Laparoscopy

Definition of laparoscopy

As a diagnostic method, it is mainly used for unclear abdominal complaints and when other examinations such as ultrasound or computer tomography did not provide any information. Laparoscopy is a minimally stressful (minimally invasive) procedure that takes place under general anesthesia. Depending on the scope of the examination, the laparoscopy is performed on an outpatient basis or in a hospital and takes about 10 to 30 minutes.

Application Examples For Laparoscopy

    • For women who want to have children, check the patency of the fallopian tubes as well as for sterilization.
    • Examination of the liver, pancreas, spleen, and uterus as well as the stomach and intestines.
    • Taking tissue samples for microscopic examination (biopsy) to assess whether a tumor is benign or malignant.
    • Testicle search

Operative interventions

    • Removal of the gallbladder (laparoscopic cholecystectomy)
    • Removal of kidney cysts
    • Removal of the appendix from the appendix (laparoscopic appendectomy) in appendicitis
    • Removal of the uterus (laparoscopic hysterectomy)
    • Removal of fibroids and islets of endometriosis in endometriosis (growths of the uterine lining)
    • Inguinal hernia surgery
    • Cutting the branches of the 10th cranial nerve (vagus nerve) to reduce gastric acid production in gastric and duodenal ulcers
    • Creation of an artificial intestinal outlet (anus praeter).

Laparoscopy

The course of the laparoscopy

General anesthesia is necessary for laparoscopy. So that the doctor has space and an overview of the abdomen, carbon dioxide is first filled into the abdomen as a gas through a small skin incision with a hollow needle. The laparoscope (instrument with light source and camera) and surgical instruments (e.g. suction devices or forceps) are inserted through further small incisions in the abdominal wall. The camera transmits the recordings to the monitor so that the surgical team can see what is happening in the abdominal cavity.

Before laparoscopy

In order to minimize complications, you should inform the doctor of any pre-existing medical conditions and previous surgeries before the laparoscopy.

After the laparoscopy

You are often allowed to leave the hospital or practice shortly after a laparoscopy. On the day of the operation, it is better not to drive yourself. Use public transport. Better yet, have someone pick you up or take a taxi.

It is generally recommended that you remain under observation for a few hours after the laparoscopy. During this and afterward, you should rest, lie in bed, and, if possible, sleep. A mild pain reliever, such as an agent with the active ingredient ibuprofen, can help against pressure pain in the abdomen. As a rule, the attending physician will give you a recommendation or even give you the medication.

Side Effects Of Laparoscopy

The side effects of laparoscopy can include:

    • Nausea, headache, exhaustion as a result of anesthesia
    • Tenderness and bruising on the abdomen
    • Pain in the shoulders and pelvis
    • Injuries to surrounding organs are very rare.

Coverage of the Laparoscopy

Not all reasons (indications) for laparoscopy are a health insurance benefit. If the doctor has a prescription (i.e. for every medically necessary procedure), the costs are usually covered.

Endoscopy: Reflection of Body Cavities

During an endoscopy, the doctor inserts a probe and optics into a body cavity. Depending on the region, for example, there are lung, stomach, intestinal or abdominal reflections

Endoscopes are rigid or flexible depending on the cavity

Depending on the body region, either rigid probes or flexible tubes are suitable as endoscopes. The optics at the top can in the simplest case consist of a mirror as in the indirect laryngoscope reflection. Often these days, however, these are high-quality miniature cameras that transmit the image to a monitor in real time during the procedure.

There are types of endoscopy in which the doctor introduces the endoscope through a natural body opening: he can control the larynx, lungs and stomach via the nose or mouth, the large intestine via the anal opening, the bladder via the urethra. Other types of endoscopy require small cuts in the skin to reach the area. Examples include joints or the abdominal cavity.

Interventions by endoscopic tools possible

An endoscopy is not only for the examination, but the doctors can also perform interventions: In tube-like endoscopes they introduce tools such as pliers and milling directly through the tube. In the context of joint reflections and laparoscopy, the doctor creates a skin incision a second or third access, in order to use his tools effectively. Physicians can use a bronchoscope to flush the lungs, a so-called bronchial lavage, and then aspirate the liquid used again.

The procedures in detail:

    1. Laryngoscopy (laryngoscopy)

The doctors distinguish between indirect and direct laryngoscopy. In indirect laryngoscopy, the doctor holds a small mirror and style in the pharynx while the patient is awake. In this way he can look at the vocal folds. The direct laryngoscopy, the doctor can perform only in an unconscious or anesthetized patient. Depending on the project, he uses either an intubation or a surgical laryngoscope. The spatula-shaped intubation laryngoscope is used for the correct placement of a breathing tube. With the tubular surgery laryngoscope the doctor performs interventions on the larynx.

