Laparoskopik Cerrahi

Laparoscopy

Laparoskopik Cerrahi

Laparoscopy is a procedure that involves using a small telescope- instrument called a laparoscope to view the inside of the abdomen and/or pelvis.

Laparoscopy can be performed as an investigation to see what might be causing certain problems, such as pelvic pain or infertility. Laparoscopic surgery is also commonly used in Australia to treat some conditions.

What happens during a laparoscopy?

During a laparoscopy, a laparoscope (a thin instrument with a camera on the end of it) is gently inserted through a small cut into the abdomen. The laparoscope allows your doctor to see inside your abdomen and pelvis.

Laparoscopy is usually performed under general anaesthetic, so you will not be conscious during the procedure.

A small cut is made in or near your umbilicus (belly-button), and a narrow tube is inserted.

Carbon dioxide gas is introduced into the abdominal cavity through this tube, ‘blowing it up’ slightly, and making it easier to see inside. The laparoscope is then inserted into the abdomen.

The laparoscope has a video camera on the end of it which takes video images that are projected onto a television screen so that your doctor can see the inside of your abdomen.

Why is laparoscopy done?

Laparoscopy may be recommended as a test to help with the diagnosis of a variety of symptoms and conditions, including:

  • endometriosis (a condition affecting women, where uterus lining tissue grows outside the uterus);
  • unexplained severe pelvic or abdominal pain;
  • infertility in women; or
  • cancers in the abdomen or pelvis.

During the procedure, your doctor may take some small tissue samples – biopsies – to help make a diagnosis.

Sometimes treatment can be carried out at the same time as a laparoscopic investigation.

Laparoscopic surgery

Laparoscopy can also be used to treat certain conditions, often with the help of additional instruments inserted through further tiny cuts made in the wall of the abdomen. Laparoscopic surgery (or minimally-invasive surgery) is also often referred to as keyhole surgery.

An increasing number of problems that used to require major surgery can now be treated with laparoscopic surgery.

Laparoscopic surgery is commonly used by gynaecologists (specialists in conditions affecting the female reproductive system) to perform procedures such as:

  • female sterilisation (having your fallopian tubes ‘tied’ or clipped as a permanent form of contraception);
  • hysterectomy (removal of the uterus);
  • removal of ovarian cysts; and
  • treatment of ectopic pregnancy (where a pregnancy implants outside the uterus – most often ectopic pregnancies occur in a fallopian tube).

Common non-gynaecological laparoscopic operations include the following.

  • Removal of the gallbladder (called laparoscopic cholecystectomy), which is a very common procedure and is usually done to treat people with gallstones that are causing problems.
  • Removal of the appendix (appendicectomy) to treat appendicitis.
  • Weight loss surgery (also known as bariatric surgery) such as laparoscopic adjustable gastric banding (LAGB) or laparoscopic sleeve gastrectomy.
  • Hernia repairs.

It is also possible to remove some cancers from the abdomen or pelvis laparoscopically. Sometimes this involves removal of the whole organ that is affected by cancer.

Recovery from laparoscopy and laparoscopic surgery

A laparoscopy is usually done as a day procedure, meaning you can go home on the same day. If you had a laparoscopy as a diagnostic procedure (where no surgery was performed), you can usually return to your usual activities within about 5 days.

People who have had laparoscopic surgery need more recovery time, and the amount of time will depend on the procedure performed. However, the recovery time is much shorter than would be needed for an open operation.

Because only tiny cuts are required with laparoscopic surgery, there is much less pain after the operation compared with open surgery (where a much larger incision is needed).

This means that having a laparoscopy reduces the length of your hospital stay. Depending on the type of surgery you have, you may be able to leave hospital on the same day as your operation.

It may take several weeks before you are able to participate in all of your usual activities – check with your doctor.

Because only small incisions are made, you will also have smaller, less noticeable scars. Your surgeon may wish to see you a week or so after the surgery to check that the wounds are healing well.

Side effects and complications of laparoscopy

After having a laparoscopy, there is usually a small amount of discomfort where the instrument was inserted. It is normal to feel tired and sore for a couple of days after the procedure.

Some people have a bloated feeling and pain felt at the tips of the shoulders after having a laparoscopy. This is due to the small amount of gas that is pumped into the abdomen to make it easier to see. These side effects generally settle within a few days , but bloating can take several weeks to resolve in some people.

