Laparoscopy ndi matenda kapena opaleshoni alowererepo pa ziwalo za m`mimba patsekeke kapena m`chiuno. Laparoscopy ndi njira yamakono opaleshoni imene opaleshoni ikuchitika osati mwa mipata zachilengedwe kapena lalikulu incisions khungu, koma kudzera ang'onoang'ono (kawirikawiri 0.5-1.5 cm) punctures, pamene opaleshoni ochiritsira amafuna incisions lalikulu motero amasiya zipsera zazikulu. Popuncture, trocar imagwiritsidwa ntchito, mothandizidwa ndi khoma la m'mimba, ndipo chipangizo chochepa kwambiri cha kuwala (laparoscope) chimalowetsedwa mu chubu chokhala ndi masentimita 0.2-1.0.
Chida chachikulu cha laparoscopy ndi laparoscope - chubu chachitsulo chokhala ndi mainchesi 5-10 mm (2 mm kwa laparoscopy yaying'ono) yokhala ndi dongosolo la mandala ovuta komanso kalozera wowunikira. Lens imatumiza chithunzicho kuchokera ku lens kupita kuchochowona, ndipo kalozera wowunikira amawongolera kuwala kuchokera pa chowunikira kupita kumimba. Mukhoza kuyang'ana mwachindunji mu lens laparoscopic - izi zakhala zikuchitika kwa zaka makumi ambiri, koma kubwera kwa makamera ang'onoang'ono a endoscopic (tsopano akulemera 50-150 magalamu) ophatikizidwa ndi lens laparoscopic m'zaka makumi atatu zapitazi, onse ogwira ntchito m'chipinda cha opaleshoni amatha kuona momwe ntchito ikuyendera pa polojekiti. Kuzindikira ndi njira zina zosavuta zimachitidwa pansi pa anesthesia wamba, ndipo njira zambiri za laparoscopic zimachitidwa pansi pa anesthesia.
Palibe "opaleshoni ya laparoscopic". Laparoscopy ndi imodzi mwa njira kupeza opaleshoni ziwalo. Mosasamala kanthu za njira yogwiritsira ntchito, chikhalidwe cha opaleshoni sichimasintha. Mawuwa amapangidwa pogwiritsa ntchito liwu loti "scope" (kuchokera ku Greek scope-I see), theka loyamba la dzina la njirayo lotanthauza chiwalo kapena chibowo chomwe chikuyendetsedwa kapena kufufuzidwa.
Laparoscopy ndi imodzi mwa mitundu ya endoscopy, ndi endoscopy zikuphatikizapo laparoscopy, thoracoscopic kufufuza, hysteroscopy, cystoscopy, arthroscopy ndi zina zotero.
Thoracoscopy - kuchitapo kanthu pa chifuwa;
Nephroscopy - kulowererapo ndi opaleshoni pa impso;
Cystoscopy - opaleshoni pa chikhodzodzo;
Hysteroscopy - kuchitapo opaleshoni pa chiberekero;
Gastroscopy - opaleshoni pamimba.
Ngati mawu oyambira "fibro" awonjezeredwa ku dzina, zikutanthauza kuti njirayi ikuchitika pogwiritsa ntchito endoscope yosinthika, mwachitsanzo, fiber hysteroscopy ndikuwunika chiberekero pogwiritsa ntchito endoscope yosinthika.
Njira ya opaleshoni ya laparoscopic imasiyanasiyana pang'ono malinga ndi mtundu wa opaleshoni ndi bungwe lachipatala. Odwala amakonzekera kulandira chithandizo chofanana ndi opaleshoni yachizolowezi. Choyamba, odwala omwe ali m'chipindacho amabayidwa ndi mankhwala kuti achepetse ululu komanso kuti azigwira ntchito bwino. Ntchitozi zimatchedwa "preoperative administration". Kenako wodwalayo amatengedwa kupita kuchipinda cha opaleshoni pa machira.
Katheta wofewa wapulasitiki amaikidwa m'mitsempha ya m'mimba mwa wodwalayo kuti amwemo mankhwala, mankhwala, mankhwala opha ululu, ndi zochepetsera ululu. Chigoba cha rabara kapena silikoni chimamangiriridwa ku nkhope ya wodwalayo ndipo kusakaniza kopumira kumaperekedwa kudzera mu chigoba.
Masekondi angapo pambuyo pake, wodwalayo amagona ndipo dokotala wogoneketsa magazi amalowetsa - amalowetsa chubu chapulasitiki chomangika mumsewu wa mpweya, amafufuma ndikuteteza njira yodutsa mpweya. Pa opaleshoni, wodwalayo amalandira ankalamulira yokumba mpweya mpweya.
