What Does a Laparoscopic Surgeon Do?

Laparoscopic surgery is a newly developed minimally invasive method, and it is an inevitable trend in the future development of surgical methods. 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and methods, and the increasingly skilled operation of doctors, many of the open surgery in the past have now been replaced by endoluminal surgery. Greatly increases the chance of surgical options. The traditional method of laparoscopic surgery is to make three small 1 cm incisions in the patient's waist, and insert a tube-shaped working channel called "trocar". All subsequent operations are performed through these three channels; then special lengthened surgical instruments are used. Complete the same steps as the open surgery under TV surveillance to achieve the same surgical results.

Laparoscopic surgery

What exactly is a laparoscope? According to experts, it is a device with a miniature camera. Laparoscopic surgery is a procedure performed using a laparoscope and its related equipment: using a cold light source to provide illumination,

Laparoscopy is used for intra-abdominal examination and treatment

(A), pelvic mirror

In 1901, Russian gynecologist DOott also cut a vaginal posterior fornix under frontal light and placed a cystoscope to observe a woman's abdominal cavity. This is the first pelvic scope.

(B) diagnostic laparoscopy

In 1910, Jacobaeus.HC first applied a cannula puncture needle into the abdominal wall and introduced air into the abdominal cavity through the cannula, and then put it into a cystoscope for examination. In 1944, France s Raoul Palmerjiang officially applied laparoscopy to the field of gynecology, inspected a large number of infertile patients, and formulated the routine of laparoscopy. Published a monograph in 1963, which systematically introduces some relatively simple operations under laparoscopy, such as: fallopian tube ventilation and fluid flow; simple organ adhesion separation; fallopian tube electrocoagulation

1. Multi-angle "inspection", the effect is intuitive: the laparoscope can be inspected from different angles and directions without involving the abdominal organs, and it can even see some deep locations to achieve the effect of intuitive inspection. Misdiagnosis.

2. Fast recovery: Laparoscopic surgery is performed in a closed pelvis and abdominal cavity with little internal environmental interference. The trauma suffered by the patient is much less than that of laparotomy, and he recovers quickly after surgery without complications and sequelae.

3. Short hospital stay: The operation is performed by a professional physician, and the treatment can be completed in a short time without affecting normal physiological functions, and normal work and life can be restored after surgery.

4. The effect of abdominal beauty is good: traditional surgical scars are long, and laparoscopic surgery does not leave scars, which is suitable for women's cosmetic needs.

5. Reduce patient's burden: Surgery is minimally invasive, less medication, low cost, fast recovery, no need to be hospitalized, and reduce patient burden.

In recent years, it has the advantages of less trauma, faster recovery, less pain, and higher cure rate.

Severe heart, lung, liver, and kidney dysfunction.

Huge mass in the pelvis and abdomen: When the upper limit of the mass exceeds the level of the umbilicus or when the uterus of the gestation is greater than 16 weeks of gestation, and the volume of the uterine fibroids exceeds 4 months of pregnancy, the space for pelvic and abdominal surgery is limited, and the lump obstructs the vision and establishes a pneumoperitoneum Or a puncture may cause the mass to rupture.

Laparoscopic minimally invasive surgery because the trauma is small, the patient's abdomen does not have long surgical scars, which meets the requirements of modern women's aesthetics, and because it is a minimally invasive surgery, the pain is greatly reduced, and because there is no open surgery, there is little physical interference to the body , Postoperative recovery is fast, the patient can get up on the day after the operation, and can be discharged from the hospital within 24 to 72 hours after operation. It meets the fast-paced and efficient living requirements of modern cities and is highly sought after by patients with gynecological diseases. on

Patients should pay attention to personal hygiene, it is best to use cotton swabs dipped in soapy water or vegetable oil to remove dirt in the umbilical foramen. Before the operation, light and easy-to-digest foods should be the main thing. Avoid large fish and meat to prevent postoperative

Within 6 hours after surgery, the supine position should be taken, with the head sideways to prevent vomit from blocking the airway. Every half an hour, the patient should turn over and massage his waist and legs to promote blood circulation. After 6 hours of surgery, the patient should take a small amount of liquid soft food, such as dilute rice soup, noodle soup, etc. Do not give the patient sweet milk, soy milk powder, etc.

