I-Laparoscopy lungenelelo lokuxilonga okanye lotyando kwizitho zangaphakathi zesisu sesisu okanye i-pelvis. I-Laparoscopy yindlela yotyando yala maxesha apho utyando lwenziwa ngokuvuleka kwendalo okanye ukonakalisa okukhulu kwesikhumba, kodwa ngokusebenzisa iipunctures ezincinci (ezidla ngo-0.5-1.5 cm), kanti utyando oluqhelekileyo lufuna ukusika okukhulu kwaye ngaloo ndlela kushiya amanxeba amakhulu. Ukugqobhoza, i-trocar isetyenziswe, ngoncedo apho udonga lwesisu luhlatywa khona, kunye nesixhobo esincinci se-optical (laparoscope) sifakwe kwi-tube enobubanzi be-0.2-1.0 cm.
Isixhobo esiphambili se-laparoscopy yi-laparoscopy - ityhubhu yensimbi enobubanzi be-5-10 mm (2 mm ye-laparoscopy encinci) kunye nenkqubo ye-lens eyinkimbinkimbi kunye nesikhokelo sokukhanya. I-lens idlulisela umfanekiso ukusuka kwi-lens ukuya kwi-eyepiece, kwaye isikhokelo sokukhanya siqondisa i-beam yokukhanya ukusuka kwisikhanyisi ukuya kwi-cavity yesisu. Unokujonga ngokuthe ngqo kwi-laparoscopic lens - oku kuye kwenziwa amashumi eminyaka, kodwa ngokufika kweekhamera ezincinci ze-endoscopic (ngoku zilinganisa i-50-150 grams) eziqhotyoshelwe kwilensi ye-laparoscopic kwiminyaka engamashumi amathathu edlulileyo, bonke abasebenzi begumbi lokusebenza banokubona yonke inkqubela yomsebenzi kwi-monitor. Ukuxilongwa kunye nezinye iinkqubo ezilula zenziwa phantsi kwe-anesthesia yendawo, kwaye ezininzi iinkqubo ze-laparoscopic zenziwa phantsi kwe-anesthesia jikelele.
Ayikho into ebizwa ngokuba "lutyando lwe-laparoscopic". I-Laparoscopy yenye yeendlela zokufikelela kwizitho zotyando. Kungakhathaliseki ukuba yeyiphi indlela yokuphunyezwa, uhlobo lwenkqubo yotyando alutshintshi. La magama abunjwa kusetyenziswa ingcambu yegama elithi “scope” (ukusuka kwi-Greek scope-ndiyabona), isiqingatha sokuqala segama lendlela elichaza ilungu okanye umngxuma osetyenziswayo okanye ovavanywayo.
I-Laparoscopy yenye yeendidi ze-endoscopy, kwaye i-endoscopy ibandakanya i-laparoscopy, uviwo lwe-thoracoscopic, i-hysteroscopy, i-cystoscopy, i-arthroscopy njalo njalo.
I-Thoracoscopy - ukungenelela kwisifuba;
I-Nephroscopy - ukungenelela kunye nokuhlinzwa kwizintso;
Cystoscopy - utyando kwisinyi;
I-Hysteroscopy - ungenelelo lotyando kwisibeleko;
Gastroscopy - utyando esiswini.
Ukuba i-prefix "fibro" yongezwa kwigama, ithetha ukuba inkqubo yenziwa ngokusebenzisa i-endoscope eguquguqukayo, umzekelo, i-fiber hysteroscopy luviwo lwesibeleko usebenzisa i-endoscope eguquguqukayo.
Ubuchwephesha botyando lwe-laparoscopic buhluka kancinci kuxhomekeke kuhlobo lotyando kunye neziko lonyango. Izigulane zikulungele ukufumana ukhathalelo olufanayo nolo tyando oluqhelekileyo. Okokuqala, izigulane ewadini zitofwa ngamachiza okuthomalalisa iintlungu ezongezelelweyo kunye nokusebenza kakuhle. Le misebenzi ibizwa ngokuba “lulawulo lwangaphambili”. Isigulane ke sithwalwa sisiwe kwigumbi lotyando nge-stretcher.
Kufakwa umtya weplastiki othambileyo kumthambo oyicubital vein ukuze kufakwe amayeza, izinyibiliko, izithomalaliso nezithomalalisi zeentlungu. I-rubber okanye i-silicone imaski ifakwe ebusweni besigulane kwaye umxube wokuphefumla unikezelwa ngemaski.
Kwimizuzwana kamva, isigulana siyalala kwaye i-anesthesiologist intubates - ifaka ityhubhu yeplastiki eboshiweyo kwindlela yomoya, ivuthele kwaye ikhusele indlela yomoya. Ngexesha lotyando, isigulane sifumana umoya olawulwayo wemiphunga eyenziweyo.
