Laparoscopic surgery is a newly developed minimally invasive method and an inevitable trend in the development of surgical methods in the future. With the rapid advancement of industrial manufacturing technology, the integration of related disciplines has laid a firm foundation for the development of new technologies and new methods. In addition, doctors have become more and more skilled in operations. Many past open operations have been replaced by intracavitary operations. Increased surgical options. The traditional method of retroperitoneal laparoscopic surgery is to make three small 1-cm incisions on the waist of the patient, and insert a pipe-like working channel called "trocar" into each, and all subsequent operations will be performed through these three pipes; and then special lengthened surgical instruments are used. Complete the same steps as open surgery under television monitoring to achieve the same surgical effect.
The advantages of two-hole retroperitoneal laparoscopic surgery are very obvious. First of all, the trauma is very small, only two small openings are required, and the scar is small. This is more noteworthy for young people and women who love beauty. Second, the operation is a straight entry, which minimizes the damage to the surrounding tissues and reduces the chance of adhesions after the operation. Third, the postoperative wound pain of the patient was significantly reduced. Fourth, the number of days of hospitalization is relatively small, and some can be discharged within 2-3 days, and can be fully recovered and put into work within 7 days, which greatly reduces the burden on patients and speeds up the turnover rate of hospital beds.
Two-hole retroperitoneal laparoscopic and laparoscopic urological surgery can be used in the following urological treatments, such as renal cyst resection, cryptorchidectomy, and high spermatic vein ligation.
Compared with traditional surgery, laparoscopic surgery is very popular with patients, especially after the scar is small and meets the aesthetic requirements, young patients are more willing to accept it. Minimally invasive surgery is the general trend and pursuit of surgical development. The gold standard of laparoscopic surgery is cholecystectomy. Generally speaking, most general surgery operations can be completed by laparoscopic surgery. Such as appendectomy, gastric and duodenal ulcer perforation repair, hernia repair, colectomy, splenectomy, adrenalectomy, as well as ovarian cyst removal, ectopic pregnancy, hysterectomy, etc., along with laparoscopic techniques With increasing perfection and improvement of laparoscopic surgeons, almost all surgical operations can use this kind of operation.
Surgical procedure
What exactly is laparoscopy? According to experts, it is a device with a miniature camera. Laparoscopic surgery is an operation that uses a laparoscope and its related equipment: cold light source is used to provide illumination, a laparoscope lens (3-10mm in diameter) is inserted into the abdominal cavity, and digital camera technology is used to make the image captured by the laparoscope lens pass through the light guide The fiber is transmitted to the downstream signal processing system and displayed on the dedicated monitor in real time. Then the doctor analyzes and judges the patient's condition through the images of the patient's organs from different angles displayed on the monitor screen, and uses special laparoscopic instruments to perform the operation. Laparoscopic surgery mostly uses 2-4 hole operation methods, one of which is opened on the human belly button to avoid leaving long strips of scars on the abdominal cavity of the patient. After recovery, only 1-3 0.5- holes are left in the abdominal cavity. A linear scar of 1 cm can be said to be a small wound and less painful operation, so some people call it a "keyhole" operation. The development of laparoscopic surgery has alleviated the pain of patients undergoing surgery, shortened the patient's recovery period, and relatively reduced the patient's expenditure. It is a surgical project that has developed rapidly in recent years.
The so-called laparoscopic surgery is to make several small incisions with a diameter of 5-12 mm in different parts of the abdomen. Through these small incisions, a camera lens and various special surgical instruments are inserted. The image of the organ is transmitted to the TV screen, and the surgeon completes the operation by observing the image and performing operations outside the body with various surgical instruments.
1. Surgery trauma is small;
2. The patient recovers quickly after surgery;
3. Short hospital stay;
4. The patient has mild postoperative pain;
5. Abdominal incision scar is small and beautiful;
6 The therapeutic effect is the same as that of open surgery.
Features and advantages
Laparoscopy is an endoscope used for intra-abdominal examination and treatment. It is essentially a fiber light source endoscope, including laparoscope, energy system, light source system, perfusion system and imaging system. It can be used in surgical patients under completely painless conditions. It can directly and clearly observe the patient's intra-abdominal conditions, understand the pathogenic factors, and perform surgical treatment on abnormal conditions. Laparoscopic surgery is also called "keyhole" surgery. Using the laparoscopic system technology, the doctor only needs to open a few "keyhole"-like small holes around the patient's surgical site. The patient can be visualized in front of the computer screen without opening the abdomen, and perform precise surgical operations. The surgical process is only It will take a short time for the treatment technology to reach the international advanced level.
