Laparoscopy
Laparoscopy, also known as minimally invasive surgery, or as it is popularly known, closed surgery, is performed through small holes of half to one and a half centimeters wide opened in the abdomen, using long, thin rod-shaped instruments. are the surgeries performed. The reason why it is called minimally invasive surgery is that it does not require large incisions on the skin and the anterior abdominal wall, as in open surgeries called laparotomy, and the surgery can be completed with tiny incisions, meaning it is very less invasive.
Another name for these surgeries is endoscopy. Endo means inside, scopy means looking inside, that is, looking inside. Laparoscopy means looking inside the abdomen. The surgery is performed by monitoring it with a camera on large screens, and can even be recorded.
The basic device used in the surgery is a camera-monitor system called a laparoscope. Today, camera systems produced with advanced technology can create HD and even 3D images and magnify the organs in the abdomen up to 10 times and project them onto the screen. Since this provides us with a clearer and more detailed view than what we can see with the naked eye, it becomes technically easier to perform many surgeries. All of the tools used in surgery, such as scissors, forceps, and portugues, which are tools used for stitching, are in the form of long, thin rods that can be entered through these small holes and used to perform surgery inside.
Which surgeries can be performed laparoscopically in gynecological diseases?
Although laparoscopic surgery is more often used in the treatment of benign diseases, closed surgeries are increasingly used in the treatment of gynecological cancers. Some examples of surgeries where laparoscopy is used in gynecological surgery can be listed as follows:
Tubal ligation with closed surgery (Laparoscopic BTL)
Diagnostic laparoscopy
Endometriosis (chocolate cyst)
Ovarian (ovarian) surgery
Removal of tumor from the uterus (myomectomy)
Removal of the uterus (hysterectomy)
Uterus (endometrium) cancer
Cervical (cervix) cancer
Uterine prolapse surgeries
How will I prepare for closed surgery?
How is bowel cleansing done?
In what position will I lie down during the surgery?
Will there be any other preparations before the surgery?
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Hysteroscopy
How is closed surgery performed, how many stitches will I have in my abdomen?
kac_stitchesIn closed surgery, The aim is to open a hole extending into the abdomen from or near the patient's belly button and look inside with a camera. Then, after filling the abdomen with carbon dioxide gas and creating a clear field of view, the surgery is performed by opening tiny holes in various parts of the abdomen and using thin, long rod-shaped instruments placed there. It is called closed surgery because the patient's abdomen is not cut or slit, only some holes are opened. Often, when starting the surgery, air is injected into the abdomen from the navel with a needle called the Veress needle, and the camera is then placed. Or, especially in patients who have had a previous cesarean section or other surgeries, when it is thought that the internal organs may be stuck together, the edge of the umbilicus can be cut and the camera can be advanced into the abdomen by directly viewing and monitoring. In laparoscopy, the camera is in the form of a long thin rod and is called laparoscope (Latin: instrument used to look inside the abdomen). The actually dark inside of the abdomen is illuminated by a cold light source system consisting of a fiber optic cable connected to the camera and a tiny lamp at the end. How it is removed from the holes is also an interesting issue. If the removed tissue is too large to come out of the one-centimeter hole, it is either placed in extractors called endobags, which are closed outside the body and opened inside and turned into bags, and pulled out without spilling into the body, or it is removed in the form of thin long strips with a morcellator, a tool similar to the meat grinder used by butchers. It is cut into pieces and removed.
Although the number of holes or stitches in the abdomen in gynecological surgeries varies depending on the type of surgery, it generally does not exceed three. The primary puncture in the navel usually creates a single stitch scar, 1 cm wide. Secondary holes sometimes do not occur at all (e.g., which can be completed through a single hole - single port - tube ligation, uterine surgeries), sometimes two or more holes are present. There may be three, but these other holes are generally smaller than the one in the hub, about half a centimeter wide. Although in some closed surgeries - especially in cancer cases - this number may be five or six, since each hole is smaller than one centimeter, most of the time there will be no scar or only a faint scar.
What is hysteroscopy and in what cases is it applied? ?
Hysteroscopy can be briefly defined as "looking inside the uterus". It was invented to visually diagnose and sometimes treat common intrauterine problems and is performed with a system similar to the camera system in laparoscopy. Unlike laparoscopy, it can also be performed under local anesthesia under office hysteroscopy, under office conditions.