As with any surgery, there is usually some pain following laparoscopic surgery. However, because the cuts with laparoscopic surgery are much smaller than with open surgery, there is usually less pain after laparoscopic surgery.

There is a very small risk of more serious complications. These include bleeding, infection, or damage to an organ (such as your bladder or bowel).

When to contact your doctor after a laparoscopy

You should contact your doctor if any of the following symptoms develop after having a laparoscopy:

  • persistent or worsening pain after a few days;
  • new abdominal pain;
  • nausea or vomiting;
  • fever;
  • fainting or feel light-headed;
  • redness, swelling, discharge or bleeding at the wound site(s); or
  • difficulty urinating.

References

1. American College of Obstetricians and Gynaecologists. Laparoscopy (updated1 July 2015). Available at: http://www.acog.org/Patients/FAQs/Laparoscopy (accessed Sep 2016).2. Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Laparoscopy: Information for patients (updated 26 Oct 2012). http://www.ranzcog.edu.au/treatments/laparoscopy.html (accessed 15 Sep 2016).3. NHS Choices. Laparoscopy (keyhole surgery) (updated 24 Sep 2015). http://www.nhs.uk/Conditions/Laparoscopy/Pages/Introduction.

aspx (accessed Sep 2016).

Источник: https://www.mydr.com.au/womens-health/laparoscopy

Laparoscopic Surgery – What is it?

Laparoskopik Cerrahi

Laparoscopic or “minimally invasive” surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal surgery.

In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.”  At each port a tubular instrument known as a trochar is inserted.  Specialized instruments and a special camera known as a laparoscope are passed through the trochars during the procedure.

At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor.

This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.

In certain situations a surgeon may choose to use a special type of port that is large enough to insert a hand. When a hand port is used the surgical technique is called “hand assisted” laparoscopy. The incision required for the hand port is larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.

WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC SUrGERY?

Compared to traditional open surgery, patients often experience less pain, a shorter recovery, and less scarring with laparoscopic surgery.

WHAT KINDS OF OPERATIONS CAN BE PERFORMED USING LAPAROSCOPIC SURGERY?

Most intestinal surgeries can be performed using the laparoscopic technique. These include surgery for Crohn’s disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.

In the past there had been concern raised about the safety of laparoscopic surgery for ­cancer operations. Recently, several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain ­colorectal cancers.

HOW SAFE IS LAPAROSCOPIC SURGERY?

Laparoscopic surgery is as safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the belly button (umbilicus).

The surgeon initially inspects the abdomen to determine whether laparoscopic surgery may be safely performed.

  If there is a large amount of inflammation or if the surgeon encounters other factors that prevent a clear view of the structures, the surgeon may need to make a larger incision in order to complete the operation safely.

Any intestinal surgery is associated with ­certain risks such as complications related to anesthesia and bleeding or infectious complications.

The risk of any operation is determined in part by the nature of the specific operation. An individual’s general heath and other medical conditions are also factors that affect the risk of any operation.

You should discuss with your surgeon your individual risk for any operation.

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training.

Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery.

They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive.

 Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed.

It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results.

The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. 

Источник: https://www.fascrs.org/patients/disease-condition/laparoscopic-surgery-what-it

Laparoscopy: Click for Procedure and Recovery Time

Laparoskopik Cerrahi

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Laparoscopy is a way of performing a surgery. Instead of making a large incision (or cut) for certain operations, surgeons make tiny incisions and insert thin instruments and a camera into an area, such as into the abdomen, to view the internal organs and repair or remove tissue.

Laparoscopy was first performed in animals in the early 1900s, and the Swedish surgeon Jacobaeus coined the term laparoscopy (laparothorakoskopie) in 1901. However, better techniques were not developed until the 1960s, when laparoscopy was accepted as a safe and valuable procedure.

Early on, the technique of laparoscopy, sometimes referred to as keyhole surgery, was used only to diagnose conditions.

Then doctors began to perform surgeries, such as tubal ligation in women using laparoscopy.

The technique has evolved so much that operations that once required doctors to make a very large incision, such as to remove the gallbladder, can now all be done with this less invasive surgery.

For patients, laparoscopy can often mean a faster recovery from surgery, less time in the hospital or outpatient surgery center, and less trauma to the body. Doctors do not have to slice through large abdominal muscles to reach vital organs.

