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LaparoscopyLaparoscopy is a surgical technique that allows to see inside the abdomen to establish a diagnosis and is also used to perform an operation. This small incisuras are made in the abdominal wall, and through them, put cameras, clips, knives and other very small devices that allow you to manipulate the internal viscera without having to open the abdomen. Laparoscopy is considered a technique of minimally invasive surgery, arthroscopy, and eRCP, neuroendoscopy, among others. Despite this, it remains a surgical operation, so it should be in an aseptic surgery and general anesthesia.
The first laparoscopic were practised by Dr Heinz Kalk in the first half of the 20th century. This surgeon published more than 2,000 studies of diagnostic laparoscopies with very good results. Gradually more techniques were done through laparoscopy, such as biopsy or minimal interventions, until in 1977 in Holland the first extraction of Appendix by laparoscopy. Almost at the same time, the Argentine Dr Aldo Kleiman performs extractions of the gallbladder (cholecystectomy) by laparoscopy, but do not find any support in his native country, where to reject it. In Spain, the first laparoscopic cholecystectomy was performed in 1990 at the San Carlos Hospital in Madrid by the Dra Vincent, and soon spread to the rest of public hospitals. A year later, in 1991, American doctors Jacobs and Plasencia published the first operations in the world of colon cancer by laparoscopy.
Minimally invasive techniques such as laparoscopy have allowed that postoperative patients is shorter and less painful, so you do not need to take so many pills for pain and hospitals saves costs to be the shorter hospital stay. They also reduced the number of infections in the postoperative period.
When a laparoscopy is doneLaparoscopy, as we have explained, can be done to establish a diagnosis, or as surgical treatment of a disease. Why are distinguished several types of laparoscopic, carried out as it is indicated in each case:
Exploratory or diagnostic laparoscopyServes to directly observe the abdominal viscera, such as the small intestine, the large intestine, stomach, etc. In this type of laparoscopic is does not operate anything, and they are only used in order to determine a diagnosis then used to indicate treatment. Usually when do Imaging tests (CT, ultrasound...) have not been useful or not they have been able to perform, or also when it is necessary to take biopsies of digestive or gynecological tumors. Some of the diseases where it is more frequent that otherwise a diagnostic laparoscopy are:
- Pictures of acute abdominal pain without a clear cause.
- Adhesions and bowel flanges.
- Spills and intestinal infarction.
- Hidden hernias and eventrations.
- Pelvic inflammatory disease, endometriosis, ectopic pregnancy, and other gynecological conditions that can be mistaken for appendicitis.
Surgical laparoscopyThis is laparoscopy that has developed in recent years, and increasingly complicated surgical operations can be performed with it. Diseases that can be treated through laparoscopic techniques most frequently are:
- Hiatal hernia.
- Cholelithiasis, cholecystitis and other diseases of the gallbladder.
- Intestinal obstructions.
- Hernias and eventrations in the abdominal wall.
- Acute appendicitis.
- Acute abdomen.
- Tumors of the colon and rectum, both benign and malignant.
- Multitude of gynecological diseases: endometriosis, ovarian cysts, tubal ligation, pregnancy ectopic, urinary incontinence, uterine and bladder prolapse, fibroids, uterus extractions, etc.
Experimental laparoscopyIt is named to the laparoscopic in which surgical techniques are practiced for the first time to check if it is possible in the future. First, they are made in animals, such as pork, and later in very selected people. One of the techniques that is being investigated in recent years is the surgery NOTES, a laparoscopic technique through natural orifices such as the navel or the vagina.
Laparoscopy is doneTo perform a laparoscopy, first you anestesiarán so that you don't feel any pain throughout the procedure. Anesthesia tends to be general, so you'll be unconscious; in few cases it is performed with local anesthesia. Then be disinfected all of the abdominal wall and be covered with a surgical sheet which limited the area of the abdomen that operates.
The surgeon will make three incisuras in the abdominal wall that will introduce camera, gas, and other instruments such as tweezers or scalpels. The camera allows you to see the inside of the abdomen (controls it a second surgeon) and the gas which is introduced for the abdomen bulge is carbon dioxide because it is not flammable when the electrical scalpel is used, and it can be easily removed. Each incision must be well separated from the other two so that the instruments do not strike each other to move inside the abdomen.