The new type of laparoscopic surgery is an operation performed by modern high-tech medical technology using advanced equipment principles such as electronics and optics. It is a trans-epochal advancement of traditional laparotomy. It is an operation performed in a closed abdominal cavity: the camera system is in good condition. Under the illumination of the light source, through the laparoscopic body connected to the abdominal cavity, the organs in the abdominal cavity are photographed on the monitoring screen. Under the supervision and guidance of the high-tech display screen, the surgeon manipulates surgical instruments outside the abdominal cavity to explore the diseased tissue , Electrocoagulation, hemostasis, tissue separation and incision, suture and other operations. It is a model for the application of high-tech technologies such as electronics, optics, and videography in clinical operations. It has the characteristics of less trauma, less complications, safety, and fast recovery. Surgical endoscopic surgery has developed rapidly and can be examined and treated at the same time. Advanced and cutting-edge minimally invasive technology. The role in the treatment of surgical diseases has attracted more and more attention. And it is developing rapidly in the international arena.
Scope of use
Laparoscopic technology is most suitable for the treatment of certain benign diseases and early tumors, such as fenestration of liver cysts, resection of colorectal tumors, esophageal hiatus hernia repair, gastric folding, external abdominal hernia repair, gastric leiomyoma resection, gastrointestinal cancer, gastrointestinal cancer Perforation repair and the release of adhesive intestinal obstruction have unique therapeutic effects. In addition, minimally invasive treatment can be performed for diseases such as thyroid, breast, varicose veins of the lower extremities, and splenectomy caused by various causes of hypersplenism, and the effect is significant.
Features
1. Multi-angle "inspection", the effect is intuitive
Laparoscopy can inspect from different angles and directions without affecting the abdominal organs, and even see some deep positions, to achieve the effect of visual inspection, no missed diagnosis, no misdiagnosis.
2. Fast recovery
Laparoscopic surgery is performed in a closed pelvis and abdominal cavity. The internal environment is minimally disturbed. The trauma suffered by the patient is much less than that of open surgery. The patient will recover quickly after the operation without complications and sequelae.
3. Short hospital stay
The operation is performed by a professional doctor, and the treatment can be completed in a short time, without affecting normal physiological functions, and normal life and work can be restored after the operation.
Fourth, the beauty of the abdomen is good
Traditional surgical scars are long linear, which affects the appearance, and endoscopic surgery does not leave scars, which is especially suitable for women's cosmetic needs.
Five, less pelvic adhesions
Minimally invasive technology, no surgery, little interference to the pelvic cavity, no gauze and hand-to-tissue contact, little or no stitches. The pelvic cavity is fully flushed during the operation, so the pelvic adhesions in patients after laparoscopic surgery are far less than open surgery.
advantage
Compared with traditional surgery, laparoscopic surgery has the following advantages:
1. Laparoscopic surgery has little disturbance to the abdominal internal organs and avoids the stimulation and pollution of the abdominal cavity by the air and dust bacteria in the air. In the operation, the main operation is electrocutting and coagulation. The blood vessels are first coagulated and then broken, hemostasis is thorough, and there is very little bleeding. Rinse thoroughly before the end of the operation to keep the abdominal cavity clean.
Therefore, the intestinal function recovers quickly after the operation, and the food can be eaten earlier, which greatly reduces the factors of postoperative intestinal adhesion.
2. Laparoscopic surgery is the representative of true minimally invasive surgery, the trauma is greatly reduced, the operation process and postoperative recovery are easy, and the pain is less.
3. You can get out of bed early after the operation, and the sleeping posture is relatively casual, which greatly reduces the intensity of accompanying family care.
4. The poke holes in the abdominal wall are small (ranging from 3-10mm), scattered and hidden, and will not affect the appearance after healing.