    1. Lung reflection (bronchoscopy)

If x-ray and computed tomography of the lungs do not provide sufficient information, pulmonary mirroring is a possible diagnostic method. It also plays a role in the treatment, for example to extract viscous mucus. During lung reflection, the doctor inserts the endoscope over his nose or mouth. This endoscope consists of a soft, flexible tube with two to six millimeters in diameter. At the top of the hose sits a camera with light source.

    1. Gastroscopy (gastroscopy or esophago-gastro-duodenoscopy)

A gastroscopy is a method of examination, with the help of which complaints of the esophagus (esophagus), the stomach (Gaster) and the duodenum (duodenum) can be clarified. The gastroscope used in this case is an optical device in the form of a flexible plastic tube. In addition to the camera and the light source, the hose also has additional working channels. Using these channels, for example, the doctor can take tissue samples with pliers, so-called biopsies. He can also spray on the gastroscope dyes on the mucous membranes to make changes more visible. If the doctor also injects contrast medium from the duodenum into the bile ducts and the pancreatic duct, and then makes an X-ray, the procedure is called ERCP. This abbreviation stands for Endoscopic Retrograde Cholangiopancreaticography).

    1. Laparoscopy

During the laparoscopy, the doctor inserts a tubular endoscope into the abdominal or pelvic cavity through the abdominal wall to assess the internal organs. In addition to the diagnosis, laparoscopic surgery is also possible in the same procedure. In contrast to an open surgery on the abdomen, the so-called laparotomy, only a few small incisions are necessary for procedures with the laparoscope. Through these small cuts, the doctor can bring both the endoscope and the surgical equipment in the abdominal cavity. Because of the small access, one also speaks of keyhole surgery.

    1. Small intestinal reflection (capsule endoscopy)

capsule-endoscopy

The small intestine is difficult to reach by tube. Therefore, there is a special form of endoscopy with the help of a camera capsule. This capsule is only about 2.5 inches long and has a diameter of just over one centimeter. The patient ingests the capsule, which then passes naturally through the gastrointestinal tract. Meanwhile, she sparks photos outside. These images record a receiver worn by the patient during the examination. The patient can therefore move freely during the examination. Subsequently, a trained doctor evaluates the automatically recorded images. Capsule endoscopy is used primarily when it comes to the question of bleeding in the small intestine or chronic inflammatory bowel disease (Crohn’s disease).

    1. Colonoscopy (colonoscopy)

colonoscopy

A colonoscopy reveals various diseases on the colon (colon) and at the end of the small intestine (terminal ileum). In addition, it is a very reliable method to detect colon cancer and its precursors. The precursors are benign mucosal growths and are called polyps. The doctor can also remove these polyps by means of colonoscopy. To prepare for the exam, the patient must remain sober the day before at noon and take laxative as prescribed by the physician. If the examination only covers the lowest sections of the colon, no oral laxatives are necessary. Depending on the extent of the examination, the doctor then talks about proctoscopy, rectoscopy or sigmoidoscopy

    1. Bladder reflexion (cystoscopy)

In the case of cystoscopy, the doctor examines the lower urinary tract with a special examination device (cystoscope). The lower urinary tracts include the urethra and the bladder. With cystoscopy, the doctor can detect and assess changes such as urethral narrowing, enlargement of the prostate, changes in bladder sphincter function, tumors or bladder stones. If necessary, minor surgical interventions in the context of a bladder reflex are possible with anesthesia. In ureteroscopy, the doctor also examines the ureters, which transport the urine from the kidneys to the bladder.

    1. Articulation (arthroscopy)

Joint Surgery is a surgical procedure in which the physician inserts an endoscope into the joint cavity. This intervention can serve both the diagnosis and the treatment. However, the need for diagnostic arthroscopy has declined significantly due to the further development of magnetic resonance imaging. Therapeutic arthroscopy, on the other hand, can often replace major surgery, for example when replacing a torn ACL in the knee joint.

    1. Endoscopy of other parts of the body

endoscopy-of-other-parts-of-the-body

Also, a reflection of the salivary glands is possible, the ENT specialist then speaks of a sialendoscopy. He can examine the nose and paranasal sinuses by means of a sinus copy. He examines the ear by ear funnels and calls it otoscopy. He can clarify the causes of snoring by means of somnoendoscopy (a kind of pharyngeal reflection) under anesthesia.

The examination of the ocular fundus is called ophthalmoscopy, although the ophthalmologist uses only a concave mirror, magnifying glass or slit lamp in front of the eye.

Gynecologists reflect vagina and cervix with a colposcopy. The uterus is examined by hysteroscopy and the breast ducts by a ductoscopy.