What to eat after laparoscopic surgery? Experts from Yiwu Hospital, usually after laparoscopic surgery to recover from waking, they can start to enter liquid food (such as porridge), the normal diet can be restored the next day, because the wound healing requires the use of protein, so it is necessary to ingest high-protein food ( For example: fish, lean meat, eggs ..) to accelerate wound healing and avoid irritating foods, so as not to stimulate gastric acid secretion and cause gastrointestinal discomfort (for example: pepper, smoke, oil, coffee).

The biggest difference between laparoscopic surgery and general open surgery is that carbon dioxide is needed during the operation to make pneumoperitoneum easy to operate. Therefore, residual carbon dioxide gas is likely to be in the abdomen after surgery.

Some countries have established criteria for grading the difficulty of laparoscopic surgery. These standards measure the level of each physician and assess surgical skills. The easiest surgeries include sterilization, ovarian cyst removal, infertility testing and ectopic pregnancy surgery. Moderately difficult surgery includes fibroids less than 4 cm in length, adhesion separation, ovarian resection, bladder neck and pubic comb ligament suspension, and simple laparoscopy with vaginal hysterectomy. The most difficult procedures include extensive pelvic adhesions separation, bowel in severe endometriosis, separation of vaginal and rectal adhesions, pelvic floor tissue repair, laparoscopic assisted vaginal hysterectomy with comorbidities, pelvic lymphadenectomy And extensive hysterectomy. According to this standard, 50% of gynecologists in Australia use laparoscopy for ectopic pregnancy, and only 8% of hysterectomy is done laparoscopically. This shows that most gynecologists lack simple laparoscopic surgery training, and only a few gynecologists can perform simple laparoscopic hysterectomy.

It can be widely used only when government health agencies, insurance companies, national professional medical organizations (such as the obstetrics and gynecology society), and patients who need surgery acknowledge the safety, efficacy, and price of laparoscopic surgery. If the government health agency recognizes the value of endoscopic surgery, it will provide financial support to establish a training center so that most doctors can participate in training and quickly become endoscopic surgeons. When the clinical value of laparoscopic cholecystectomy was recognized, its popularity in developed countries took only one year. Surgeons use this method only for cholecystectomy, which is good for governments, patients, and insurance companies.

Due to lack of funds in developing countries, they cannot purchase equipment, train enough teachers, and participate in national and international conferences to obtain new knowledge and technical information. Some international organizations such as WHO, IsGE and the International Endoscopy Society have set out to assist developing countries in performing endoscopic surgery.

The operation steps of any surgery need to be grasped by understanding and memorizing. Based on the knowledge of anatomy and pathology, the common ovarian resection procedures are described here to make the operation safer and more effective.

I. Conceptual differences:

1. Hysteroscopy is mainly used for inspection. Hysteroscope is an optical instrument used to observe, diagnose and treat the uterine cavity.

2. Laparoscopy is mainly used for treatment. Laparoscopic surgery mostly uses 2-4 holes, one of which is opened on the navel of the human body to avoid leaving long scars in the patient's abdominal cavity. After recovery, only 1 to 3 0.5 ~ A 1-cm linear scar can be said to be a small wound with little pain, so it is also called a "keyhole" operation.

2. Different technical advantages ^[1] :

1. Hysteroscopy advantages: Hysteroscopy can clearly and intuitively find the cause of female infertility and treat the symptom. As a minimally invasive surgery, the uterine cavity can reduce the trauma to a minimum, and it is safe, painless and quick to recover. The most advanced and cutting-edge technology in infertility surgery in the world.

2. Laparoscopic advantages: Laparoscopic surgery has the advantages of less damage and faster recovery. After laparoscopic dissection of pelvic adhesions, hysteroscopic intubation and perfusion can achieve twice the result with half the effort.