Kwa laparoscopy, mimba ya m'mimba imadzazidwa ndi mpweya - nthawi zambiri, carbon dioxide imagwiritsidwa ntchito. Gasi amabayidwa kuti akweze khoma la m'mimba ku mawonekedwe a dome pamwamba pa ziwalo ndikupereka mawonekedwe abwino ndi mwayi wopita ku ziwalo. Othandizira ndi madokotala ochita opaleshoni anachiritsa mimba yonse ya wodwalayo ndi mankhwala ophera tizilombo toyambitsa matenda kuti athe kusintha kuti atsegule opaleshoni ndipo, malinga ndi malangizo a dokotala wogonetsa, anaika singano yaitali ya Veress kudutsa mchombo. Amapangidwa ndi kasupe wodzaza ndi masika kuti achepetse kuwonongeka kwa ziwalo zamkati zamkati panthawi yopunthwa m'mimba. Pambuyo potsimikizira mothandizidwa ndi mayesero angapo kuti singano ilidi m'mimba, payipi ya insufflator imamangiriridwa ku singano. Zamagetsi zapamwambazi zimalola kutulutsa mpweya woipa m'bowo ndikusungabe kupanikizika komweko ndi kulondola kwa 1 mmHg.
Kuthamanga kwa mpweya mumtsempha kufika pa 10-16 mmHg (malingana ndi kusankha kwa dokotala), singano ya Veress imachotsedwa ndipo trocar yoyamba imalowetsedwa kudzera mumchombo - chubu chachitsulo kapena pulasitiki momwe kafukufuku wa trihedral kapena tapered amayikidwa. Pambuyo kuboola khoma, stylet imachotsedwa ndikulowetsedwa kudzera mu cannula (chubu) mu endoscope ndi laparoscope. Laparoscope ndi 10, 5 kapena 2 mm m'mimba mwake (pogwiritsa ntchito micro laparoscope) chubu lachitsulo chokhala ndi lens yovuta komanso kalozera wowunikira. Ndi makamera ang'onoang'ono amakanema olemera magalamu 50-100 ndi magetsi amphamvu a halogen kapena xenon (zounikira), gulu lonse la opareshoni limatha kuwona momwe ntchitoyi ikuyendera pa pulogalamu yowunikira.
Pambuyo poyambitsa laparoscope, yang'anani pamimba pamimba ndikuyika ma trocars 2-4 pansi pazithunzi. Mfundo ya trocar introduction imadalira chiwalo chomwe chikugwiritsidwa ntchito ndi mtundu wa chithandizo - mu cholecystectomy, trocar imayikidwa pamwamba pa mimba pansi pa mtengo wamtengo wapatali, mu opaleshoni ya amayi - m'munsi mwa mimba.
Kwenikweni, zida zokhala ndi kutalika kwa 30-40 cm ndi mainchesi 2 mpaka 12 mm zimatha kuchita ntchito zomwezo monga njira zochitira opaleshoni. Kusungidwa, kubedwa kumbali, kugwidwa kwa chiwalocho ndi tatifupi, kumasulidwa ndi kupatukana kwa chiwalo kuchokera ku minofu yozungulira (kutupa) pogwiritsa ntchito ma dissectors, lumo la endoscopic ndi zida zamagetsi, mothandizidwa ndi coagulation, kutha kwa magazi ang'onoang'ono. Coagulation - mapuloteni pindani pansi pa chikoka cha high-frequency alternating current, kotero kuti lumen ya chotengera magazi kutseka. Kutulutsa magazi m'ziwiya zazikulu kumatha kuyimitsidwa podula (pogwiritsa ntchito titaniyamu), kumanga ndi suture, ndi suturing ndi endoscopic stapler.
Ma endoscopic staplers amagwira ntchito yofunika kwambiri pa opaleshoni ya endoscopic - izi zingawoneke zachilendo, koma mmalo mwa scalpel dokotala wa opaleshoni akugwira chogwirira singano kwa nthawi yaitali - Njira yopangira, kupukuta, ndi kumanga bandeji imatenga nthawi yochuluka kwambiri kusiyana ndi kupasuka kwa minofu. Dokotala waluso amatha kumanga mfundo pafupifupi 60 pa mphindi imodzi, kapena mfundo imodzi pa sekondi imodzi. Panthawiyi, mu opaleshoni ya endoscopic, manja a dokotala amasinthidwa ndi zida zowonda kwambiri zomwe zimakhala zovuta kwambiri kumanga. Kotero, mwachitsanzo, European Association of Physicians and Surgeons inakhazikitsa muyezo - kumanga mfundo katatu mu masekondi 40. Kotero uku kunali kusintha kwatsopano komwe kunathandiza kwambiri kukulitsa kukula kwa njira zothandizira endoscopic, ma staplers. Madokotala amatha kupanga inter enteric anastomoses ndi kusuntha kwa dzanja limodzi, ndikudutsa m'matumbo, mitsempha yotulutsa magazi m'mitsempha, ndi zina zambiri, m'malo mogwiritsa ntchito njira yayitali komanso nthawi zina yosatheka. Zakhala zotheka mwaukadaulo kuchita maopaleshoni aliwonse pogwiritsa ntchito njira ya endoscopic mothandizidwa ndi stapler.