Laparoscopic instruments and techniques are used for a variety of procedures, including knee and shoulder surgery. Operations now often performed laparoscopically include the following, among many others:

  • Removal of diseased organs such as the gallbladder or appendix
  • Removal or repair of diseased parts of the colon or stomach (digestive system)
  • Removal or repair of the bladder, ureters, or kidneys (urinary system)
  • Removal or repair of women's reproductive organs, such as the uterus or fallopian tubes
  • Tubal ligation
  • Removal of a kidney in a living donor
  • Weight-reduction procedures, such as gastric bypass
  • Repair of a hernia
  • To view the liver and pancreas for the presence of cancer tumors
  • To view the abdomen for signs of disease that has been difficult to diagnose (exploratory surgery)
  • To view a tumor in the abdomen
  • To check the source of abdominal pain or remove scar tissue
  • To look for the source of internal bleeding or fluid buildup if the patient has a normal blood pressure
  • To view injury following trauma or an accident

Laparoscopy Preparation

As with any surgery, food and drink are restricted for eight hours before the procedure, unless the surgery is done as an emergency. The patient is asked to sign a consent form that tells about the procedure and about its risks. Patients need to understand what the surgeon will do during the procedure and understand the answers to their questions.

General anesthesia is provided, which means the patient is asleep during the procedure. The anesthesiologist speaks with each patient about any drug allergies beforehand.

Recovery time is much shorter with laparoscopy than with regular (open) surgery. The procedure may even be performed on an outpatient basis, meaning the patient can return home the same day of the procedure. For outpatient surgeries, someone else should come along to drive the person who has just had surgery home. Patients are instructed not to wear jewelry or bring any expensive items.

Patients planning to undergo laparoscopy should speak with their doctor a few days before the procedure to ask whether they should take their current medications. This is particularly important for people who take aspirin, blood thinners, or certain herbal supplements that can make it harder for the blood to clot.

What percentage of the human body is water? See Answer

During the Laparoscopy

With laparoscopy, tiny fiber-optic instruments are inserted into the body through small surgical openings (thus the name “keyhole”). A person may have one or more small incisions. A video camera is inserted into the opening, which guides the surgeon who is manipulating the instruments in any other openings.

Sometimes, only one incision is used an all the instruments are placed into it. This is called single incision laparoscopic surgery or SILS. On the ends of these instruments are such devices as scissors, surgical staplers, scalpels, and sutures (stitches).

Abdominal laparoscopy involves the following steps:

  • Once the patient is asleep, the surgeon makes a small cut near or at the navel and inserts a thin, hollow tube called a trocar. The tube extends from inside the abdomen to the outside.
  • Carbon dioxide gas is injected into the abdomen to expand it and allow the doctor more room to view the organs.
  • The laparoscope, a medical instrument with a high-intensity light and very tiny camera, is inserted into the abdomen through the trocar. The surgeon views a large image from the camera on a TV screen in the operating room.
  • Other instruments are inserted into small incisions. The surgeon manipulates these to perform the procedure, whether it is removing an organ, taking a sample of tissue, or repairing an organ.
  • When the surgery is finished, the surgeon removes the instruments.
  • The incisions are stitched closed, and bandages are placed over them. Very small incisions may not require stitches, just small strips of sterile tape.

The patient is asleep and feels nothing during the procedure.

After the Laparoscopy

  • Some pain or throbbing is possible where the small cuts were made. The doctor may recommend a prescription or over-the-counter pain reliever.
  • If stitches were used, a follow-up appointment for removal of stitches may be scheduled in a week or two as directed.
  • Sometimes the carbon dioxide gas can trigger shoulder pain after the procedure. Some of the same nerves that reach the shoulder are present in the diaphragm, and the gas may irritate the diaphragm. The pain goes away over time.
  • Pressure from the gas may cause a sensation of needing to urinate more often and more urgently. This sensation goes away over time.
  • The doctor will determine when eating and drinking can be resumed.
  • Once a person has sufficiently recovered, he or she can be sent home. Someone else should drive.

Next Steps after Laparoscopy

If the procedure was for diagnosis of a condition or to view a diseased organ, the patient will meet with the doctor to go over the results of the exploratory surgery. For other procedures, follow up with your doctor as advised. Avoid heavy lifting or strenuous activity until fully recovered.

