Laparoscopy wani bincike ne ko aikin tiyata akan gabobin ciki na kogon ciki ko ƙashin ƙugu. Laparoscopy wata hanya ce ta tiyata ta zamani wacce ba a yin ta ba ta hanyar buɗaɗɗen yanayi ko manyan ɓangarorin fata ba, amma ta hanyar ƙananan huda (yawanci 0.5-1.5 cm), yayin da tiyata na al'ada yana buƙatar manyan ɓangarorin don haka yana barin manyan tabo. Don huda, ana amfani da trocar, tare da taimakon wanda aka huda bangon ciki, kuma an saka na'urar gani na bakin ciki (laparoscope) a cikin bututu mai diamita na 0.2-1.0 cm.
Babban kayan aikin laparoscopy shine laparoscope - bututun ƙarfe tare da diamita na 5-10 mm (2 mm don micro laparoscopy) tare da tsarin ruwan tabarau mai rikitarwa da jagorar haske. Ruwan tabarau yana watsa hoton daga ruwan tabarau zuwa gunkin ido, kuma jagoran hasken yana jagorantar hasken haske daga mai haskakawa zuwa cikin rami na ciki. Kuna iya duba kai tsaye a cikin ruwan tabarau na laparoscopic - an yi wannan shekaru da yawa, amma tare da zuwan ƙananan kyamarori na endoscopic (yanzu suna auna 50-150 grams) a haɗe zuwa ruwan tabarau na laparoscopic a cikin shekaru talatin da suka wuce, duk ma'aikatan dakin aiki zasu iya ganin duk ci gaban aikin a kan mai saka idanu. Ana yin bincike da wasu hanyoyi masu sauƙi a ƙarƙashin maganin sa barci na gida, kuma yawancin hanyoyin laparoscopic ana yin su ne ta hanyar maganin sa barci na gabaɗaya.
Babu wani abu kamar "laparoscopic tiyata". Laparoscopy yana daya daga cikin hanyoyin shiga gabobin tiyata. Ko da kuwa hanyar aiwatarwa, yanayin aikin tiyata ba ya canzawa. An samar da waɗannan sharuɗɗan ta amfani da tushen kalmar “scope” (daga ma’anar Hellenanci-na gani), rabin farkon sunan hanyar da ke nuna sashin jiki ko rami da ake sarrafa ko bincika.
Laparoscopy yana daya daga cikin nau'ikan endoscopy, kuma endoscopy ya hada da laparoscopy, gwajin thoracoscopic, hysteroscopy, cystoscopy, arthroscopy da sauransu.
Thoracoscopy - tsoma baki a kan kirji;
Nephroscopy - tsoma baki da tiyata a kan kodan;
Cystoscopy - tiyata a kan mafitsara;
Hysteroscopy - aikin tiyata a kan mahaifa;
Gastroscopy - tiyata a cikin ciki.
Idan an ƙara prefix "fibro" a cikin sunan, yana nufin cewa ana yin aikin ta amfani da endoscope mai sassauƙa, alal misali, fiber hysteroscopy shine jarrabawar mahaifa ta amfani da endoscope mai sauƙi.
Dabarar tiyatar laparoscopic ta bambanta dan kadan dangane da nau'in tiyata da cibiyar kiwon lafiya. An shirya marasa lafiya don karɓar kulawa iri ɗaya kamar aikin tiyata na al'ada. Na farko, an yi wa marasa lafiya a cikin unguwa allura da kwayoyi don ƙarin jin zafi da ingantaccen inganci. Ana kiran waɗannan ayyukan "gwamnatin kafin aiki". Daga nan sai a kai majinyacin zuwa dakin tiyata a kan shimfida.
Ana saka catheter mai laushi mai laushi a cikin jijiyar majiyyaci don jiko magunguna, mafita, maganin sa barci, da rage radadi. Ana haɗe abin rufe fuska na roba ko silicone a fuskar mara lafiya kuma ana ba da cakudawar numfashi ta abin rufe fuska.
Bayan dakika kadan, majiyyaci ya yi barci kuma likitan anesthesiologist ya shigar da shi - ya sanya bututun filastik da aka daure a cikin hanyar iska, yana busawa kuma ya tabbatar da hanyar iska. Yayin tiyata, majiyyaci yana karɓar iskar huhu ta wucin gadi.
