Diagnostic and Therapeutic Laparoscopy
Definition
It is the exploration of the abdominal cavity through optics introduced through holes in the abdomen and which purpose is the observation of abdominal organs, which is carried out through small incisions through a needle that insufflates gas (CO2) and trocars; it can be diagnostic or therapeutic.
Indications
- Ectopic pregnancy.
- Adhesive Syndrome.
- Parity satisfied (tubal obstruction).
- Ovarian cysts.
- Tubo-ovarian abscess.
- Uterine Myomatosis.
- Chronic pelvic pain.
- Severe dysmenorrhea.
- Pelvic Inflammatory Disease.
- Oncological Pathology.
Contraindications
Absolutes
- Persistent hemodynamic instability.
- Shock Condition.
- Sepsis.
- Peritonitis.
- Intestinal Obstruction.
- Severe uncorrected coagulation disorders.
- Large Abdominal-Pelvic Tumors (Abdominal Cancer).
- Severe cardiorespiratory diseases (ASA IV)
- Irreducible external hernia.
Relative
- Previous abdominal surgery.
- Abdominal wall infection.
- Portal Hypertension.
- Extreme obesity.
- Hiatal Hernia.
- Ischemic Cardiopathy.
- Uncooperative patient.
- Corrected coagulation disorders.
Surgical Technique
The laparoscope is introduced through a small cut (or incision in the navel). The laparoscope projects images of the pelvic organs onto a screen. The uterine manipulator moves the organs around so they can be seen.
Advantages
- Minimal scar.
- Less post-operative pain.
- Reduced hospitalization and recovery time.
- Reduced risk of infection.
- Lower risk of adhesions.
- Better and more complete visualization of anatomical structures.
Complications
- Hyperextension of the brachial plexus.
- Anesthesia-related.
- Inadequate inflation (extra-peritoneal).
- Direct trauma: Bowel, bladder, major abdominal vessels and anterior abdominal wall vessels.
- Subcutaneous emphysema.
- Gas embolism or systemic CO2 absorption (rare).
- Pneumothorax or mediastinal emphysema.
- Post-operative infection at entry site.