Laparoscopic surgery

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Diagnostic and surgical laparoscopy

Definition of laparoscopic operation

It is a short and simple surgery performed in the abdomen or pelvis and is used either to examine and diagnose a condition or to perform operations through 3-4 small abdominal wounds through which the endoscope is inserted

Often the causes are discovered and treated at the same time where the therapist can see the organ and the pathology such as the uterus, ovaries and tubes in gynecology

 

Advantages of laparoscopy for surgical procedures

  • Laparoscopic operations are distinguished from traditional surgery by
  • Opening the abdominal wall by 3-4 small opening, each about 1 cm, so it is better cosmetically
  • Postoperative pain is much less
  • Less blood loss
  • The duration of stay in the hospital does not exceed 48 hours
  • Ability to return to normal activities faster after the operation.

 

Location and anesthesia

The operation is performed in the operating room under general anesthesia

 

Steps of the procedure

In the case of a diagnostic laparoscopy

  • It is done through a small hole approximately one cm on the skin above or below the navel
  • The patient lies down on her back in the head done position, until the intestines are removed from the field of entry of the endoscope into the abdominal cavity.
  • The abdomen is inflated by pumping carbon dioxide to a certain degree to create an intra-abdominal space for viewing and for surgical intervention
  • The endoscope camera is then inserted and the abdominal cavity and pelvis are seen from the inside through what the camera transmits on a television screen that can be monitored with the naked eye.
  • The doctor can make a second and possibly a third wound on one side of the lower abdomen and then insert a tube so that the doctor can insert surgical instruments to be able to move the internal organs more broadly and examine it more precisely
  • After the laparoscope is completed, all laparoscopic instruments are pulled and then small surgical sutures are used to close the openings from which the laparoscope was inserted, leaving small wounds of approximately 1 cm length ranging from one wound as in a diagnostic laparoscope, to 3 or 4 wounds in the surgical laparoscope, according to the number of instruments used according to the difficulty of the operation.

 

In case of surgical laparoscopy

  • The same as steps as the diagnostic laparoscopy but the doctor can make a second and possibly a third wound on one side or both sides of the lower abdomen and then the doctor can insert surgical instruments through the tubes to be able to perform the surgical procedure

 

Indications for diagnostic laparoscopy in the field of gynecology, obstetrics and infertility

Diagnosis of pelvic infections such as inflammation of the fallopian tubes, where the cause of the pain is unknown.

Diagnosis of adhesions between internal organs in the abdominal cavity and pelvis in cases of infertility:

  • Adhesions are usually caused by previous abdominal operations or inflammation of the pelvic organs that lead to obstruction of the fallopian tubes or severe pain with the cycle.

Examination of fallopian tubes in cases of infertility

  • The physician examines the fallopian tubes by injecting sterile blue fluid through the vagina and cervix. If the fallopian tubes are intact, the fluid appears in the abdominal cavity and if they are closed, the doctor may inject an additional amount. So the strong dye infusion can remove the blockage.
  • Very important note: tubal block can be diagnosed through hysterosalpingography (HSG) and the strong dye infusion can remove the simple blockage (such as the presence of mucous plug inside the tubes)

Diagnosis of endometriosis

  • Endometriosis can only be seen with the naked eye, either through surgery in which the abdominal cavity is opened and internal organs are examined the spots of endometriosis or through a laparoscope.
  • Endometriosis is the appearance of endometrial tissue in areas outside the uterus, inside the pelvis and abdomen, such as the ovaries, intestines and rectal urinary bladder and on the outside of the uterine wall.
  • The disease is often coincided with ovarian cysts that contain an old coagulated blood called the chocolate cyst, which also causes adhesions.

Diagnosis of the cause of internal hemorrhage

  • Detection of the cause of the accumulation of blood in the abdominal cavity through the sonar and does not know the source. .

Confirmation of ectopic pregnancy

 

Indications of surgical laparoscope in the field of gynecology, obstetrics and infertility

Treatment of cysts or tumors in the ovary

  • Ovarian enlargement, which may be caused by a cavity filled with an opaque fluid (non-functional cyst) or tumor and through the laparoscope can see the difference between the two cases and it is possible to take sample to see if the tumor is malignant or benign and can be removed with laparoscope, but this requires a high skill because keeping a small part of it may require more surgery.

Myomectomy

  • Myomas are benign tumors that arise in the muscle of the uterine wall and occur in 20% or more of women over the age of “35” years and accompanied by abdominal and pelvic pain and increased menstrual flow
  • In pregnant women, fibroids may lead to complications in pregnancy such as premature birth depending on the size of the fibroid

Removal of adhesions between internal organs in the abdominal cavity and pelvis in cases of infertility

  • Adhesions are usually caused by previous abdominal operations or inflammation of the pelvic organs and through the laparoscopic process.

Treatment of cases of PCOS that is not responsive to hormone therapy

  • It is a medical condition experienced by a woman in about five women, which is an hormonal imbalance and is diagnosed by the doctor through the ultrasound and hormonal analysis and can be treated with medications
  • When the ovary is very large due to multiple large cysts, a laparoscopic drilling may be needed by making small openings (holes) in the ovary either by diathermy, to empty these small cysts to increase the response of the ovary to drugs that stimulate ovulation.

Treatment of endometriosis

  • endometriosis can be treated through surgical intervention or through a surgical laparoscope by cauterization of the endometriosis spots

Rapid intervention for internal bleeding:

  • After detecting the cause of blood accumulation in the abdominal cavity and its source through the diagnostic laparotomy, it is treated through a surgical laparoscope such as in ectopic pregnancy in the fallopian tube

Ligation of the fallopian tubes

The fallopian tubes can be closed by means of a laparoscope by means of a loop or by electric cauterization:

  • As a means of contraception, and this prevents the arrival of sperm and fertilize the eggs and thus prevent pregnancy.
  • To close the tube in cases of infiltration inside the tube before the ICSI to prevent the entrance of this liquid into the uterus after embryos transfere, which may affect the embryos and lead to the failure of ICSI

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Dr. Mohamed Sehsaah

Dr. Mohamed Sehsaah is an Egyptian doctor who grew up in the united Arab Emirates (UAE) and then he obtained the medical degree from Egypt.
He obtained the master’s degree in obstetrics and gynecology from Ain- Shams University in Cairo, with a special study and research in the field of recurrent miscarriage, to become a specialist in obstetrics and gynecology.

He joined the Royal College in the UK and passed the first part of the British Fellowship (MRCOG)