Laparoscopy

Laparoscopy

The Laparoscopy is the vision of the abdominal-pelvic cavity through a tube (optical) that contains a lens system. It is connected to an optical fiber which transmits light generated by an external source to light up the cave.

HOW IS THE LAPAROSCOPY? 

She should be with general anesthesia, surgical recostada on the table. Then, through the navel is to inflate the abdominal cavity gas (CO2). Once this was achieved, it introduces small trocares (tubes) through different points of the abdominal wall. They have diameters between 5 and 10 mm and will allow the introduction of the laparoscope (camera) and surgical instruments specially designed for this purpose. The image obtained from the abdominal cavity, is transmitted to a monitor, which allows the surgeon to perform the operation. 

Once recognized the internal structures of the abdominal wall are performed punctures accessory 5 or 10 mm, whose number and location dependent on the anatomic elements of the wall and disease or abnormality found. These punctures allow for the introduction of surgical instruments and performing various procedures. 

Once you have completed the punctures were systematically explores the pelvic cavity and perform therapeutic procedures. Subsequently performing a thorough washing of the peritoneal cavity with saline and suturan abdominal incisions. 

BENEFITS OF SURGERY LAPAROSCOPY

  • Less pain after surgery allows patients to get up and walk a few hours after surgery
  • Reduced rate of infection of the wound: delicate internal tissues of the body are not exposed to ambient air, unlike open surgery. In addition, the video-magnification allows manage in a more precise and sensitive, protecting vital organs.
  • Faster time to hospitalization
  • Reduced post-operative pain.
  • Return job earlier.
  • Minor-time convalescence.
  • Minimum-surgical injury in the abdominal wall.
  • Excellent aesthetic result.
  • Less blood loss.

INDICATIONS 

Infertility: laparoscopy is essential in the study of infertile women. The moment that is done depends on the age and background of the patient. It is necessary to assess the overall appearance of internal genitalia, mobility and tubal, endosálpinx, the relationship fimbrio-ovarian and characteristics of the peritoneum. The most common are endometriosis, pelvic syndrome Adhesive, tubal blockage, hydrosalpinx, myomatosis uterus and uterine malformations.
Adherencial Syndrome: anatomic distortion caused by pelvic adhesions can cause infertility and Pelvic pain. Traditionally it has done laparotomy with microsurgical techniques to release adhesions, with intrauterine pregnancy rate of 54%. Laparoscopy is a surgical alternative which has similar results pregnancy rates and recurrence of adhesions.

Endometriosis: the location of ectopic endometrial often suspected by clinical history and physical examination suggestive, but direct visualization of the pelvis is the only accurate way of diagnosing the disease. Allows also determine their size, level of activity and perform at the same time the surgical treatment of the disease. 

The surgical technique can be conservative or radical, depending on age and symptoms of the patient, the size and location of the disease. Surgical treatment includes electronica lightning of endometriosis sites, adherenciolisis, ooforolisis, resection of endometriomata, ooferectomía Section ligaments uterosacros, dissection of rectovaginal septum and hysterectomy. 

Hidrosálpinx: most are diagnosed by histerosalpingografía but laparoscopy is what allows us to evaluate tubal size, wall thickness, endosálpinx characteristics, size and type of adhesive partner, which depends on the surgical indication. The pregnancy rate of hydrosalpinx approached by laparoscopy is similar to that obtained through laparotomy microsurgery. 

Uterine malformations: be suspected in patients with a history of habitual abortion or premature birth. The histerosalpingografía and ultrasound are very suggestive of the diagnosis in utero or septado bicorne, however, it is necessary to perform a laparoscopy to establish the definitive diagnosis.

Pregnancy tubal: identifying serial beta subunit of hCG, the use of transvaginal ultrasound and the use of laparoscopy, have facilitated the early diagnosis of ectopic pregnancy, which has enabled 95% can be solved by laparoscopy. The hemodynamic instability is the only absolute contraindication of the proceedings. The prognosis for further fertility is similar to laparotomy surgery, being intrauterine pregnancy rates close to 50% and the rate of relapses of about 17%. The surgical techniques used are more aspiration and expression tubal, salpingostomy linear salpingectomy partial or total.