5. General anesthesia is generally used, and the monitoring is complete, and the safety is greatly increased.
6. Poke hole infection is far less than traditional incision infection or fat liquefaction.
7. The abdominal wall poke hole replaces the abdominal wall incision, avoiding the damage of abdominal wall muscles, blood vessels and corresponding nerves. After the operation, there will be no abdominal wall weakness and abdominal wall incisional hernia, and the scarring of the abdominal wall muscles will not affect the motor function, and it will not be caused by the abdominal wall nerves. The cut causes numbness of the corresponding skin.
shortcoming
However, laparoscopic surgery also has its own shortcomings such as:
1. Laparoscopy equipment is expensive and complicated to operate. Retraining in laparoscopic surgery is required, and there are technical requirements for surgeons.
2. It is difficult to estimate the operation time before the operation. In special circumstances, it is necessary to change to open surgery during the operation.
3. Laparoscopic surgery increases the risk of surgery under special circumstances.
develop
(1) Pelvic mirror
In 1901, the Russian gynecologist D.O.ott also incised the posterior fornix of the vagina under frontoscopic illumination and put it into a cystoscope to observe a woman's abdominal cavity. This is the first pelvic mirror.
(Two), diagnostic laparoscopy
In 1910, Jacobaeus.H.C first used a cannula puncture needle to be inserted into the abdominal wall and air was injected into the abdominal cavity through the cannula, and then put into a cystoscope for examination. In 1944, Raoul Palmerjiang of France officially applied laparoscopy in the field of gynecology, examined a large number of infertile patients and formulated the operating routine of laparoscopy. Published a monograph in 1963, systematically introducing some relatively simple operations under laparoscopy, such as: tubal ventilation and fluid drainage; simple organ adhesion separation; fallopian tube electrocoagulation and sterilization; endometriotic focus electrocoagulation , Electrocautery, etc.
(Three), surgical laparoscopy
After entering the 1970s, due to the invention of cold light source and glass fiber endoscope, Germany Semm's artificial pneumoperitoneum monitoring device, an automatic pneumoperitoneum machine, came out. So far, laparoscopic surgery has developed vigorously. Because of its small damage and no need for laparotomy, it was quickly accepted by both doctors and patients. In 1980, Dr. Nezhat in the United States began to use video laparoscopy for surgery. The surgical field is clearly displayed on the screen, and the field of vision is enlarged. Many doctors can see the operation process at the same time, which is conducive to technical communication and research, as well as the cooperation of assistants and the assistance of anesthesiologists. In the late 1980s, Professor Kurt Semm in Germany invented many new surgical instruments and techniques. Such as: microscopic suture instruments, flushing pumps, various forceps, scissors, combined pulverizers, cutters, etc. There are various methods for hemostasis under the microscope: monopolar coagulation, bipolar coagulation, ligation ferrules, internal suture technology, titanium clips, staplers and other technological advancements have enabled more complicated operations to be completed under the microscope. In 1988, Reich H performed the first laparoscopic total hysterectomy. Since then, the scope of gynecological surgery has expanded. Almost 90% of gynecological operations can be completed under laparoscopic surgery.
Advantage
1. Multi-angle "inspection" with intuitive effects: endoscopy can inspect from different angles and directions without affecting the abdominal organs, and even see some deep positions, achieving the effect of visual inspection, no missed diagnosis, no Misdiagnosed.
2. Fast recovery: Laparoscopic surgery is performed in a closed pelvis and abdominal cavity, with little internal environment interference. The trauma suffered by the patient is far less than that of open surgery, and he recovered quickly after the operation without complications and sequelae.
3. Short hospital stay: the operation is performed by a professional doctor, and the treatment can be completed in a short time without affecting normal physiological functions, and normal work and life can be restored after the operation.
4. Abdominal cosmetic effect is good: traditional surgical scars are long linear, and endoscopic surgery does not leave scars, which is suitable for women's cosmetic needs.
5. Reduce the burden on patients: The operation is minimally invasive, with less medication, low cost, quick recovery, no hospitalization, and reduces the burden on patients.
Scope of application
In recent years, minimally invasive surgery, which has the advantages of small trauma, quick recovery, light pain, and high cure rate, has developed rapidly. As a representative of minimally invasive surgery, laparoscopy is widely used in the field of surgery, involving many diseases and operations, and is welcomed by patients. And with the continuous advancement of science and technology, the improvement and innovation of surgical instruments, the space for laparoscopy will become larger and larger.