Laparoscopy Risks

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Complications are rare, but as with any surgery, infection is a risk. Bleeding in the abdomen is also possible. Scars may develop. Anesthesia during surgery can cause heart attack, stroke, and pneumonia, but these consequences are rare.

During laparoscopy, the following risks exist:

  • The surgeon may puncture an blood vessel or organ. This could cause bleeding or injury to the organ. If the colon is ruptured, its contents may spill into the abdomen.
  • Scar tissue from previous operations could present a problem for the trocars to be inserted properly into the abdomen. Scar tissue could prevent the gas from expanding the abdomen.

If complications develop or are found, the surgeon may decide to proceed with a larger incision and a standard surgery rather than laparoscopy. This is a decision made with a patient's safety in mind.

If complications develop, the surgeon may follow up by prescribing:

  • Antibiotics for infection control
  • Blood transfusion to replace lost blood

Laparoscopic surgery on people who are obese can be complicated. Many doctors advise people to lose weight before surgery, if possible. Certain weight-loss surgeries are, however, now being performed laparoscopically.

Laparoscopy Results

Results depend on which procedure was performed and what was found. In most cases, people recover quickly with minimal pain and discomfort because they have only small incisions to heal.

When to Seek Medical Care for Laparoscopy

If, after a laparoscopic procedure, a person develops any of these problems, a doctor should be contacted:

  • Chills or fever
  • Nausea or vomiting
  • Bleeding, drainage, or redness from any of the small incisions
  • Swelling of the surgical area
  • Inability to urinate
  • Pain that can't be controlled with prescribed medication

The 14 Most Common Causes of Fatigue See Slideshow Sources:

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care REFERENCE: “Abdominal access techniques used in laparoscopic surgery”

UpToDate.com

Источник: https://www.emedicinehealth.com/laparoscopy/article_em.htm

Laparoskopik Cerrahi

Laparoskopik Cerrahi

Gelişen teknolojik imkanlarla birlikte artık karın içi ameliyatlarının bir çoğu karnı açmadan yapılabilmektedir.

Laparoskopik cerrahi ile temel cerrahi prensipleri aynı olmakla beraber açık cerrahiden (klasik cerrahi) en önemli farkı karın cildine yapılan büyük kesilerin önlenebilmesidir.

Laparoskopik ameliyatlar, karın duvarına açılan, hemen hemen kalem çapı büyüklüğündeki deliklerden yerleştirilen tüplerin içinden geçirilen video kameralar ve özel aletlerle yapılmaktadır. Bu yöntem yaklaşık 100 yıldır kadın doğum alanında uygulanmaktadır.

Genel cerrahi alanında ise özellikle safra kesesi ameliyatlarında yaygın olarak tercih edilmiştir. Ardından diğer karın içi ameliyatlarında başarı ile kullanılmıştır. Son 10 yıl içinde kalın bağırsak cerrahisinde (kolon ve rektum cerrahisi) kullanılmaktadır.

Laparoskopik Cerrahi Uygulama Alanları

Açık ameliyata göre daha avantajlı olması nedeniyle hem doktor hem de hastalar tarafından tercih edilen laparoskopik yöntemler uygun vakalarda kalın bağırsak kanseri tedavisi gibi daha zor ameliyatlarda bile başarılı sonuçlar vermektedir.

Hastalıkları tedavi amaçlı kullanımın yanında teşhis amaçlı olarak rahatsızlıkların nedenlerini bulmak amacıyla da kullanılmaktadır. Tanı konulamayan karın içi rahatsızlıklarda laparoskopik yöntem kullanılarak kamera ile karın içi boşluğu değerlendirmesi yapılabilmektedir.

Günümüzde uygun hastalarda laparoskopik ameliyatlar neredeyse tüm karın içi rahatsızlıklarda kullanılabilmektedir. Bunlardan başlıcaları;

  • Safra kesesi ameliyatı
  • Fıtık ameliyatı
  • Dalak ameliyatı
  • Böbrek ameliyatı
  • Böbreküstü bezi ameliyatı
  • Mide fıtığı ameliyatı
  • Şişmanlık ameliyatı
  • İnce ve kalın barsak ameliyatları

Özellikle kalın bağırsak cerrahisinde laparoskopik cerrahi ile tedavi edilebilecek hastalıklar;

  • Crohn's hastalığı
  • Kalın bağırsak kanseri – Kolon / Rektum kanseri
  • Divertikülozis
  • Ailesel Adenomatöz Polipozis (FAP)
  • Rektal Prolapsus
  • Ülseratif kolit

Laparoskopik Cerrahi Kimler İçin Uygundur?