Assisted Fertilization: laparoscopy has been used in assisted reproduction procedures, primarily in obtaining in oocytes in vitro fertilization and transfer intratubaria of gametes or embryos. 

Algia chronic pelvic: defined as pelvic pain lasting longer than six weeks, affects a significant number of women and constitutes from 2% to 10% of gynecological consultations. Laparoscopy is crucial in the study and treatment of these patients, and should be performed in cases where it fails non steroidal anti-inflammatory therapy. Depending on the underlying cause, you can make release of adhesions, endometriosis foci electrofulguration, resection of endometriomata, adnexectomy, myomectomy, hysterectomy, and so on. In patients with chronic pelvic pain without anatomical substrate, it is possible to section ligaments uterosacros, carrying afferent fibers and parasimpáticas sympathetic to the neck and uterus. His section can be done with laser or electrocauterio, proximal to the uterus after identifying trail urethral and uterine vessels. 

Pelvic tumors: laparoscopy can determine the source of a pelvic injury (or ovarian extraovárica), to provide guidance on its nature and whether it is possible treatment by endoscopic surgery. Before addressing laparoscópicamente ovarian lesions, it must make a careful preoperative evaluation that includes the characteristics of the patient (age, family history of ovarian cancer, etc.), clinical and ultrasonographic characteristics of the lesion and the presence of tumor markers such as CA -125, alpha-fetoprotein, beta subunit of hCG, and so on. If all preoperative findings directed to a benign lesion, the patient can be assessed laparoscópicamente. Depending on the endoscopic findings, resolves whether or not the patient is a candidate for laparoscopic surgery.

Instead, laparotomy should be performed if there is suspicion of malignancy. In premenopausal women with ovarian cystic lesions, clinical and ultrasound findings suggestive of benign, the laparoscopic approach is feasible. In postmenopausal patients this approach is more questionable and raise only those who meet strict criteria above, including an AC-125 negative. The type of surgery depends on the age, tumor features and desire fertility of the patient. You can understand lumpectomy, or oophorectomy adnexectomy. 

Pelvic inflammatory process: the diagnosis of pelvic inflammatory processes (PIP) has traditionally been performed by the clinical and physical examination, but the diagnostic specificity of these elements is only 50 to 75%. In 15 to 30% is confused with other illnesses and a 20-25% is not a cause. For this reason, most authors recognized the utility of laparoscopy in the diagnosis of PIP. This method confirms the positive cases, directly produces the peritoneal fluid and properly plan the antibiotic therapy. The laparoscopic findings of PIP are swelling and mobility tubal diminished flow tubal purulent and formation of inflammatory masses (tuboovárico complex). In selected cases of patients with abscesses tuboováricos, laparoscopy also allows debridar, drain and pelvic clean collections. It must associate antibiotic treatment. 

Uterine myoma: uterine leiomyoma is the most common solid pelvic tumor, as occurs in 20% of women over 35 years. Most patients are asymptomatic, but can express pelvic pain, infertility, repeated abortion, prematurity and altering flows red. In these cases, surgical treatment is indicated, which can be radical or conservative (hysterectomy) (myomectomy). Classically, these procedures have been performed by laparotomy, but in selected cases each has been made by laparoscopy.

Hysterectomy: hysterectomy is the most common gynecological surgery and has traditionally been done by abdominal or vaginal. In 1989, Reich published the first case of laparoscopic hysterectomy, demonstrating that the benefits of the endoscopic surgery were applicable to this type of intervention. Since then it has spread universally as surgical technique. The indications are similar to those of conventional hysterectomy. However, the uterine size greater than that of a 12-14 weeks of gestation should contraindication the procedure. It is imperative that this is done only by experienced specialists in operative laparoscopy.

Laparoscopic hysterectomy is a therapeutic alternative real well selected patients. I recognized advantages, such as less bleeding and surgical trauma, less analgesic requirement, short recovery and less hospitalization time. Its main disadvantage is the longest duration of the operation, which can be reduced according to the experience of the operator.

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