Laparoscopy is a medical device with a miniature camera, by the laparoscopic video surveillance system, CO2 pneumoperitoneum system, electric cutting system, irrigation - suction system, surgical instruments composed of endoscopes commonly used in medicine, can be used in two major areas of surgical treatment and medical examination.
Two, what are the clinical application fields of laparoscopy
1, surgery
(1) general surgery: cholecystectomy, hepatic cysts open window drainage, intestinal adhesion release, splenectomy, hernia repair, gastrointestinal tract surgery.
(2) Urology: renal cyst opening and drainage, adrenal tumor removal.
(3) Obstetrics and gynecology: ectopic pregnancy removal, uterine fibroids, total hysterectomy.
(4) Thoracic surgery: pulmonary alveolus resection, spontaneous hemopneumothorax hemostasis.
2. Diagnosis
(1) puncture biopsy under direct vision, cutting biopsy, ultrasound localization.
(2) Unexplained chronic abdominal pain.
(3) Characterization and staging of abdominal tumors.
(4) Differential diagnosis of liver disease and ascites.
(5) Lymphatic biopsy.
(6) Non-traumatic examination _ difficult to confirm the diagnosis when used.
Three, laparoscopic surgery how to do
Laparoscopic surgery is the use of laparoscopy and its related instruments for surgery, laparoscopic surgery process is:
1, artificial pneumoperitoneum
In the umbilical chakra lower edge of the incision of the skin 1cm, from the incision to 45 degrees inserted into the pneumoperitoneum needle, back to the bloodless and then connected to a syringe, if saline smoothly into the flow, that the puncture is successful! If the saline flows in smoothly, the puncture is successful, and the needle is in the abdominal cavity. Connect the CO2 insufflator, the speed of air intake does not exceed 1L/min, the total amount of 2-3L is appropriate. The intra-abdominal pressure should not exceed 2.13KPa (16mmHg).
2. Trocar puncture
Laparoscopy needs to be inserted into the abdominal cavity from the trocar, so the trocar needs to be punctured first. Laparoscopic trocar is thicker, the incision should be 1.5cm. lift the abdominal wall below the umbilicus, insert the trocar needle into the abdominal cavity slowly and obliquely, then vertically, there is a sense of breakthrough into the abdominal cavity, pull out the trocar core, hear the sound of gas rushing out of the abdominal cavity after inserting the laparoscope, turn on the light, adjust the patient's body position into a head-low-hip-height 15-degree position, and continue to inflate the gas slowly.
3. Laparoscopic observation
The operator holds the laparoscope and observes the uterus and ligaments, ovaries and fallopian tubes, and the rectal uterine pit. Observation assistant can move the uterus lifter, change the position of the uterus with the examination. If necessary, the suspicious lesions can be taken to send the tissue for pathological examination.
4, remove the laparoscope
Check that there is no internal bleeding and organ damage, before removing the laparoscope, discharging intra-abdominal gas after removing the trocars, suture the abdominal incision, covered with sterile gauze, adhesive tape fixed.
5. Post-laparoscopy treatment
(1) Give antibiotics to prevent infection.
(2) Although the abdominal incision has been ventilated before suturing, the abdominal cavity may still have residual gas and shoulder pain and epigastric discomfort, which are usually not serious and do not require special treatment.
Four, what are the advantages of laparoscopic surgery
1, laparoscopic surgery without opening the abdomen, abdominal wall trauma is small, because the incision is from the muscle gap into the abdominal cavity, did not destroy the muscle layer, so more than the postoperative pain, usually without pain treatment. The chances of postoperative incision bleeding, infection and cracking are very small.
2, internal trauma is slight, laparoscopic images can be magnified 8-10 times, so small blood vessels, nerves can be seen very clearly, not easy to accidentally injure, intraoperative bleeding is very small, there is almost no postoperative abdominal cavity seepage.
3. The hospitalization time after laparoscopic surgery is significantly shortened, usually 2-3 days after surgery, you can be discharged from the hospital, and you can return to normal life in 3-5 days.
4, laparoscopic surgery in the body for surgical operations, in a completely closed state of surgery, so the chance of causing abdominal infection than open surgery is much smaller, the postoperative antibiotic time is also shorter, and thus by the application of antibiotics caused by the side effects are also reduced.
5. The patient's gastrointestinal function recovers quickly after laparoscopic surgery. They can resume eating and get out of bed on the second day after surgery, which effectively reduces the amount and duration of postoperative fluid infusion. Prevention of postoperative intestinal adhesion, intestinal obstruction and lung infection, deep vein thrombosis, urinary retention and other complications.
6, laparoscopic surgery postoperative abdominal cosmetic effect is good. The size of the abdominal wall incision is usually 0.5-1.0cm and is decentralized with 2-4, and the healing scar is very small.
7, laparoscopic surgery through the electronic recording system will be the entire surgical process displayed on the TV screen, members of the surgery can be observed, and can be discussed at any time on the disease and surgical methods.
V. Frequently asked questions and answers about laparoscopic surgery
1. What is the effect of laparoscopic surgery on over-obese people with coagulation disorders? Can it be thorough?
Some patients have concerns that laparoscopic surgery is not as intuitive and reliable as open surgery. In fact, laparoscopic images are enlarged 5-7 times, and the surgeon operates under a magnifying glass, which makes the operation fine and the possibility of side injuries very low, and the resection of the lesions is thorough, and the safety and postoperative effects are higher than those of open surgery.
2. Can a patient who has been operated on before have laparoscopic surgery?
Previously said that the surgical site of the previous history of surgery, it is estimated that the abdominal cavity adhesion is heavier, is not suitable for laparoscopic surgery, but not absolutely, for example, some of the kidney and ureteral surgery open surgery mostly through the retroperitoneum, the abdominal cavity is not adhesion, such as the operation time of more than two years can be considered for laparoscopic surgery: in addition to the recurrent hernia laparoscopic treatment, due to a change in the surgical pathway, the open surgery of the laparoscopic operation has no any effect.
3, obese patients can do laparoscopic surgery?
Compared with open surgery, general obese patients are more suitable for laparoscopic surgery, because open surgery in obese patients is prone to incisional liquefaction, infection, incisional hernia and other complications, while laparoscopic surgery can avoid the above complications, except for the excessively obese patients, excessive obesity patients regardless of which surgical procedure is very difficult to operate.
4, a surgery can treat a variety of diseases?
Laparoscopy in the abdominal cavity to observe a large range of patients with general, obstetrics and gynecology diseases can be treated by laparoscopic surgery at the same time. For example, cholecystectomy with hernia repair, ovarian cyst removal, and so on.
5, laparoscopic surgery cost?
General laparoscopic surgery is 200-500 yuan more expensive than open surgery, but the total cost of hospitalization, the two are comparable, small and medium-sized laparoscopic surgery, because of the number of days of postoperative hospitalization, one or two days can be discharged, so the total cost of some lower; larger, more complex laparoscopic surgery, because of the operation of the use of special instruments, consumables increase the cost of the total cost of the operation is higher than the open surgery.
6, pediatric and elderly can do laparoscopic surgery?
Age is not a contraindication to laparoscopic surgery, pediatrics and the elderly can have laparoscopic surgery, we do cryptorchid release and fixation of two-year-old children, postoperative recovery is very good, two days after the hospital; the elderly cardiopulmonary function is not abnormal, laparoscopic surgery is safer than open surgery.