Almost every person in his life faces the need for surgery for himself or a loved one. Knowledge in this matter will help to solve this problem without misunderstandings and disappointments. Of all types of surgeries, laparoscopic surgeries are by far the most popular and are performed more often than others. This article will be devoted specifically to laparoscopic surgeries.
Laparoscopic surgery is an operation performed through small 0.5-1.5 cm incisions. Instruments and video camera with illuminator are introduced into the cavity through these incisions, and the surgeon's hands are above the anterior abdominal wall. Everything that happens in the operating field is displayed on a monitor screen.
The term laparoscopy means laparo- abdominal cavity, scopy- inspection. With the development of surgical techniques, other types of operations have emerged: thoracoscopy - operations in the chest cavity, arthroscopy - operations in the joint cavity. Laparo-, thoraco-, arthroscopy, etc. are all separate types of endoscopic operations. Removal of the gallbladder, removal of part of the intestine, removal of the kidney, almost all types of gynecological operations - these are the operations that are now performed endoscopically in almost all surgical hospitals.
Over the past 35 years, laparoscopic gynecology has evolved from an extremely limited diagnostic procedure to a surgery in which most gynecologic surgeries are performed. By the way, for the first laparoscopic surgeries, patients had to be persuaded for a long time, as it was impossible to even imagine that the surgeon could perform operations without touching the organ and without seeing it in front of him. Subsequently, it was patients who appreciated these operations, and the growing popularity of endoscopic surgeries among patients contributed to the surge in the development of endoscopic equipment and the widespread use of these operations.
What are the reasons for this popularity? Below are the advantages of laparoscopic surgeries over open surgeries.
Blood loss and infectious complications in laparoscopic surgeries are much lower than in open surgeries.
Small incisions provide significantly less pronounced pain syndrome in the postoperative period, and therefore less need for pain medications.
Small incisions after wound healing are almost invisible, which provides a significant cosmetic effect, in contrast to the noticeable scars after open surgery (Photo 2, right)
The time spent in hospital and on sick leave is almost halved.
Psychological comfort experienced by patients during laparoscopic surgeries is much higher than during open surgeries. The factor of psychological comfort plays an essential role for rehabilitation in the postoperative period and further positively affects the social behavior of the patient.
However, there are also disadvantages, they mainly concern surgeons and clinic owners. From the patient's point of view, the operation seems simple. This impression is created because of the rapid recovery and minimal pain. But for the surgeon, endoscopic surgery is not a simple procedure, except for a number of small operations. First of all, the limited confined space creates technical difficulties, resulting in a loss of speed of movement. The second difficulty is that the surgeon sees the image on the screen in 2D, i.e. a planar image, which creates difficulties in calculating movements. To overcome this difficulty, the surgeon has to create a visual image of a volumetric object and calculate movements taking into account the imaginary volumetric space. This puts a lot of strain on the visual organs. Fortunately, 3D screens are now being produced. The surgeon performs the operation while wearing glasses similar to those that viewers wear in 3D movie theaters. This makes the work much easier and brings it closer to the real image. And another important disadvantage is the extremely high price of equipment and instruments, which have to be replaced regularly.
What complications are possible in laparoscopic surgeries? Laparoscopic surgeries have the same risks as open surgeries - vascular injury and bleeding, nerve damage, intestinal damage, bladder injury. In the postoperative period are possible, as well as in open surgeries, thrombosis, infection, adhesions. But there are specific, characteristic only for laparoscopic operations, complications. During the operation, bleeding is stopped mainly by electrocoagulation (electric burn). In this regard, due to technical errors, electric burn is possible. The next complication is related to the fact that gas is introduced into the abdominal cavity under certain pressure in order to increase the space and convenient access to the organs. In some cases, especially in obese or elderly patients, complications of the heart or lungs may occur. However, these complications are rare, and an experienced surgeon can always eliminate or prevent difficulties.
Tips for those who are going to have surgery.
Discuss the need for surgery in detail with your doctor and surgeon. It is important to be clear, firstly, why and for what purpose the operation is necessary, and secondly, that other options are impractical or have been exhausted.
Have a clear idea of the scope of the operation, i.e. what and where it will be removed, examined, dissected, etc.
Before the operation, you will be asked to sign a so-called "informed consent" - a form where you give your consent to the operation. Read all points carefully, if something is unclear, do not hesitate to ask or clarify. Some patients mistakenly believe that by signing the consent, they remove responsibility from the surgeon. This is a misconception. Informed consent shows mutual understanding and trust between the patient and the surgeon, it specifies the scope of the operation and your consent or disagreement to change it. In this case, the surgeon is liable according to the law.
When discharged from the hospital, the patient is given a so-called epicrisis (discharge sheet). It indicates the diagnosis with which the patient was in the hospital, the date and extent of the operation, the results of the examination, the treatment carried out. The last section - recommendations should be carefully read. It should include recommendations on the intake of painkillers and other drugs, terms of incapacity for work, the date of the follow-up visit, etc. This epicrisis should be kept. The information in it may be necessary and useful even 20-30 years from now.
In general, laparoscopic surgeries are safe and allow you to solve many health problems on a modern level. Science does not stand still and robot-assisted surgeries are on the way. However, this equipment is very expensive and cannot be afforded even by large clinics in Ukraine.