Diagnostic laparoscopy is a modern diagnostic method that is considered one of the most informative and reliable. As a rule, laparoscopy is performed on the abdominal and pelvic organs, which is reflected in the very name of the procedure: the term “laparoscopy” is derived from the Greek words “womb” and “watch”. Synonyms of the term "laparoscopy" are "peritoneoscopy" and "ventroscopy". This procedure involves examining the internal organs through small openings using a special instrument, the laparoscope.
Laparoscopic diagnosis is carried out in the event that other types of examinations were not sufficiently informative.
Before the advent of laparoscopy, the only way to examine the organs of the abdominal cavity was laparotomy. In other words, the patient cut the abdomen and after this incision was performed inspection and surgery. 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 patients recovered very slowly.
For the first time, diagnostic laparoscopy was talked about in the early twentieth century, but the technique remained practically in its “embryonic” state until the 1960s.
The pioneer of laparoscopy is the Russian obstetrician-gynecologist Dr. Ott. It was he who in 1901 conducted the first endoscopic examination of the abdominal cavity of a patient using a frontal reflector, an electric lamp and a mirror. He called his method ventroscopy. In the same year, in Germany, Professor Kelling was the first to carry out an endoscopic examination of the abdominal organs in animals.
During the 1920s and 1930s, a large number of publications on endoscopic research appeared. Their authors were scientists from Switzerland, Denmark, Sweden and the United States. They extol laparoscopy as a highly effective method for the diagnosis of liver disease. In the same period, the first, still extremely imperfect, laparoscopes appear. In the 1940s, the design of the apparatus for laparoscopy improved, there are laparoscopes, equipped with devices for biopsy. In the same period, laparoscopy begins 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
To date, 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 then carry out a radical surgical intervention 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. For tumors of the abdominal cavity, during a diagnostic laparoscopy, the doctor has the opportunity to carefully examine the formation and conduct a biopsy. For patients suffering from liver diseases, laparoscopy is one of the safest methods for obtaining a piece of organ tissue for the study. In addition, diagnostic laparoscopy is used in gynecology for a more complete diagnosis of patients suffering from infertility, endometriosis, uterine myoma, and cystic formations in the ovaries. Finally, the doctor may recommend a diagnosis for an incomprehensible etiology of abdominal and pelvic pain.
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 forbidden for hemorrhagic shock caused by severe blood loss, and in the presence of adhesions in the abdominal cavity. Also, the reason for refusal of the procedure is hepatic and renal failure, an acute form of cardiovascular disease, and lung disease. Laparoscopy is contraindicated in cases of severe bloating and intestinal colic, as well as in ovarian cancer.
Allergic to several types of drugs, the presence of fibroids of large sizes, gestation period exceeding sixteen weeks, diffuse peritonitis are considered as relative contraindications for diagnosis. The procedure is not recommended if the patient suffered from acute respiratory viral infections or colds less than four weeks ago.
Compared with laparotomy, laparoscopy has a huge number of advantages:
- First of all, this method is minimally invasive. In other words, the operational impact is very gentle, the risk of infection is minimal, there is practically no blood loss. In addition, since the peritoneum is not damaged, adhesions will not form after the procedure. Pain syndrome is also minimal, since during abdominal operations, the source of the main discomfort is the stitches imposed on the incision. Cosmetic effect is also important - after laparoscopy, unaesthetic scars are not formed, which are the result of a laparotomy.
- In addition, after laparoscopy, the patient recovers faster. Due to the fact that there is no need to observe strict bed rest, the risk of blood clots 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 optimal method of therapy. Due to the removal of repeatedly enlarged images of internal organs on the screen, the doctor gets the opportunity to study the tissue 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 to avoid complications.
In addition, with insufficient qualifications of the doctor who performs the diagnosis, there is a risk of injury to the organs when inserting instruments. Due to the fact that the doctor acts with instruments "remotely", he sometimes cannot adequately assess the force applied to the tissues. Tactile sensations are reduced, which can complicate the diagnosis, if the doctor still lacks experience.
