Laparoscopy chirongwa chekuongorora kana kuvhiya panhengo dzemukati dzedumbu remudumbu kana pelvis. Laparoscopy inzira yekuvhiya yemazuva ano umo kuvhiyiwa kunoitwa kwete kuburikidza nekuvhurwa kwechisikigo kana ganda rakakura, asi kuburikidza nediki (kazhinji 0.5-1.5 cm) punctures, nepo kuvhiyiwa kwakajairika kunoda kucheka kukuru uye nokudaro kunosiya mavanga makuru. Pakuputira, trocar inoshandiswa, nerubatsiro rwekurovera rusvingo rwemimba, uye chigadziro chakaonda (laparoscope) chinopinzwa muchubhu ine dhayamita ye 0.2-1.0 cm.
Chishandiso chikuru chelaparoscopy i laparoscope - chubhu yesimbi ine dhayamita ye5-10 mm (2 mm ye micro laparoscopy) ine yakaoma lens system uye mwenje gwara. Iyo lens inoendesa mufananidzo kubva kune lens kuenda kune yeziso, uye mwenje gwara rinotungamira mwenje wemwenje kubva kune chekuvhenekesa kupinda mugomba redumbu. Iwe unogona kutarisa zvakananga mukati me lens ye laparoscopic - izvi zvave zvichiitwa kwemakumi emakore, asi nekuuya kwekamera diki endoscopic (ikozvino inorema 50-150 gramu) yakabatanidzwa kune laparoscopic lens mumakumi matatu emakore apfuura, vese vashandi vemukamuri yekuvhiya vanogona kuona kufambira mberi kwese kwekushanda pamonitor. Kuongororwa uye mamwe maitiro akareruka anoitwa pasi peanesthesia yemunharaunda, uye maitiro akawanda e laparoscopic anoitwa pasi peanesthesia yakawanda.
Iko hakuna chinhu chakadai se "laparoscopic surgery". Laparoscopy imwe yenzira dzekuwana nhengo dzekuvhiya. Pasinei nenzira yekushandiswa, maitiro ekuvhiya haashanduki. Mazwi aya anogadzirwa pachishandiswa izwi rekuti "scope" (kubva muGreek scope-ndinoona), hafu yekutanga yezita renzira inoreva nhengo kana mhango iri kushandiswa kana kuongororwa.
Laparoscopy ndeimwe yemhando dze endoscopy, uye endoscopy inosanganisira laparoscopy, thoracoscopic kuongororwa, hysteroscopy, cystoscopy, arthroscopy uye zvichingodaro.
Thoracoscopy - kupindira pachipfuva;
Nephroscopy - kupindira uye kuvhiyiwa paitsvo;
Cystoscopy - kuvhiyiwa pamusoro dundira;
Hysteroscopy - kupindira kwekuvhiya pachibereko;
Gastroscopy - kuvhiyiwa mudumbu.
Kana iyo prefix "fibro" yakawedzerwa kune zita, zvinoreva kuti nzira inoshandiswa uchishandisa endoscope inoshanduka, semuenzaniso, fiber hysteroscopy kuongorora kwechibereko uchishandisa endoscope inoshanduka.
Unyanzvi hwekuvhiyiwa kwelaparoscopic hunosiyana zvishoma zvichienderana nerudzi rwekuvhiya uye nzvimbo yekurapa. Varwere vakagadzirira kuwana rubatsiro rwakafanana nekuvhiyiwa kwakajairika. Chekutanga, varwere vari muwadhi vanobayiwa majekiseni emishonga kuti vawedzere marwadzo uye kushanda nesimba. Aya mabasa anonzi "preoperative administration". Murwere anobva atakurwa oendeswa mukamuri rokuvhiya ari pamubhedha.
Katheta yepurasitiki yakapfava inopinzwa mucubital tsinga yemurwere kuti iisirwe mishonga, zvinogadzirisa, zvinotindivadza, uye zvinopedza marwadzo. Rabha kana silicone mask inosungirirwa kumeso kwemurwere uye musanganiswa wekufema unopihwa kuburikidza nemask.
Masekonzi gare gare, murwere anobatwa nehope uye anesthesiologist anopinza - anoisa chubhu yepurasitiki yakavharwa munzira yemhepo, inoputika uye inochengetedza nzira yemhepo. Panguva yekuvhiyiwa, murwere anogamuchira inodzorwa yekugadzira mapapu ventilation.