Don laparoscopy, rami na ciki yana cike da gas - a mafi yawan lokuta, ana amfani da carbon dioxide don wannan dalili. Ana allurar iskar gas don ɗaga bangon ciki zuwa siffar kubba a sama da gabobin da samar da kyakkyawar gani da samun damar shiga gabobin. Mataimakan da likitocin fiɗa sun yi wa majinyacin gabaɗayan ciki magani tare da maganin kashe ƙwayoyin cuta don yuwuwar sauye-sauye don buɗe aikin tiyata kuma, bisa ga umarnin likitancin, an saka dogon allurar Veress ta cibiya. An ƙera shi tare da cibiya mai ɗorewa na bazara don rage yuwuwar lalacewar gabobin ciki a lokacin huda ciki. Bayan tabbatarwa tare da taimakon gwaje-gwaje da yawa cewa allurar tana cikin rami na ciki, an haɗa bututun insufflator zuwa allura. Wannan na'urorin lantarki na zamani yana ba da damar isar da carbon dioxide cikin rami kuma ta atomatik yana kiyaye matsa lamba a ciki tare da daidaiton 1 mmHg.
Bayan karfin iskar gas a cikin rami ya kai 10-16 mmHg (ya danganta da zabin likitan fiɗa), an cire allurar Veress kuma an saka trocar ta farko ta cibiya - bututun ƙarfe ko filastik wanda aka shigar da bincike na trihedral ko tapered a ciki. Bayan an huda bangon, za a cire salon a saka ta cikin cannula (tube) a cikin endoscope da laparoscope. Laparoscope shine diamita 10, 5 ko 2 mm (ta amfani da micro laparoscope) bututun ƙarfe tare da tsarin ruwan tabarau mai rikitarwa da jagorar haske. Tare da ƙananan kyamarori na bidiyo da aka haɗe masu nauyin gram 50-100 da halogen ko xenon hasken hasken wuta (masu haskakawa), dukan ƙungiyar masu aiki za su iya lura da ci gaban aikin akan allon saka idanu.
Bayan gabatar da laparoscope, duba kogon ciki kuma saka ƙarin trocars 2-4 a ƙarƙashin kulawar gani. Ma'anar gabatarwar trocar ya dogara da sashin da aka yi wa aiki da nau'in shiga tsakani - a cikin cholecystectomy, an shigar da trocar a cikin babban ciki a ƙasa da ƙananan kaya, a cikin tiyata na gynecological - a cikin ƙananan ciki.
A ka'ida, kayan aikin da ke da tsayin 30-40 cm da diamita na 2 zuwa 12 mm na iya yin duk ayyuka iri ɗaya kamar fasahar tiyata na al'ada. Riƙewa, sacewa zuwa gefe, kama sashin jiki tare da shirye-shiryen bidiyo, saki da rabuwa na gabobin da ke kewaye da nama (dissection) ta hanyar dissectors, endoscopic almakashi da kayan aikin lantarki, tare da taimakon coagulation, dangi na dakatar da zubar da jini na ƙananan tasoshin. Coagulation - sunadaran suna ninkawa a ƙarƙashin rinjayar babban ƙarfin halin yanzu, don haka lumen na jini yana rufewa. Za a iya dakatar da zubar da jini daga manyan tasoshin ta hanyar yankan (amfani da shirye-shiryen titanium), ɗaure tare da kayan suture, da kuma sutura tare da stapler endoscopic.
Endoscopic staplers suna taka muhimmiyar rawa a cikin aikin tiyata na endoscopic - wannan na iya zama kamar sabon abu, amma a maimakon fatar jiki likitan likitan yana riƙe da mariƙin allura na tsawon lokaci - Tsarin dinki, sutura, da bandeji yana ɗaukar lokaci mai yawa fiye da rarrabawar nama. Kwararren likita na iya ɗaure kusan kullin aminci 60 a cikin minti ɗaya, ko kulli ɗaya a cikin daƙiƙa guda. A halin yanzu, a cikin aikin tiyata na endoscopic, hannun likitan tiyata ana maye gurbinsu da kayan siririn da ke da wahalar ɗaure. Don haka, alal misali, ƙungiyar Turai ta Turai da likitocin su saita daidaitaccen - ƙulla da sau uku ƙulli a cikin sakan 40. Don haka wannan bidi'a ce ta juyin-juya-hali wacce ta taka muhimmiyar rawa wajen fadada iyakokin ayyukan endoscopic, staplers. Likitoci na iya aiwatar da anastomoses na ciki tare da motsi ɗaya na hannu, suna wucewa ta cikin hanji, suture tasoshin jini, da dai sauransu, maimakon dogon lokaci kuma wani lokacin kusan ba zai yiwu ba. Ya zama mai yiwuwa a zahiri don yin kowane aikin tiyata ta hanyar aikin tiyata na endoscopic tare da taimakon stapler.