The instruments used in laparoscopy are very varied: tweezers, scalpel, punches, sutures, etc. With them, the surgeon manipulates the inside of the abdomen and seeks to solve the problem. Throughout the procedure is recorded on video so the doctor can get back to see her, and also so that others can learn. If we had to remove a piece from the inside of the abdomen can be put in plastic bags, which are then removed through one major incisura.
When the intervention is finished all the instruments are removed and the incisions are closed with simple points, which are covered with bandages or dressings.
Preparation for laparoscopyIf they are going to perform a laparoscopy, these are issues that you must consider when ready to test:
Duration: laparoscopy has a variable duration according to the surgical technique that is going to be done. It can take from a few hours (resections of Appendix, repair hernias, etc.), up to a whole morning or afternoon (solve intestinal obstructions or resection of tumors).
Entry: laparoscopy usually requires hospital admission the night before the operation. Later, the postoperative period can be extended about three or four days, but if all goes well it will not arrive a week as a general rule. If laparoscopy has only been exploratory you can receive discharge within 24 hours.
Is necessary to be accompanied?: Yes, is recommended. After the laparoscopy must not make efforts, and you may need help to go to the bathroom or merge. When you receive the high it is not recommended that you drive any vehicle, especially if the laparoscopy done before 24 hours approximately.
Drugs: is not necessary to take any prior medication. Must be communicated to the doctor all the medicines taken regularly, and will decide which suspend or maintain. You should avoid taking medications that hamper the clotting of blood two weeks prior to laparoscopy, such as aspirin, ibuprofen and other NSAIDs.
Food: must remain in fasting from the eight hours before the laparoscopy. If you need to take any medication, take the pills with a small SIP of water.
Clothing: once the street clothes enters hospital is changed by a gown more comfortable and suitable for the operating room. Clothing is recommended for sleep and comfortable footwear for the entry.
Documents: is advisable to take the medical history about the disease is going to intervene, although the doctor will already have it. Before you undergo the intervention you will sign the informed consent, which you agree to make yourself the technique and you will know the potential risks.
Contraindications: main contraindication is having an once in a lifetime to abdominal surgery, laparoscopy or not, because when the abdomen is always operated internal viscera rozan and form ties between them, i.e. fibrous scars that unite the intestines and other internal organs together making it difficult to separate them, which complicates their manipulation in laparoscopy. Another contraindication would be urgent situations in which there is no time to prepare a laparoscopy.
Pregnancy and lactation: laparoscopy should be limited to the second trimester of pregnancy when necessary; in very urgent situations can be at any time, although the risk of pregnancy is higher. There is nothing that contraindicated laparoscopy during lactation, although the postoperative period and the hospital admission may hinder breastfeeding schedule.
Complications of laparoscopyLaparoscopy is a safe and widely used technique today, but it is not without risk, as with any surgical operation. The complications which arise most frequently are:
Bleeding from the cuts by poor healing.
Hernias or eventrations through the incisions.
In the postoperative surgical wound infections; take antibiotics before operation prevents them to a large extent. In extreme situations infection can be on the inside of the abdomen and cause a peritonitis.
Injury during operation of arteries, veins, intestines, stomach, ureters or other abdominal viscera. This complication requires to open the abdomen immediately via laparotomy.
Problems caused by general anaesthesia, as happens in other procedures.
Results of laparoscopyLaparoscopy results tend to be very good, since the recovery of such interventions is much more rapid, painless and grateful that when operating the abdomen by opening it with a wide incision directly.
When you wake up from the anesthesia you're drowsy, and you can have nausea. A few hours stop feel as well and you can recover your normal life in a few days. It is also likely that abdominal incisions painful, especially to make efforts such as coughing, so it is advisable to take the painkillers the doctor you.
It is usual that the abdomen is slightly distended because some gas is always inside after the laparoscopy. You can put pressure on the bladder, thus increasing urination, and you can also press to the liver or diaphragm, causing pain in the shoulders. If the intestines have operated is often recommended fasting for a variable time until they return to work properly.
In case of a diagnostic laparoscopy doctor can communicate its outcome shortly after completing it, unless you have to wait for the analysis of biological samples such as biopsies.
A few days of the intervention you cite in the hospital or the clinic to check abdominal incisions to heal properly.