Application scope of laparoscopic surgery:
Hepatobiliary Surgery
Cholecystectomy, choledocholithotomy, liver resection, fenestration and drainage of liver cysts, drainage of liver abscess, and biliary and enteral drainage.
Spleen Pancreatic Disease Surgery
Splenectomy, fenestration and drainage of splenic cyst, internal drainage of pancreatic pseudocyst, partial pancreatectomy.
Gastrointestinal surgery
Subtotal gastrectomy, vagus nerve trunk transection, appendectomy, ulcer perforation repair, gastric volume reduction surgery for obesity, intestinal adhesion release, colorectal tumor resection.
Thoracic Disease Surgery
Lobectomy, bullaeectomy, spontaneous hemothorax surgery, esophageal cancer resection, palsy surgery, esophageal hiatal hernia surgery, thymoma resection, mediastinal tumor resection, pericardiotomy, artery Patent catheter ligation.
Surgery for neck and breast diseases
Thyroid and parathyroid surgery, axillary lymph node dissection for breast cancer, breast lumpectomy.
Urinary system disease surgery
Nephrectomy, adrenalectomy, ureterectomy lithotripsy, pyeloplasty, bladder diverticulectomy, renal cyst fenestration.
Gynecological Disease Surgery
Hysterectomy, uterine fibroids enucleation, ovarian cystectomy, ectopic pregnancy surgery, fallopian tube surgery, infertility exploration, pelvic dissection.
other
Inguinal hernia repair, ligation of the communicating branch of the great saphenous vein. Especially used in inguinal hernia surgery, it can greatly reduce the recurrence rate of the operation. It is used for pediatric hernias, middle-aged and elderly hernias, and physically weak hernia patients.
Hysteroscopy minimally invasive technology can treat almost all gynecological diseases, such as ectopic pregnancy, ovarian benign tumors, pelvic endometriosis, uterine prolapse, polycystic ovary, uterine fibroids, uterine sparing tumor removal, hysterectomy Surgery, diagnosis and treatment of infertility, etc. Minimally invasive surgery allows women to avoid the pain and pain of an open stomach, and regain their health just around the corner.
Indications
Laparoscopy diagnosis
①Understand the location, source, nature, and size of pelvic and abdominal masses, and biopsy if necessary.
②Look for the cause of infertility, determine the corrective method, and judge the prognosis and outcome of reproduction.
③Diagnosis, staging and follow-up of treatment effect of endometriosis.
④ Identify the causes of acute and chronic abdominal pain.
⑤Understand the deformity of the reproductive tract, ovarian morphology, and biopsy if necessary.
⑥ Evaluation of curative effect and prognosis of malignant genital tract tumors after surgery or chemotherapy
Laparoscopic surgery
①Pelvic mass: fenestration and drainage of ovarian cysts, ovarian tumor extirpation, adnexectomy, mesangial cyst resection, etc.
②Uterine fibroids: removal of uterine fibroids, adenomyoma, resection of adenomyosis, hysterectomy, etc.
③Early diagnosis of ectopic pregnancy and concurrent conservative or radical surgery.
④Pelvic adhesion decomposition and fallopian tube plastic surgery were performed while diagnosing the cause of infertility.
⑤ Electrocoagulation or resection of endometriosis lesions.
⑥Inspect the pathogens of pelvic infectious diseases, and perform pelvic adhesion decomposition, abscess incision and drainage, and fallopian tube ovarian cyst excision at the same time.
⑦Family planning: removal of birth control ring, repair of uterine perforation wound, sterilization, tubal anastomosis.
⑧Reproductive assistance: mature egg extraction, gametophyte intrafallopian tube transplantation, polycystic ovary puncture, and perforation.
⑨ Surgery for malignant tumors of the genital tract: early endometrial cancer, cervical cancer, ovarian cancer surgery, including extensive total hysterectomy, pelvic and para-aortic lymphadenectomy, omentum and appendectomy.
Contraindications
① Severe heart, lung, liver, and kidney insufficiency.
②Huge pelvic and abdominal mass: the upper boundary of the mass exceeds the umbilicus
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