Diagnostic laparoscopy in gynecology
Diagnostic laparoscopy is widely used in gynecology. During the procedure, the doctor may conduct a detailed examination of the internal genital organs of the woman: the ovaries, uterus and fallopian tubes.
Gynecological laparoscopy is performed either under general anesthesia or under local anesthesia combined with sedation. The method of its implementation is almost the same as with conventional laparoscopy. A cannula is introduced into the abdominal cavity, through which the gas enters, as a result of which the abdominal wall is raised by the dome. Next, a small incision is made through which the trocar is inserted. The latter is used for insertion into the abdominal cavity of a tube equipped with a video camera lens and a light bulb. The image of the pelvic organs is displayed on the monitor, and the course of diagnostic laparoscopy is recorded on the information carrier.
In gynecology, diagnostic laparoscopy is indicated when it is impossible to identify the cause of diseases of the reproductive system using ultrasound and x-ray methods. In particular, diagnostic laparoscopy can be used in gynecology to identify the cause of pain, to clarify the nature of tumor formation in the pelvis, to confirm previously diagnosed edometriosis and inflammatory diseases. Also, this procedure helps to check the fallopian tubes and identify the cause of their obstruction.
Preparing for the diagnosis
In order for the procedure of diagnostic laparoscopy to take place without complications and to be as informative as possible, it is necessary to carry out a number of examinations in advance and comply with the recommendations of physicians.
Preparation for routine diagnostic laparoscopy is recommended to begin about a month before the procedure. During this period, the patient must undergo the most thorough examination, including a complete history, as well as laboratory diagnostics and consultations of narrow specialists. Doctors should find out what diseases the patient had previously suffered, whether he had serious injuries, or whether he had undergone surgery. It is imperative to check the presence of an allergic reaction to drugs.
To find out whether the patient suffers from diseases that can be considered as contraindications for diagnosis, you must visit a cardiologist, a general practitioner and a gynecologist and other specialists. Ultrasound, fluorography and standard blood tests, as well as coagulogram, HIV, hepatitis and syphilis are also performed. Determined blood type and Rh factor in case of complications.
Despite the fact that this surgical procedure is considered relatively safe, patients should be informed about all 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 eliminate spicy and fried foods, smoked meats, as well as dishes that stimulate gas formation from the menu. Two to three days before laparoscopic examination, it is necessary to reduce the amount of ingested food, and within a day - to reduce it to a minimum.
Dinner on the eve of the procedure should be very light. Usually, doctors recommend an evening cleansing enema.
Diagnostic laparoscopy is performed exclusively on an empty stomach. Immediately before surgery, an anesthesiologist is consulted.
Methods of diagnostic laparoscopy
As noted above, laparoscopic diagnosis is most often performed under general anesthesia. It begins with the fact that an abdominal puncture is performed, after which heated carbon dioxide is injected 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, in certain points of the abdomen, small incisions are made into which a laparoscope is inserted - a tool with which the organs are examined and all the manipulations are monitored. The laparoscope is equipped with a high-resolution video camera that displays the image on the screen.
If necessary, a few more punctures are made on the anterior abdominal wall, through which various manipulators are inserted, allowing, for example, to perform a biopsy or dissect adhesions. After the introduction of a laparoscope, the doctor begins to examine the upper abdominal cavity, evaluates the condition of the organs.
After the operation is completed, the instruments are removed, the gas is removed from the abdominal cavity, and small incisions are treated with an antiseptic and stitched.
Regimen after diagnostic laparoscopy
Since diagnostic laparoscopy is a low-impact diagnostic method, and damage to the muscles and tissues of the body is minimal, patients recover much more easily. As a rule, a day after the procedure, you can be discharged from the hospital and return to normal life with minor restrictions.
Within a few hours after the manipulation, patients are allowed to walk. Moreover, walking is even more welcome, since physical activity allows us to avoid adhesions and the occurrence of blood clots.
However, one should not be especially zealous - it is better to start with walks for a short distance, gradually increasing the load and pace.
There is also no need to follow a strict diet after diagnostic laparoscopy. The doctor may recommend temporarily eliminating gas formation products from the diet: black bread, legumes, raw vegetables, milk.
To eliminate discomfort in the area of punctures, conventional painkillers can be prescribed.