3 days from the onset of the disease);
• Asymptomatic cholecystolithiasis (gallbladder stones).

• Abscess in the gallbladder area;
• Severe diseases of the cardiovascular or respiratory system in the stage of decompensation;
• Third trimester of pregnancy (from 27 weeks to birth);
• Unclear location of organs in the abdominal cavity;
• Operations on the abdominal organs performed in the past via laparotomy;
• Intrahepatic location of the gallbladder;
• Acute pancreatitis;
• Obstructive jaundice caused by blockage of the bile ducts;
• Suspicion of the presence malignant tumor in the gallbladder;
• Severe scarring in the hepatic ligament or neck of the gallbladder;
• Blood clotting disorders;
• Fistulas between the biliary tract and intestines;
• Acute gangrenous or perforated cholecystitis;
• "Porcelain" cholecystitis;
• Presence of a pacemaker.

Preparation for laparoscopy of the gallbladder

• General blood and urine analysis;
• Biochemical blood test with determination of the concentration of bilirubin, total protein, glucose, alkaline phosphatase;
• Coagulogram (APTT, PTI, INR, TV, fibrinogen);
• Vaginal flora smear for women;
• Blood for HIV, syphilis, hepatitis B and C;

In addition, in the process of preparing for laparoscopy of the gallbladder, you should take control of the course of existing chronic diseases respiratory, digestive and endocrine system and take medications agreed upon with the surgeon who will operate.

On the day before surgery, you should finish eating at 6:00 pm and drinking at 10:00 pm. From ten o'clock in the evening on the eve of the operation, a person cannot eat or drink until the start of the operation. surgical intervention. To cleanse the intestines on the day before surgery, you should take a laxative and give an enema. An enema should also be given in the morning immediately before surgery. Laparoscopic removal of the gallbladder does not require any other preparation. However, if in any individual case the doctor considers it necessary to perform any additional preparatory manipulations, he will say this separately.

Laparoscopy of the gallbladder - postoperative period

On the second day after surgery, you can start eating light, soft foods, for example, weak broth, fruits, low-fat cottage cheese, yogurt, boiled lean minced meat, etc. Food should be taken frequently (5 – 7 times a day), but in small portions. During the entire second day after surgery, you need to drink a lot. On the third day after the operation, you can eat regular food, avoiding foods that cause severe gas (legumes, black bread, etc.) and bile secretion (garlic, onion, hot, salty, spicy). In principle, from 3 to 4 days after the operation you can eat according to diet No. 5, which will be described in detail in the corresponding section.

For 1–2 days after surgery, a person may experience pain in the area of ​​punctures on the skin, in the right hypochondrium, and also above the collarbone. These pains are caused by traumatic tissue damage and will completely disappear in 1 to 4 days. If the pain does not subside, but, on the contrary, intensifies, you should immediately consult a doctor, as this may be a symptom of complications.

During the entire postoperative period, which lasts 7–10 days, you should not lift heavy objects or perform any work related to physical activity. Also during this period you need to wear soft underwear that will not irritate painful punctures on the skin. The postoperative period ends on days 7–10, when the sutures from the punctures on the abdomen are removed in the clinic.

Sick leave for laparoscopy of the gallbladder

If any complications develop, the sick leave is extended, but in this case the period of incapacity for work is determined individually.

After laparoscopy of the gallbladder (rehabilitation, recovery and lifestyle)

And normal well-being and the ability to perform usual work, if it is not related to physical activity, appears within 10–15 days after surgery. Starting from this period, for the best rehabilitation, the following rules should be strictly adhered to:

• Sexual rest should be observed for one month or at least 2 weeks after surgery;
• Eat right, avoiding constipation;
• Start any sports training no earlier than a month after surgery, starting with minimal load;
• For a month after surgery, do not engage in heavy physical labor;
• During the first 3 months after surgery, do not lift more than 3 kg, and from 3 to 6 months - more than 5 kg;
• For 3–4 months after surgery, follow diet No. 5.

Pain after laparoscopy of the gallbladder

After removing the sutures on days 7–10 after surgery, the pain no longer bothers you, but may occur with any active actions, or strong tension in the anterior abdominal wall (straining when trying to defecate, lifting weights, etc.). Such moments should be avoided. In the long-term period after the operation (a month or more) there is no pain, and if any appears, this indicates the development of some other disease.

Diet after laparoscopic gallbladder removal (diet after laparoscopy of the gallbladder)

On days 3–4 after surgery, a person can eat pureed vegetables, low-fat cottage cheese, as well as boiled meat and low-fat fish. This diet should be maintained for 3 – 4 days, after which you switch to diet No. 5.

So, diet No. 5 involves frequent and fractional meals (small portions 5–6 times a day). All dishes should be chopped and warm, not hot or cold, and food should be prepared by boiling, stewing or baking. Frying is not allowed. The following dishes and products should be excluded from the diet:

• Fatty foods (fatty fish and meats, lard, high-fat dairy products, etc.);
• Roast;
• Canned meat, fish, vegetables;
• Smoked meats;
• Marinades and pickles;
• Spicy seasonings (mustard, horseradish, chili ketchup, garlic, ginger, etc.);
• Any offal (liver, kidneys, brain, stomachs, etc.);
• Mushrooms in any form;
• Raw vegetables;
• Raw green peas;
• Rye bread;
• Fresh white bread;
• Butter pastries and confectionery (pies, pancakes, pies, pastries, etc.);
• Alcohol;
• Cocoa and black coffee.

• Low-fat varieties of meat (turkey, rabbit, chicken, veal, etc.) and fish (pike perch, perch, pike, etc.) boiled, steamed or baked;
• Semi-liquid porridges from any cereals;
• Soups with water or weak broth, seasoned with vegetables, cereals or pasta;
• Steamed or stewed vegetables;
• Low-fat or skim dairy products (kefir, milk, curdled milk, cheese, etc.);
• Non-acidic berries and fruits, fresh or in compotes, mousses and jellies;
• Yesterday's white bread;