Definition
Laparoscopy is the observation of the abdominal cavity with the help of a video camera. The video camera is inserted through a small hole in the abdominal cavity, usually the hole is made below the navel to view the organs of the abdomen and also the pelvis (especially the female pelvis in gynecology). Laparoscopy is not only used in gynecology, but also in surgical operations, as the operating field and thus the risk of infection can be kept very small. Thus, laparoscopy can be used for surgical purposes, i.e. as a treatment option, but is also of crucial importance for diagnostics.
Procedure
A laparoscopy always requires a certain amount of experience on the part of the doctor and should be carefully examined for advantages and disadvantages. There are also certain conditions that must be met during a laparoscopy. On the one hand, a patient should not have fresh scars in the abdomen or upper pelvic area, and on the other hand, there should not be too many older scars.
Since carbon dioxide (CO2) must be pumped into the abdominal cavity during laparoscopy and this is only eliminated by breathing, it is important that the patient has good to sufficient lung function. Patients with severe asthma or chronic obstructive pulmonary disease are therefore often ruled out for laparoscopic surgery. Patients with limited heart function are also often no longer able to undergo laparoscopic surgery because the risk of unexpected complications due to CO2 in the abdominal cavity is too high.
To perform a laparoscopy, the patient must be transferred under general anesthesia. Only then can the doctor apply 3-4 stitches in the area of the abdominal wall, depending on the organ that is diagnosed/treated. The first stitch is usually located directly below the navel.
This has optical advantages, because the scar is hardly noticed in this area, and the position for the laparoscope is the best. The laparoscope is a small camera, which also has a small lamp or light source to make the area to be examined brighter. The laparoscope (which is a special endoscope) is inserted through the hole below the navel and from here the organs of the abdominal cavity, i.e. intestine, liver, gallbladder and so on, can be examined.
Depending on which organs are to be examined, the patient must be positioned differently. When examining the abdominal cavity, the patient lies flat on his back. In an examination of the female reproductive organs, the patient also lies on her back, but her pelvis is positioned upwards so that the pelvis is at its highest point.
As a result, all abdominal organs slide towards the chest and the female genitals are much better and also more easily accessible and visible. When the laparoscope is inserted through the abdominal wall into the abdominal cavity, the other necessary instruments (forceps, scissors…) are also inserted into the abdominal cavity through 2-3 additional holes in the abdominal wall. In order to obtain a better view of the area to be operated on or viewed, the abdominal cavity is pumped up with carbon dioxide (CO2).
For this purpose, a small incision is made in the abdominal wall, through which a so-called special insufflation cannula (Veres cannula insert) is then inserted. This insufflation cannula is a kind of mini tube through which the CO2 is pumped and which is then replaced by a so-called trocar (also a kind of small tube) through which the video camera is then inserted. Depending on the abdominal girth and height of the patient, up to 7l of Co2 can be pumped into the abdominal cavity.
This causes the abdomen to inflate enormously, so that the abdomen is tense during the entire operation, just like a pregnancy in the last month. The advantage of this is that the field of vision is much larger and therefore much easier to handle. In addition, the CO2 can be absorbed by the surrounding tissue and then breathed out through the lungs without any complications or allergic reactions, since CO2 is a natural substance in our body with which the body is already familiar.Only in rare cases a so-called lift system is used, in which the abdominal wall is lifted without CO2 to enlarge the operating room.
The hospital stay after a laparoscopy is already significantly shortened compared to procedures with an open abdomen. A very short time after the procedure, the patient can get up and resume everyday activities. It is even possible to perform a laparoscopy on an outpatient basis.
In this case, however, it is important to consider the after-effects of anesthesia. After such an operation you will not be able to actively participate in traffic, so you should be picked up by someone or take a cab. Public transport can also be used, but is considered a less good option.
The operation of heavy machinery should also be resumed the day after the surgery at the earliest. Usually, however, after a laparoscopy, you will need to take it easy and you will still be on sick leave for several days. In the case of outpatient procedures, one should still take sufficient care at home, not lift heavy things in the first few days and pay attention to the healing of the small wounds on the abdomen.
