Laparoscopy is a kind of medical instrument with a micro-camera, which consists of laparoscopic video monitoring system, CO2 pneumoperitoneum system, electrotomy system, irrigation suction system and surgical instruments. It is a commonly used endoscope in medicine, which can be used for surgical treatment and medical examination.
2. What are the clinical application fields of laparoscopy?
1, surgery
(1) General surgery: cholecystectomy, fenestration and drainage of hepatic cyst, intestinal adhesion release, splenectomy, hernia repair, gastrointestinal surgery.
(2) Urology: fenestration of renal cyst and adrenalectomy.
(3) Obstetrics and Gynecology: ectopic pregnancy excision, hysteromyoma and total hysterectomy.
(4) Thoracic surgery: bullae resection and spontaneous hemopneumothorax hemostasis.
Step 2 diagnose
(1) Puncture biopsy, biopsy and ultrasound localization under direct vision.
(2) Chronic abdominal pain of unknown cause.
(3) Qualitative and staging of abdominal tumors.
(4) Differential diagnosis of liver disease and ascites.
(5) Lymphatic biopsy.
(6) Non-invasive examination is used when it is difficult to diagnose.
Third, how to do laparoscopic surgery?
Laparoscopic surgery is a surgery using laparoscopy and related instruments. The process of laparoscopic surgery is:
1, artificial pneumoperitoneum
Incise the skin at the lower edge of navel wheel 1cm, insert the pneumoperitoneum needle from the incision at 45 degrees, and connect the needle tube after blood drawing. If normal saline flows in smoothly, it means that the puncture is successful and the needle is in the abdominal cavity. Connect the CO2 inflator, and the intake speed shall not exceed 1L/min, and the total amount shall be 2-3L. The intra-abdominal pressure should not exceed 2.65438 0.3 kPa (65438 0.6 mm Hg).
2, trocar puncture
Laparoscopy needs to insert the cannula into abdominal cavity, so it needs to insert the cannula first. Laparoscopic intubation is thick, and the incision should be 1.5cm. Lift the abdominal wall under the umbilicus, then slowly insert the trocar into the abdominal cavity obliquely and vertically, and there is a sense of breakthrough when entering the abdominal cavity. Pull out the trocar core, insert it into the laparoscope after hearing the sound of gas rushing out of the abdominal cavity, turn on the light source, adjust the patient's position to the position with head down and hip height 15 degrees, and continue to inflate slowly.
3. Laparoscopic observation
The operator holds the laparoscope and observes the uterus, ligaments, ovaries, fallopian tubes and rectocele uterus with eyepiece. During observation, the assistant can move the uterine lifting device, change the position of the uterus and cooperate with the examination. If necessary, the suspected pathological tissue can be sent for pathological examination.
4. Take out the laparoscope
After checking that there is no internal bleeding and organ damage, the laparoscope can be taken out. After the gas in the abdominal cavity is exhausted, the cannula is pulled out, the abdominal incision is sutured, covered with sterile gauze and fixed with adhesive tape.
5. Post-treatment of laparoscopy
(1) Give antibiotics to prevent infection.
(2) Although air has been exhausted before abdominal incision suture, air may still remain in abdominal cavity, resulting in shoulder pain and epigastric discomfort, which is usually not serious and does not need special treatment.
What are the advantages of laparoscopic surgery?
1, laparoscopic surgery does not require laparotomy, and the abdominal wall trauma is small. Because the incision enters the abdominal cavity from the muscle space, it does not destroy the muscle layer, and there is no pain after operation, so there is generally no need for analgesic treatment. The chances of postoperative bleeding, infection and dehiscence are very small.
2. The internal injury is slight, the laparoscopic image can be enlarged by 8- 10 times, and the small blood vessels and nerves can be seen clearly, which is not easy to be accidentally injured. There was little bleeding during operation and almost no ascites after operation.
3. The hospitalization time after laparoscopic surgery was significantly shortened. Generally, you can leave the hospital in 2-3 days after operation and return to normal life in 3-5 days.
4. Laparoscopic surgery is performed in vivo, and the operation is performed in a completely closed state, so the probability of abdominal infection is much smaller than that of open surgery, and the time of using antibiotics after surgery is also short, so the side effects caused by using antibiotics are also reduced.
5. The gastrointestinal function of patients recovered quickly after laparoscopic surgery. Eating and getting out of bed can be resumed the next day after operation, which effectively reduces the amount and time of postoperative infusion. Prevention of postoperative complications such as intestinal adhesion, intestinal obstruction and lung infection, deep venous thrombosis and urinary retention.
6. The abdominal beauty effect after laparoscopic surgery is good. The size of abdominal incisions is generally 0.5- 1.0cm, and there are 2-4 scattered incisions. After healing, the scars are very small.
7. Laparoscopic surgery displays the whole process of surgery on the TV screen through the electronic video recording system, so that the surgical members can observe it at any time and discuss the disease and surgical methods at any time.
Five, common questions and answers of laparoscopic surgery
1. What is the effect of laparoscopic surgery on obese patients with coagulation dysfunction? Can it be thorough?
Some patients worry that laparoscopic surgery is not as intuitive and reliable as open surgery. Actually, it is not. The laparoscopic image is enlarged by 5-7 times. Doctors operate under a magnifying glass, and the possibility of collateral injury is very low. The lesion was completely removed, and the safety and postoperative effect were higher than those of open surgery.
2. Can a patient who has had a knife undergo laparoscopic surgery?
As mentioned above, the surgical site has a history of surgery, and it is estimated that those with severe abdominal adhesion are not suitable for laparoscopic surgery, but it is not absolute. For example, some open operations of kidney and ureter are mostly retroperitoneal, and the abdominal cavity is not adhered. If the operation time is more than two years, laparoscopic surgery can be considered. In addition, laparoscopic treatment of recurrent hernia has no effect on laparoscopic surgery because of the change of surgical approach.
3. Can obese patients have laparoscopic surgery?
Compared with open surgery, ordinary obese patients are more suitable for laparoscopic surgery, because open surgery for obese patients is prone to complications such as incision liquefaction, infection and incisional hernia. Laparoscopic surgery can avoid the above complications, except for obese patients, and it is difficult to operate in any way.
4. Can one operation treat multiple diseases?
Laparoscopy has a wide range of observation in abdominal cavity, and patients with general surgery and gynecological diseases can undergo laparoscopic surgery together. Such as: cholecystectomy and hernia repair, ovarian cyst resection, etc.
5. Is laparoscopic surgery expensive?
Generally, laparoscopic surgery is 200-500 yuan more expensive than open surgery, but the total hospitalization expenses are the same. Small and medium-sized laparoscopic surgery can be discharged in one or two days because of the short hospitalization days after operation, so the total cost is low; The cost of large and complicated laparoscopic surgery is higher than that of open surgery, because the cost of special instruments and consumables increases.
6. Can children and the elderly have laparoscopic surgery?
Age is not a taboo in laparoscopic surgery. Children and the elderly can have laparoscopic surgery. We performed cryptorchidism on a two-year-old child, who recovered well after the operation and was discharged two days later. For the elderly with normal cardiopulmonary function, laparoscopic surgery is safer than open surgery.