Tüm hastalar laparoskopik cerrahiye uygun olmayabilir. Özellikle sağ ve sol kolonu (kalın bağırsağı) tutan iyi huylu ve komp olmayan (problemsiz) lezyonlar için uygundur.

Her bireyin anatomisinin birbirinden farklı olması nedeni ile de bazen laparoskopik başlanan girişimler açık ameliyata dönülerek tamamlanabilir.

Hangi yöntemin sizin için uygun olduğunu doktorunuza (cerrahınızla) konuşmalısınız.

  • Karın duvarında enfeksiyonu olanlarda
  • Kanama bozukluğu olan kişilerde
  • Bağırsak tıkanıklığı olan kişilerde
  • İleri evre kanserlerde
  • Karın içi enfeksiyonu – yaygın peritoniti olan bireylerde
  • Gebelik (Bazı dönemlerinde)
  • Geçirilmiş karın ameliyatları olanlarda
  • Ağır solunum ve kalp bozukluğu olan kişilerde
  • Aşırı şişman hastalar
  • Diğer

Bu durumlarda laparoskopik ameliyat uygun olmayabilir.

Her hastanın kendine özgü durumu olduğu için doktor hastanın yaşı, altta yatan hastalıkları, hastalığının derecesi, eski ameliyatları, vücut yapısı gibi birçok özelliğini değerlendirerek ameliyatın laparoskopik olup olmayacağına karar verecektir.

Ameliyatın açık veya laparoskopik olması hastalığın tedavisi açısından fark etmemektedir. Önemli olan doğru tanı ve doğru ameliyatın yapılmasıdır. Laparoskopik veya açık ameliyat olması sadece estetik açıdan önem kazanmaktadır.

Laparoskopik Cerrahi Nasıl Yapılır?

Laparoskopi, karın bölgesinden (5-10mm'lik kesi ile) kamera ile girilerek karın içindeki organları incelemek anlamına gelir.

Kameranın girdiği yer haricinde ameliyatın şekline göre karın bölgesinde farklı yerlere 2 – 4 adet daha (5-10mm'lik) küçük kesiler yapılabilir. Sonuç olarak ortalama 3-4 adet boru (trokar) karın içine yerleştirilir.

Bu borulardan karın içine uzatılan kamera ve aletler yardımı ile ameliyat yapılabilmektedir.

Açık ameliyatlardan temel farkı cerrahi alanın çıplak göz yerine “trokar” adı verilen kılıflara yerleştirilen kamera aracılığı ile karın içi organlarının televizyon ekranından (monitörden) görülmesi, el ve açık cerrahi aletler yerine yine trokarlardan yerleştirilen özel laparoskopik aletlerin kullanımıdır.

Teknik açıdan bakıldığında, kamera sayesinde çıplak gözle görülenden en az 20 kat daha büyük ve ayrıntılı bir görüntü elde edilebilmesi ve anatomik yapıların daha ince detaylarına kadar görülebilmesi ciddi bir avantaj getirir.

Ayrıca açık cerrahide görülemeyen ve ulaşılamayan yerlere de açılı kameralarla ulaşabilir ve görüntü alınabilir.

Fakat açık ameliyatlarda hasta olan organları elle direkt olarak değerlendirmek – muayene etmek mümkün iken bu yöntemde dokunma duyusu olmadan ameliyat yapılmaktadır.

Geleneksel açık cerrahi işlemlerde cerrah karında en az 10 ila 20 cm arasında bir karın kesisi yapar. Laparoskopik, daha çok bilinen adıyla kapalı ameliyatlarda ise karında yarım ile bir santimetre arasında 3 – 4 küçük kesi yapılır.

Karın içindeki organların daha iyi görülmesi ve daha rahat çalışması için karın içi karbondioksit gazı ile şişirilir. Kesilerden yerleştirilen kamera ve el aletleri yardımıyla karın içerisi açık ameliyata göre çok daha büyütülmüş olarak televizyon ekranından (monitörden) izlenerek ameliyat gerçekleşir.