Kwi-laparoscopy, isisu sesisu sigcwele igesi - kwiimeko ezininzi, i-carbon dioxide isetyenziselwa le njongo. Igesi ijojowe ukuphakamisa udonga lwesisu kwi-dome shape ngaphezu kwamalungu kwaye ibonelele ngokubonakalayo kunye nokufikelela kwizitho. Abancedisi kunye noogqirha baphatha isisu sonke sesigulana kunye nezisombululo zokubulala iintsholongwane ukwenzela utshintsho olunokwenzeka lokuvula utyando kwaye, ngokwemiyalelo ye-anesthesiologist, bafake inaliti ende yeVeress kwinkaba. Yenzelwe i-spring-loaded core ukuze kuncitshiswe umonakalo onokwenzeka kwizitho zangaphakathi zangaphakathi ngexesha lokuhlatywa kwesisu. Emva kokuqinisekisa ngoncedo lweemvavanyo ezininzi ukuba ngokwenene inaliti ikwisigxina sesisu, i-hose ye-insufflator ifakwe kwinaliti. Le zixhobo ze-elektroniki eziyinkimbinkimbi zivumela ukubonelela nge-carbon dioxide kwi-cavity kwaye igcina ngokuzenzekelayo uxinzelelo apho ngokuchaneka kwe-1 mmHg.
Emva kokuba uxinzelelo lwegesi kwi-cavity lufikelela kwi-10-16 mmHg (kuxhomekeke kukhetho logqirha), inaliti ye-Veress isusiwe kwaye i-trocar yokuqala ifakwe kwi-navel - i-tube yensimbi okanye yeplastiki apho i-trihedral okanye i-tapered probe ifakwe. Emva kokubhoboza udonga, i-stylet iyasuswa kwaye ifakwe kwi-cannula (ityhubhu) kwi-endoscope kunye ne-laparoscope. I-laparoscope yi-10, 5 okanye i-2 mm ububanzi (usebenzisa i-micro laparoscope) ityhubhu yensimbi enenkqubo ye-lens eyinkimbinkimbi kunye nesikhokelo sokukhanya. Ngeekhamera zevidiyo ezincinci eziqhotyoshelweyo ezinobunzima be-50-100 grams kunye ne-halogen enamandla okanye imithombo yokukhanya ye-xenon (izikhanyisi), lonke iqela elisebenzayo linokubona inkqubela yomsebenzi kwisikrini sokujonga.
Emva kokuzisa i-laparoscope, jonga i-cavity yesisu kwaye ufake i-2-4 ngaphezulu kwe-trocars phantsi kolawulo olubonakalayo. Iphuzu lokungeniswa kwe-trocar lixhomekeke kwilungu eliqhutyelwayo kunye nohlobo lokungenelela - kwi-cholecystectomy, i-trocar ifakwe kwisisu esiphezulu esingaphantsi kwe-costal arch, kwi-gynecological surgery - kwisisu esisezantsi.
Ngokomgaqo, izixhobo ezinobude be-30-40 cm kunye nobubanzi be-2 ukuya kwi-12 mm zingenza yonke imisebenzi efanayo kunye neendlela eziqhelekileyo zotyando. Ukugcinwa, ukuthunjwa kwicala, ukubanjwa kwelungu kunye neziqeshana, ukukhululwa kunye nokwahlulwa kwelungu kwizicubu ezijikelezileyo (i-dissection) ngokusebenzisa i-dissectors, i-endoscopic scissors kunye nezixhobo ze-electrosurgical, ngoncedo lwe-coagulation, ukupheliswa kwesihlobo sokuphuma kwegazi elincinci. I-Coagulation - iiprotheyini zigoqa phantsi kweempembelelo ze-high-frequency alternating current, ngoko ke i-lumen yomkhumbi wegazi ivala. Ukopha kwimikhumbi emikhulu kunokunqandwa ngokunqunqa (usebenzisa ikliphu zetitanium), ukubopha ngezinto ze-suture, kunye ne-suturing nge-endoscopic stapler.
I-Endoscopic staplers idlala indima ebaluleke kakhulu kwi-endoscopic utyando - oku kunokubonakala kungavamile, kodwa endaweni ye-scalpel ugqirha ubambe isibambi senaliti ixesha elide - Inkqubo yokuthunga, i-suturing, kunye ne-bandaging ithatha ixesha elide kunokuba i-tissue dissection. Ugqirha wotyando onobuchule unokubopha malunga namaqhina okhuseleko angama-60 ngomzuzu, okanye iqhina elinye ngomzuzwana. Okwangoku, kutyando lwe-endoscopic, izandla zogqirha zitshintshwa zizixhobo ezibhityileyo ekunzima kakhulu ukuzibopha. Ngoko, umzekelo, i-European Association of Physicians and Surgeons ibeka umgangatho - ubophe iqhosha eliphindwe kathathu kwimizuzwana engama-40. Ke olu yayilutshintsho lwenguqu oludlale indima ebaluleke kakhulu ekwandiseni umda wongenelelo lwe-endoscopic, i-staplers. Oogqirha banokwenza i-inter enteric anastomoses ngokushukuma kwesandla esinye, ngokutywina badlule emathunjini, kwimithambo yokopha, njl. Kuye kube yinto enokwenzeka ngokobugcisa ukwenza naluphi na utyando ngotyando lwe-endoscopic ngoncedo lwe-stapler.