Hysteroscopy is performed to examine the endometrial cavity (inside the uterus), the openings of the tubes and the endocervical canal, most frequently in the following cases:
Abnormal premenopausal or postmenopausal uterine bleeding,
Endometrial thickening (thickening of the uterus) or polyps,
Submucosal myomas (growing into the uterus),
Intrauterine adhesions,
Congenital disorders such as intrauterine curtain,
Spirals and similar foreign objects that stick to the uterus and do not come out,
Request for blockage of the tubes,
Cleaning of remaining pregnancy residues stuck to the uterus,
Endocervical (intrauterine Myometrial (muscle wall of the uterus) thickness, whether the tubes are adherent or the outer walls of the uterus cannot be evaluated with hysteroscopy. For this reason, hysteroscopy and laparoscopy are performed together in many cases where these examinations are required.
Who cannot undergo hysteroscopy?
Those with significant intrauterine pregnancy
Those with active pelvic infection (including genital herpes infection). )
Hysteroscopy should not be performed on people with known cervical or uterine cancer.
In those with excessive bleeding, bleeding may make the hysteroscopy procedure technically difficult, but this is not a contraindication.
What kind of system is the hysteroscopy system?
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Rigid hysteroscope is a device similar to a laparoscope. It is a telescope inside an outer sheath, allowing fluid passage and the passage of instruments in the form of long thin rods when intervention is required. There are most channels. There are also flexible hysteroscopes, which are not shaped like a rigid tube but are made of a material that can be bent and bent. Although surgery-related pain is slightly higher with rigid hysteroscopes, image quality and procedure success are higher. For this reason, flexible types are not preferred routinely, but in the presence of conditions that make the procedure difficult, such as adhesions or anomalies in the uterus. In the hysteroscopy system, the image is projected on the screen with a camera system, and the illumination is obtained by cameras called optics, which are bendable tubes that do not produce heat, called fiberoptic light sources.
In diagnostic hysteroscopy, the aim is to make a diagnosis just by looking. In operative hysteroscopy, intervention can be made using tools such as scissors, clamps, cautery, and polyps and submucous myomas can be removed with a tool called resectoscope.
When is it most appropriate to perform hysteroscopy?
For women with regular menstruation before menopause. The best time to visualize the inside of the uterus is during the proliferative period, that is, the first 14 days of the menstrual cycle. Since the uterine lining will thicken in the second 14 days, an endometrial polyp-like appearance may be obtained. During menstrual bleeding, blood may distort the image.
It is difficult to predict the ideal timing in women with irregular menstrual bleeding. For this reason, the intervention may be attempted at a specified time, and if the intrauterine thickness is not suitable, it may need to be repeated at a later date.
Another approach is to thin the endometrium (inside the uterus) with medication. Slimming agents should be used when procedures such as myoma removal or endometrial ablation are planned. Because these agents can disrupt the cellular structure of the endometrium and be misleading in pathological examination.
For post-menopausal women, hysteroscopy can be performed at any time.
What should be done before and after hysteroscopy?
In order for the hysteroscope to pass through the cervix, which is a hard and closed tissue, and enter the uterus, the cervix may need to be loosened mechanically (using tools called bougies) with medications or after anesthesia.
In women who have never given birth, the cervix is more closed and tight. Therefore, the medicine may need to be used the night before. In hysteroscopy procedure, rut In general, antibiotic use is not required. It is sufficient to clean the vagina and cervix with iodine solution before the procedure.
A good approach is to apply anesthesia to increase patient comfort. Generally, a light anesthesia in the form of sedation is applied and this is sufficient. Although office hysteroscopy can sometimes be performed with local anesthesia, by numbing only the cervix, this is not a common practice. Taking a painkiller from the nonsteroidal anti-inflammatory drug group before the procedure can reduce the pain felt after the procedure.
After hysteroscopy, cramp-like pain or slight bleeding and vaginal discomfort may occur. Pain medication can be used for these complaints. The patient can return to normal daily activities within 24 hours after the procedure. It is free to take a shower standing up, do light housework, and continue normal daily life, but it is necessary to avoid penetrating practices such as vaginal tampons, sexual intercourse, and vaginal showers for at least ten days after the procedure. It is appropriate to go to your doctor for a check-up ten days after the procedure.
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