VERIFIED CONTENTAuthor: lek. Patryk Jasielski
Laparoscopy has dominated the way operations are performed in many areas of surgery. It is an excellent method of treatment, which in many aspects has advantages over traditional surgery. Its implementation requires appropriate technique and equipment. How is laparoscopy done? What are the contraindications for laparoscopy?
Most operations can be performed in two ways: by cutting through the skin with a scalpel and then using conventional surgical instruments, without the use of a camera. It is an open surgery or laparotomy. A newer way of performing surgery islaparoscopy . To perform it, you need specialized equipment. The basis is a laparoscope, i.e. a device that allows you to view the operating field. It consists of a telescope, a camera and a light source. Other essentials include the Veress Needle, a pneumothorax needle, and an insufflator to maintain the pneumothorax. Laparoscopy is performed with the use of trocars, i.e. instruments containing a tissue piercing tip, a channel through which surgical instruments are inserted, and a valve that prevents the gas from escaping into the abdomen. The individual stages of laparoscopic surgery are described below.
Preparation for surgery
Before performing the procedure, it is necessary to properly prepare the patient. If it is a planned operation, blood is taken for basic tests first, the blood type is determined (if necessary, a transfusion) and the body is properly hydrated.
Laparoscopy is performed under general anesthesia (the patient is unconscious during the procedure). Before the procedure, an anaesthesiological consultation takes place in order to obtain the necessary information and to calm the patient down.
All these procedures are for the best preparation so that laparoscopy can proceed without complications.
Contraindications for laparoscopy
Not all patients can be operated on with this technique. There are a number of contraindications, the most important of which are:
- no consent from the patient,
- severe obesity,
- diffuse peritonitis,
- decompensated cardiopulmonary failure,
- seriouscoagulation disorders,
- extensive surgery in the digestive system due to cancer in the past,
- hemorrhagic shock,
- intestinal distension.
It should also be remembered that not all organs can be operated laparoscopically. Examples include cardiac surgery on the heart, such as bypasses. Having a complete set of tests and excluding contraindications, the patient may undergo laparoscopy. He is first anesthetized in the operating room.
Insertion of the Veress needle and production of a pneumothorax
When the patient is unconscious, first insert the Veress needle through the skin and create a pneumothorax. It is usually introduced through the navel, because it is a relatively safe place, it is difficult to damage any organ or arteries here. The skin in the navel is incised about 10 mm long and the needle inserted.
Then it is checked if the needle is really in the peritoneum - the liquid in the syringe attached to the needle should fall down. When the correct position of the needle is confirmed, a pneumothorax is generated in the next stage. It is a kind of "air space" inside the abdominal cavity.
It separates the digestive system organs from the abdominal wall. This enables tools to be manipulated safely and operations performed. Pneumothorax is produced by pumping carbon dioxide through a Veress needle. The correct pressure is maintained by a constant supply of gas from the insufflator.
Introduction of trocars and operational tools
In the next stage, when the pneumothorax is already formed, the surgical equipment is inserted into the abdominal cavity. It starts with the main trocar, placed in the navel, through which the endoscopic camera and all optics are inserted. Next, the inside of the abdominal cavity is assessed using a camera, the image of which is visible on the monitor.
This is the so-called "Surgical examination" aimed at additional checking of the general condition of the abdominal organs. In the next stage, three additional trocars are placed through which the appropriate surgical instruments are inserted.
Two are placed on the sides, after cutting the skin about 5 mm. One, central one, is located below the navel, after the skin has been incised by 10 mm. Depending on the type of surgery, the number and arrangement of trocars may be different to ensure the best access to the operated organ.
When the operational field is properly prepared, operational tools are used in the next stage. These are various types of devices for grasping, cutting and sewing.
Complete operation
When the operation is done, thenthe operating tools are pulled out and the trocars are removed. The inside of the abdomen is re-examined for bleeding. If everything is fine, the holes formed by the trocars are sewn up.
In one of them a drain is left, i.e. a tube through which the fluid is evacuated after the surgery. It is usually removed after a few days. Laparoscopy wounds are small and heal quickly. They are covered with dressings.
Laparoscopy: keep it safe
Excision of an organ or its fragment is the first stage of the operation. Another is to remove it from the abdominal cavity. In the case of laparoscopic gynecological surgeries or suspected cancer, the excised organ, e.g. the ovary, is placed in a special bag before being taken out. This is a very important moment in the operation. The point is to prevent cancer cells in the ovary from spreading to other organs or the skin. In times when pouches were not used, there were cases of implanting cancer cells into muscles or skin adjacent to trocars. Similarly dangerous situations for the patient happened when colon cancer was started laparoscopically. Today, the diseased part of the intestine is first inserted into the sac and then taken out through an additional skin incision in the groin area. The body around the incision is covered with a special sleeve that prevents contact with cancer cells.