Bu sayede vücuda en az zarar verilerek (minimal invaziv cerrahi) istenen müdahale yapılmış olur.

Laparoskopik Cerrahi

Kesilere yerleştirilen kameralar sayesinde iç organların büyütülmüş görüntüleri monitöre yansıtılır. Ameliyat bu görüntüler sayesinde yapılmaktadır.

Bu ameliyatlarda cerrahın göz-el koordinasyonu ve tecrübesi açık ameliyatlardan çok daha önemlidir.

Laparoskopik alanda deneyimli bir cerrah, iki boyutlu görüntüyü izleyerek üç boyutlu düzlemde ameliyatı gerçekleştirmektedir. Günümüzde üç boyutlu sistemlerde mevcuttur.

Neden Laparoskopik Cerrahi? (Kapalı Ameliyat)

Laparoskopik cerrahinin amacı büyük bir kesiden kaçınmaktır. Normal cerrahi ile karşılaştırıldığında çok daha az ağrıya sebep olur.

Ayrıca hastanede kalış süresinin kısa olması günlük aktivitelere daha kısa sürede dönme, daha az nedbe dokusu (iz) bırakma gibi avantajları da mevcuttur.

Hastalar açısından, açık cerrahi ile karşılaştırıldığında araştırmalarda belirlenmiş birçok fayda sağlanmaktadır.

Avantajları şu şekilde sıralanabilir;

  • Operasyonlar geniş kesi yapılmadan, yani karın açılmadan gerçekleştirilmektedir. Ciltte geniş ameliyat izi olmaz.
  • Laparoskopi ameliyatları mikro-cerrahi prensipleriyle yapıldığından, karın içerisinde ve ameliyat alanlarında minimal hasar meydana gelmekte ve iyileşme daha kolay ve çabuk olmaktadır.
  • Karın içinde gözlenmesi en zor bölgeler laparoskopi yöntemiyle rahatlıkla görülebildiğinden tedavi imkanı ve başarısı artmaktadır.
  • Laparoskopik ameliyatlar sonrası hastanın ağrı şikayeti daha az olduğundan hastanın genel durumu daha iyi olmaktadır.
  • Laparoskopik ameliyatlar sonrası hastanede kalış süresi daha kısadır. Çoğunlukla aynı gün veya ertesi gün taburcu olunmaktadır. Hastanın ayağa kalkma ve normal fiziksel aktivitesine kavuşması daha kolay ve hızlı olmaktadır. Karın duvarı açılmadığı için hasta daha çabuk iyileşir.

Günümüzdeki tedavi imkanları ile açık cerrahi ve laparoskopi cerrahi açısından her ne kadar yukarıda anlatılan farklar olsa da en önemli nokta doğru tanı ve doğru ameliyat yönteminin uygun hasta için kullanılmasıdır.

Yani kısaca bir ameliyatın laparoskopik yapılması (kapalı ameliyat ile yapılması) hastanın daha iyi bir tedavi olduğu anlamına gelmemelidir. Bunun tam tersi de doğrudur.

Açık ameliyat (klasik ameliyat) olmuş bir hasta daha kötü bir tedavi almış demek değildir.

Laparoskopik Cerrahi Güvenli Olabilir Mi?

Laparoskopik bağırsak cerrahisi bu teknik için özel eğitim almış bir cerrahi ekip tarafından yapıldığı zaman açık cerrahi metod kadar güvenlidir.

Laparoskopik cerrahinin en büyük dezavantajları daha pahalı teknik donanım gerektirmesi, kullanılan aletlerin pahalı olması, eğitim sürecinin normal cerrahiden uzun olması, dokunma hissi ve üçüncü boyutun olmamasıdır.

Laparoskopik Cerrahi Komplikasyonları

Laparoskopik cerrahi ile tedavi güvenlidir. Fakat çok ender gelişebilecek olan yan etkiler (komplikasyonlar) ve riskler vardır. Bunlar enderdir fakat olasılıkları vardır. Bunları bilmeniz olası gelişebilecek komplikasyonların erken tanımlanması ve tedavisine yardımcı olur.

Bu olası yan etkiler ve riskler tek başına laparoskopik yönteme veya ameliyat tekniğine ait olabilir.