Kune laparoscopy, dumbu remimba rinozadzwa negesi - kazhinji, carbon dioxide inoshandiswa nokuda kwechinangwa ichi. Gasi rinoiswa jekiseni kuti risimudze madziro emudumbu kuita dome chimiro pamusoro penhengo uye kupa kuoneka kwakanaka uye kuwana kunhengo. Vabatsiri nevarapi vairapa dumbu rose remurwere nemishonga yekuuraya utachiona kuitira kuti pave neshanduko yekuvhura kuvhiyiwa uye, maererano nemirairo yeantesthesiologist, vakapinza tsono refu yeVeress nepaguvhu. Yakagadzirwa ine chitubu-yakatakurwa core kuti ideredze kukuvara kunogoneka kune yakadzika nhengo dzemukati panguva yekubaya mudumbu. Mushure mekusimbisa nerubatsiro rwezviedzo zvakawanda kuti tsono iri mudumbu redumbu, hose ye insufflator inosungirirwa pane tsono. Izvi zvemagetsi zvemhando yepamusoro zvinobvumira kupa kabhoni dhaikisaidhi mukati megomba uye zvinongo chengetedza kudzvanywa kurimo nekurongeka kwe1 mmHg.
Mushure mekunge gasi riri mugomba rasvika 10-16 mmHg (zvichienderana nesarudzo yachiremba), tsono yeVeress inobviswa uye trocar yekutanga inopinzwa nemuguvhu - simbi kana yepurasitiki chubhu umo inopinzwa trihedral kana tapered probe. Mushure mekubaya madziro, iyo stylet inobviswa uye inopinzwa kuburikidza necannula (tube) muendoscope uye laparoscope. Laparoscope i10, 5 kana 2 mm dhayamita (ichishandisa micro laparoscope) chubhu yesimbi ine yakaoma lens system uye light guide. Iine akabatanidzwa madiki evhidhiyo makamera anorema 50-100 magiramu uye ane simba halogen kana xenon light sources (mailluminators), iyo yese timu inoshanda inogona kuona kufambira mberi kwekushanda pachiratidziro chemonita.
Mushure mekuzivisa iyo laparoscope, ongorora mhango yedumbu uye isa 2-4 mamwe trocars pasi pekutarisa kwekuona. Pfungwa yetrocar introduction inobva pane nhengo iri kuvhiyiwa uye rudzi rwekupindira - mu cholecystectomy, trocar inoiswa mudumbu repamusoro pasi pemutengo wemari, mukuvhiyiwa kwevakadzi - mudumbu rezasi.
Muchidimbu, zviridzwa zvine kureba kwe30-40 cm uye dhayamita ye2 kusvika ku12 mm zvinogona kuita mabasa ese akafanana seakajairika maitiro ekuvhiya. Kuchengeta, kubiwa kune rumwe rutivi, kutorwa kwenhengo nezvikamu, kusunungurwa uye kupatsanurwa kwenhengo kubva kune yakatenderedza tishu (dissection) nenzira ye dissectors, endoscopic scissors uye electrosurgical instruments, nerubatsiro rwekubatanidza, kushamwaridzana kupera kwekubuda ropa midziyo miduku. Coagulation - mapuroteni anopeta pasi pesimba re-high-frequency alternating current, saka lumen yemudziyo weropa inovhara. Kubuda ropa kubva mumidziyo mikuru kunogona kumiswa nekucheka (uchishandisa titanium clips), kubatanidza ne suture material, uye suturing ne endoscopic stapler.
Endoscopic staplers inoita basa rakakosha mukuvhiya endoscopic - izvi zvingaite sezvisina kujairika, asi pachinzvimbo chekuvhiya chiremba anovhiya akabata tsono kwenguva yakareba - Iyo nzira yekusona, suturing, uye bhandiji inotora nguva yakawanda kupfuura kutsemuka kwenyama. Chiremba ane hunyanzvi anogona kusunga mapfundo angangoita 60 paminiti, kana pfundo rimwe pasekondi. Zvichakadaro, mukuvhiyiwa kwe endoscopic, maoko echiremba anovhiyiwa anotsiviwa nemidziyo mitete iyo yakanyanya kuoma kusunga. Saka, semuenzaniso, European Association of Physicians and Surgeons yakaisa chiyero - sunga pfumo katatu mumasekondi makumi mana. Saka iyi yaive shanduko yechimurenga yakaita basa rakakosha mukuwedzera chiyero che endoscopic kupindira, iyo staplers. Vanachiremba vanovhiya vanogona kuita inter enteric anastomoses nekufamba kweruoko kamwe chete, kuvharika nemukati meura, suture kubuda ropa midziyo, nezvimwewo, panzvimbo peiyo refu uye dzimwe nguva isingaite yebhuku endoscopic suturing. Izvo zvave zvehunyanzvi zvinogoneka kuita chero kuvhiya kuvhiya ne endoscopic yekuvhiya nzira nerubatsiro rwe stapler.