Laparoscopy is widely used in gynecology, such as hysterectomy, ovarian cystectomy, ectopic pregnancy, etc. The following describes the operation methods and precautions of laparoscopic surgery.
Operation method of laparoscopic surgery:
1. Anesthesia: local anesthesia or general anesthesia is often used;
2. Position: Take the bladder lithotomy position, routinely disinfect the vulva and vagina, place the uterine lift, and pay special attention to cleaning the umbilical fossa and draping when disinfecting the abdominal skin.
3. Artificial pneumoperitoneum: Use two towel pliers to symmetrically clamp the skin and subcutaneous fat tissue on both sides of the navel chakra, incise the skin 1cm below the manipura chakra, lift the abdominal wall as much as possible, and insert the pneumoperitoneum needle at an angle of 45° below the incision. After needle aspiration, a water experiment was performed, and it was confirmed that the CO2 inflator was connected after entering the abdominal cavity, and then the pressure experiment was performed. If the pressure was normal, the artificial pneumoperitoneum was started, usually the inflation volume was 2.5-4L, and the intra-abdominal pressure was 2.00kPa (15mmHg).
4. Trocar puncture: After the pneumoperitoneum is successful, pull out the pneumoperitoneum, slowly insert the trocar into the abdominal cavity at the incision, and pull out the trocar core after you feel it enters the abdominal cavity, and insert the laparoscope after hearing the gas rushing out of the abdominal cavity .
5. Laparoscopic observation: place the patient at a 30-degree angle to the horizontal with the head low and buttocks high. The surgeon is on the left side of the patient, holding a laparoscope, and sequentially observe the uterus, fallopian tubes, ovaries, uterine rectal depression, and other lesions in the pelvic cavity. , Move the endoscope or use the uterine lifter to move the uterus as needed to expose the various parts of the pelvic cavity. If necessary, perform different operations as needed; if you want to check whether the fallopian tube is unobstructed, you can inject pigment fluid from the uterine variator catheter to observe the degree of unobstructedness; , Pay attention to whether there is bleeding or injury, then pull out the laparoscope, drain the gas in the abdominal cavity, slowly pull out the sleeve, suture the incision, and cover with sterile gauze.
Operation precautions for laparoscopic surgery:
1. Patients with ascites must put about 3000ml of ascites first, and then check.
2. When artificial pneumoperitoneum is performed, the pneumoperitoneum needle must be prevented from penetrating the blood vessel and omentum.
3. When checking the upper abdominal organs, you can take the head high and the feet low, and the opposite is the case when checking the lower abdominal organs. If necessary, you can rotate the patient's position at any time, such as from the supine position to the right elevated position.
4. The following complications can occur and should be prevented: 1. Subcutaneous emphysema, abdominal emphysema, omental emphysema, mediastinal emphysema, pneumothorax, air embolism, etc. occur during artificial pneumoperitoneum. 2. When the laparoscopic puncture cannula is inserted, bleeding and organ damage may occur, so do not use violence in the operation. 3. Bleeding can be caused when living tissue is taken, so it should be detected early and dealt with in time.