The wounds are regularly checked by the family doctor in the first few days to ensure a good healing process and to be able to act early in case of inflammation. When a laparoscopy is indicated depends entirely on the diagnosis or surgery to be performed. As already mentioned, laparoscopy is often used in gynecology to make a diagnosis that cannot be made by external palpation or ultrasound.
Laparoscopy is often used to examine the patency of the fallopian tubes (tuba uterina), for example in the case of an unfulfilled desire to have children. In this case, a dye, usually a so-called contrast medium, is injected into the uterus. With the help of a video camera, the migration of the dye from the uterus through the fallopian tubes can be observed.
If the fallopian tubes are continuous, this can be seen by the smooth color gradient; if they are not, a stop of the color gradient can be seen somewhere. In addition to the diagnosis of the fallopian tubes, gynecologists also diagnose endometriosis or cysts using laparoscopy. In addition to diagnostics, laparoscopy is also used in gynecology for treatment.
On the one hand, in an ectopic pregnancy in which the fertilized egg implants in the fallopian tube instead of in the uterus, it can be removed, and on the other hand, the fallopian tubes can also be severed. A planned cut leads to sterilization of the woman, which means that she cannot have any more children afterwards. It should be noted that even sterilization does not lead to a hundred percent certainty and in rare cases pregnancy can occur despite sterilization.
In addition to this drastic method of treatment, a doctor can also take tissue samples, for example from the uterus, to determine whether a tumour is present and whether it is benign or malignant. Laparoscopy is very popular not only in gynecology. Laparoscopy is also being used more and more frequently in general surgery.
In many cases, laparoscopy even belongs to the so-called gold standard, which means that laparoscopy is the first and best option. On the one hand, laparoscopy is used as an aid in making a diagnosis. For example, biopsies, i.e. tissue sections, can be taken to determine whether a tumor tumor is present.
Thus, laparoscopy is used for unclear findings, but it is also the method of choice for many operations. For example, laparoscopy has become the gold standard for appendectomy, the removal of the appendix appendix appendix. Laparoscopy is also the method of choice for the removal of the gall bladder (cholecystectomy), parts of the liver (partial liver resections) or parts of the intestine (e.g. iliocecal resection, sigmoid resection, rectal resection…).
In addition, adhesions can occur in various areas of the gastrointestinal tract (gastrointestinal tract, or GIT for short). This means that individual sections of the intestine stick together and thus make the passage of food through the intestine considerably more difficult or impossible. These adhesions can then be removed by laparoscopy, a procedure known in medicine as adhesiolysis.
The removal of the spleen (splenectomy) or the kidney (nephrectomy) can also be performed laparoscopically.In addition, so-called hernias, i.e. protrusions of intestine through the abdominal wall due to excess pressure from the abdominal cavity, are treated with the help of laparoscopy, whereby a net is inserted at the appropriate point so that the intestine can once again lie in the abdominal cavity and cannot protrude through the abdominal wall. There are two different techniques, TAAP (TransAbdominal PrePeritoneal) and TEP (Total ExtraPeritoneal). The stomach can also be removed laparoscopically, whereby often only parts of the stomach are removed and not the entire stomach.
Indications here are, for example, patients with food addiction who cannot reduce their weight without a partial removal of the stomach. Laparoscopy can also be used as a therapeutic option in cases of reflux disease. In addition, laparoscopy is used to sew over this area around an open (perforated) stomach ulcer (ulcer) in a patient with an open (perforated) stomach ulcer.
In addition to general surgery and gynecology, laparoscopy is also used in urology. Here, laparoscopy is used to remove the prostate, for example, as this can lead to major problems such as urinary incontinence, constant urge to urinate or even cancer, especially in older patients. As already mentioned, the kidneys are also removed by means of laparoscopy. In addition, the ureter, which leads from the kidneys into the bladder, can be straightened by means of laparoscopy in the event of any bottlenecks or unevenness, this procedure is called ureteroplasty. In general, laparoscopy is being used more and more often, as the optical results after the operation are usually much more appealing and the risk of infection as well as the time spent in hospital can be reduced.
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