  • Karın boşluğunu şişirmek için kullanılan CO2 (karbondioksit) gazı cilt altı dokularda birikebilir. (Deri altı amfizemi). Bu birikim karın duvarında, göğüs kafesi üzerinde, boyunda ve genital bölgede şişmeye yol açabilir.
  • Trokarların karın boşluğuna yerleştirilmeleri sırasında bazen damarlarda yaralanma ve buna bağlı kanamalar oluşabilir.
  • Mide, bağırsak ve idrar torbası (mesane) yaralanmaları laparoskopi sırasında oluşabilecek bir komplikasyonlardır.

Hatırlanması Gereken Noktalar

  • Açık ameliyata göre daha avantajlı olması nedeniyle hem hekim hem de hastalar tarafından tercih edilen laparoskopik yöntem birçok karın içi hastalığının tedavisinde kullanılmaktadır.
  • Açık ameliyatlardan temel farkı cerrahi alanın çıplak göz yerine “trokar” adı verilen kılıflara yerleştirilen kamera aracılığı ile televizyon ekranından (monitörden) görülmesi, el ve açık cerrahi aletler yerine yine trokarlardan yerleştirilen özel laparoskopik aletlerin kullanımıdır.
  • Tüm hastalar laparoskopik cerrahiye uygun olmayabilir. Hangi yöntemin sizin için uygun olduğunu cerrahınızla kararlaştırmalısınız.
  • Laparoskopik cerrahinin amacı büyük bir kesiden kaçınmaktır. Normal cerrahi ile karşılaştırıldığında çok daha az ağrıya sebep olur. Ayrıca hastanede kalış süresinin kısa olması günlük aktivitelere daha kısa sürede dönme, daha az nedbe dokusu (iz) bırakma gibi avantajları da mevcuttur.
  • Laparoskopik bağırsak cerrahisi bu teknik için özel eğitim almış bir cerrahi ekip tarafından yapıldığı zaman açık cerrahi metot kadar güvenlidir.
  • Laparoskopik cerrahi ile tedavi güvenlidir. Fakat çok ender gelişebilecek olan yan etkiler (komplikasyonlar) ve riskler vardır. Bunları bilmeniz olası gelişebilecek komplikasyonların erken tanımlanması ve tedavisine yardımcı olur.

Источник: https://www.kolonrektum.com/laparoskopik-cerrahi

Laparoscopic Hysterectomy – Minimally Invasive Procedures | CIGC

Laparoskopik Cerrahi

There are different ways hysterectomy can be performed, from least invasive to most invasive with varying degrees of risks and benefits.

It is always better for the patient to have a minimally invasive hysterectomy, as recovery is faster than open. Each method has its own limitations.

Look carefully at the advantages and disadvantages of each technique, the total incision length, and the recovery time.

Dualportgyn Hysterectomy

A DualPortGYN hysterectomy is an advanced minimally invasive surgery that outperforms other hysterectomy techniques for surgical results and patient satisfaction. Hysterectomy is the procedure that removes the uterus, and in many cases, the cervix and fallopian tubes. For many women, it is possible to retain their ovaries, which can prevent them from experiencing surgical menopause.

Advantages

Excellent cosmetic results with barely visible scars after surgery.

  • Two 5 mm incisions, located at the belly button and just above the pubic bone.
  • Incisions are placed in the midline, avoiding the abdominal muscles.
  • This placement minimizes bleeding and pain, un conventional laparoscopic and robotic procedures. Incision size and location avoids herniation of bowel through the incision site.

Despite the overwhelming use of open procedures for hysterectomy across the United States, most women are candidates for a DualPortGYN hysterectomy. This includes:

  • Women with an enlarged uterus or large fibroids. Can be used to remove fibroids and the uterus up to 2,500 g. The average uterus weighs between 70 and 100g so almost all patients are candidates for this approach.
  • Patients who have had prior cesarean section or other prior pelvic surgical procedures.
  • Women who are not candidates for vaginal hysterectomy.
  • For those patients who are not candidates for DualPortGYN, a Retroperitoneal Hysterectomy can be accomplished.

All procedures are performed as outpatient surgery. Patients are discharged after surgery on the same day.

Minimal pain, very fast recovery. Recovery is about 1 week.

DualPortGYN is far less expensive, decreasing costs to the patient and the healthcare system. Very low cost compared to conventional or robotic procedures.

