One of the minimally invasive methods is Laparoscopic surgery. It is the general name of the operations performed through small incisions of 5-10 mm in the abdominal cavity. Laparoscopy surgery takes place under general anesthesia. It is entered with a camera by making a -10 mm incision in the patient's belly button, and 2 or 3 5 mm wide incisions are made in the lower abdomen to allow the insertion of surgical instruments, so there is no surgical scar left after the operation. During the operation, the intra-abdominal image is projected onto the screen with an optical device, and CO2 gas is injected into the abdominal cavity for better visualization of the intra-abdominal organs. Operations performed with the laparoscopic surgery method should not be performed on every patient, but only on patients who meet certain criteria and by doctors who have experience in this field. Some precautions should be taken to reduce complications: mechanical bowel cleansing should be performed before the surgery, the umbilicus should be thoroughly cleaned, if there is a piercing, it should be removed, a urinary catheter should be inserted during the surgery to balance the bladder filling and therefore prevent damage. The reason why the patient's preparation for surgery takes a long time is that correct positioning of the patient is important in preventing nerve injury.
A Veress needle is applied to the lower part of the belly button of patients who are anesthetized. After the injection is applied, the abdominal area is inflated with CO2 gas. Gas application also allows the internal organs to be seen much more clearly. After the abdominal area is inflated, a camera is inserted inside using a trocar. Then, approximately 5 mm incisions are made around the belly button to allow entry of other instruments to be used in the surgery, and the surgery is performed in this way. If a hysterectomy (uterus removal) is to be performed, the uterus is generally removed from the vagina, during myomectomy (only myoma removal), it is removed by enlarging the incision a little, or if the myoma is very large, it is divided with special tools (morcellators) and removed using carrier bags.
After the surgery is completed, the camera and Other instruments are removed, the gas given to the patient is emptied, and the incisions are closed. In this way, the patient's operation is completed.
TO WHOM IS GYNECOLOGICAL LAPAROSCOPY PERFORMED?
Laparoscopy surgery is performed in oncological patients as well as in benign surgeries. Despite this, patients should be evaluated carefully before undergoing laparoscopic surgery. The size of the mass should not be larger than 15 cm. Taking up too much space on the umbilicus causes a decrease in the range of motion of laparoscopic instruments. The patient's age, previous surgical interventions, previous radiation therapy, and adhesions due to previous surgeries should be taken into consideration.
When there is excessive adhesion in the abdomen, it becomes difficult to perform in cases of ovarian cancer, and we may face the risk of perforation (intestinal damage). In some cases, conversion to open surgery is seen; if the preliminary evaluation is done well, this situation is less common.
In gynecology: Laparoscopic surgery of patients with uterine myomas in cases of subserous myoma, intramural myomas, ovarian cysts, dermoid cysts, endometriosis cysts, and ectopic pregnancy. It can be done.
In oncology patients with endometrial cancer, the surgery is performed laparoscopically. Lymph dissection of the patients and laparoscopic trachelectomy is performed for those who want to have children in the early stages of cervical cancer and in the future.
Laparoscopic sentinal lymph nodes are removed and the patient's surgery is performed. We will be informed about how far to go. Laparoscopic surgery means few small instrumentation sites, less blood loss, and earlier return to home or work.
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