Laparoscopy

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 Laparoscopy is a modern surgical method that allows diagnostics and surgical
interventions through small openings in the anterior abdominal wall.
 Advantages of Laparoscopic Surgery:

1. Insignificant blood loss

2. Small scar on abdomen
3. Short hospital stay (2-3 days)
4. Fast recovery after surgery
5. Less soreness
6. Modern laparoscopic equipment gives magnification up to 40 times, that is, the operation is
performed almost like under a microscope
7. The used optics allows you to look at the object of the operation from different angles (from
different sides), which gives a much greater viewing opportunity than in traditional operations.
 Disadvantages of Laparoscopic Surgery:
• 1.Limited range of motion in the operated area
• 2. Distorted perception of wound depth
• 3.The need to use tools to interact with the tissue, rather than working
directly with your hands
• 4. Laparoscopy is non-intuitive motor skills that are difficult to learn.
 Contraindications for laparoscopic operations:

Absolute contraindications:
1.Acute myocardial infarction
2.Acute disorders of cerebral circulation
3.Uncorrectable coagulopathy
Relative contraindications:
1. Intolerance to general anesthesia
2 diffuse peritonitis
3.Previously transferred operations in the area of ​the intervention object
4 tendency to bleed
5.Late pregnancy
6. Obesity 3-4 degrees
 Possible complications of
laparoscopy:

1) sedimentation during the imposition of

pneumoperitonium (emphysema, pneumomediastinum,
gas embolism, cardiovascular collapse)
2) damage to the abdominal organs with a needle or
trocar
3) injury of large vessels with the introduction of a
needle or trocar
 Classification of laparoscopy
Classification of therapeutic laparoscopy:
• conservative (these are non-invasive interventions
during laparoscopy - supply of drugs, adhesive
applications, tissue chipping);
• operative (this is a surgical intervention in violation of
the integrity of organs and tissues).
Classification of laparoscopy: G.I. Perminova (1983) according to the terms of
execution:
• planned;
• emergency;
• delayed (up to 3 days);
• preoperative;
• postoperative laparoscopy.
By research objectives:
• diagnostic;
• therapeutic;
• control.
 Technique for performing laparoscopy:

1. Creation of laparoscopic access: intra-umbilical incision, insertion of a Verisch

needle, creation of a pneumoperitonium, extraction of a Verisch needle, introduction of
the main trocar with a telescope and secondary trocars into the right and left iliac
regions with manipulators.
2. Visual inspection and assessment of the condition of the pelvic organs.
3. Execution of the main operational reception.
4. Removal of the macro-preparation from the abdominal cavity.
5. Lavage of the abdominal cavity with underwater control of hemostasis.
6. Removal of trocar sleeves under visual control of puncture sites.
7. Suturing the anterior abdominal wall.
 DIAGNOSTIC LAPAROSCOPY

INDICATIONS:
• Suspicion of malignant and benign tumors of the abdominal cavity and
retroperitoneal space, which cannot be excluded by other, less invasive research
methods.
• Staging of malignant tumors to determine the extent of the process.
• Differential diagnosis of liver diseases.
• Ascites of unknown etiology.
 Emergency laparoscopy:

• Acute and blunt abdominal trauma to diagnose the nature and extent of injuries.
• Suspicion of acute surgical pathology with an unclear clinical picture.
• Acute appendicitis
• Acute cholecystitis
• acute pancreatitis
• perforated ulcer of stomach and duodenum
• acute intestinal obstruction
• GIT bleeding into abdomen
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