Disadvantages

Limited for patients with extreme adhesive disease.

Vaginal Hysterectomy

Vaginal hysterectomy is the removal of the uterus with or without the tubes and ovaries completely through the vaginal opening. This procedure does NOT use any incisions in the abdominal wall. It is the least invasive of all the hysterectomy procedures.

Retroperitoneal Hysterectomy

This approach uses three to four 5 mm incisions to remove the uterus.

This procedure is performed on those patients that have a very large uterus, have a large pelvic mass, extreme endometriosis, and have very extensive scar tissue that requires more than two ports to complete the surgery. In these patients, the use of additional ports is needed to ensure the procedure is completed laparoscopically.

The technique of retroperitoneal dissection is used extensively in these operations, and in 99.5 percent of patients prevents the use of an open incision.

Many patients who would otherwise have had an open surgery using a large incision can have a retroperitoneal hysterectomy, thereby preventing the severe pain, six to eight week recovery, and higher complication rates with open procedures.

Standard Conventional Laparoscopic Hysterectomy

This procedure uses between three and five incisions, ranging in size from 5 mm to 15 mm. This is the conventional approach used by laparoscopic specialists and OBGYN surgeons.

Standard conventional laparoscopy is preferred to robotics or open procedures. The incisions are smaller and the recovery can be faster.

Standard conventional laparoscopy does NOT use retroperitoneal dissection techniques, and can be limited in the extent of surgery performed. It is important to understand that not all surgeons performing this technique have the same skills or experience.

The results with conventional laparoscopy depend on the training and focus of the surgeon doing the procedure.

Surgeons specializing in laparoscopic surgery are able to apply conventional laparoscopy to difficult cases with success, whereas the OBGYN performing only one to two hysterectomies a month ( an 2008 ACOG study) may be limited to patients with smaller uteri and no risk factors such as prior surgery, endometriosis, etc.

Robotic Hysterectomy

Robotic techniques have been applied to benign GYN surgery with some controversy.

In general, robotic procedures allow OBGYNs who are not well trained or comfortable with laparoscopic techniques (DualPortGYN, retroperitoneal, or conventional laparoscopy) to perform hysterectomy procedures through a “minimally invasive” approach. In many cases, these surgeons are primarily comfortable performing open procedures.

Robotic procedures use up to five incisions located throughout the pelvic AND the abdominal cavity, often placed through the abdominal wall musculature.

This means the incisions are often located above the belly button to the right and left sides of the abdomen. The size of the incisions are larger, and range between 8 mm and 1.5 cm totaling up to 50 mm in length.

The total incision length for DualPortGYN is 10mm, one fifth the size of the robotic approach.

Robotic hysterectomy has not been advocated by major medical societies. The American Medical Association (AMA) clearly stated that there is no medical advantage to robotic hysterectomies, but there is a dramatically higher cost. The same has been stated by the American Association of Gynecologic Laparoscopic Surgeons (AAGL), and the American College of OBGYN (ACOG).

In addition, complications with this approach have been higher, with many class action lawsuits arising from complications reported in GYN and urological procedures. The FDA also recently submitted a warning to a company regarding the use of a robot for surgery.

Open Abdominal Hysterectomy

Open abdominal hysterectomy is still the most common method used for hysterectomy in the US. This operation uses a large incision, either horizontal or vertical, to open the abdomen and remove the uterus. The reason most patients undergo this approach is the limited laparoscopic training of their OBGYN.

Beware of explanations of how “your uterus is too large to remove laparoscopically”, “you are too heavy”, or have had “a cesarean section.

” There are much better approaches to a hysterectomy for almost all patients and any size uterus, resulting in much faster recovery, less pain, and fewer complications than open procedures.

Open abdominal hysterectomy is not advocated for any patient that can undergo a laparoscopic procedure. Patients need to do their research to find experts in minimally invasive GYN surgery in their area. Most laparoscopic experts can perform hysterectomies safely and effectively without the use of invasive open techniques.

Patients need to consider a second opinion to these experts to optimize their surgical care and avoid unnecessary complications and long recovery. Remember YOU are undergoing the surgery, not your OBGYN. Ask the right questions and be your own best advocate.

Find the best possible surgical care to avoid the increased pain, recovery, and complications of an unnecessary open surgical procedure.

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