I-Laparoscopy iyindlela yokuxilonga noma yokuhlinzwa ezithweni zangaphakathi zomgodi wesisu noma i-pelvis. I-Laparoscopy iyindlela yesimanje yokuhlinza lapho ukuhlinzwa kwenziwa khona hhayi ngezimbobo zemvelo noma izimbobo ezinkulu zesikhumba, kodwa ngamabhobho amancane (okuvame ukuba ngu-0.5-1.5 cm), kuyilapho ukuhlinzwa okuvamile kudinga ukusika okukhulu futhi ngaleyo ndlela kushiye izibazi ezinkulu. Ukubhoboza, kusetshenziswa i-trocar, ngosizo lapho udonga lwesisu lugwazwa khona, futhi idivayisi encane ye-optical (laparoscope) ifakwe ku-tube enobubanzi obuyi-0.2-1.0 cm.
Ithuluzi eliyinhloko le-laparoscopy yi-laparoscope - ithubhu yensimbi enobubanzi obuyi-5-10 mm (2 mm ye-laparoscopy encane) enesistimu ye-lens eyinkimbinkimbi kanye nomhlahlandlela wokukhanya. Ilensi idlulisa isithombe sisuka kulensi siye ececeni lamehlo, futhi umhlahlandlela wokukhanya uqondisa i-beam yokukhanya ukusuka kusikhanyisi ukuya emgodini wesisu. Ungabheka ngqo kwilensi ye-laparoscopic - lokhu sekungamashumi eminyaka kwenziwa, kodwa ngokufika kwamakhamera amancane e-endoscopic (manje anesisindo esingamagremu angu-50-150) axhunywe kwilensi ye-laparoscopic emashumini amathathu eminyaka adlule, bonke abasebenzi basegunjini lokuhlinza bangabona yonke inqubekelaphambili yomsebenzi ku-monitor. Ukuxilongwa kanye nezinqubo ezithile ezilula zenziwa ngaphansi kwe-anesthesia yendawo, futhi izinqubo eziningi ze-laparoscopic zenziwa ngaphansi kwe-anesthesia ejwayelekile.
Ayikho into ebizwa ngokuthi "ukuhlinzwa kwe-laparoscopic". I-Laparoscopy ingenye yezindlela zokufinyelela izitho zokuhlinzwa. Kungakhathaliseki ukuthi iyiphi indlela yokuqaliswa, uhlobo lwenqubo yokuhlinzwa alushintshi. Lawa magama akhiwa kusetshenziswa igama elingumsuka elithi “scope” (kusuka kwelesiGreek scope-I see), ingxenye yokuqala yegama lendlela esho isitho noma umgodi osetshenziswayo noma ohlolwayo.
I-Laparoscopy ingenye yezinhlobo ze-endoscopy, futhi i-endoscopy ihlanganisa i-laparoscopy, ukuhlolwa kwe-thoracoscopic, i-hysteroscopy, i-cystoscopy, i-arthroscopy nokunye.
I-Thoracoscopy - ukungenelela esifubeni;
I-Nephroscopy - ukungenelela nokuhlinzwa ezinso;
Cystoscopy - ukuhlinzwa kwesinye;
I-Hysteroscopy - ukungenelela kokuhlinzwa esibelethweni;
I-Gastroscopy - ukuhlinzwa kwesisu.
Uma isiqalo esithi "fibro" sengezwe egameni, kusho ukuthi inqubo yenziwa ngokusebenzisa i-endoscope eguquguqukayo, isibonelo, i-fiber hysteroscopy ukuhlolwa kwesibeletho usebenzisa i-endoscope eguquguqukayo.
Inqubo yokuhlinzwa kwe-laparoscopic iyahluka kancane kuye ngokuthi uhlobo lokuhlinzwa kanye nesikhungo sezokwelapha. Iziguli zikulungele ukuthola ukunakekelwa okufanayo nokuhlinzwa okuvamile. Okokuqala, iziguli ewadini zijovwa ngemithi ukuze kuthuthukiswe izinhlungu futhi kusebenze ukusebenza kahle. Le misebenzi ibizwa ngokuthi "ukuphathwa kwangaphambi kokuhlinzwa". Isiguli sibe sesithwalwa siyiswe egunjini lokuhlinza ngohlaka.
I-catheter yepulasitiki ethambile ifakwa emthanjeni oyi-cubital wesiguli ukuze kufakwe imithi, izisombululo, izibulala-zinzwa, nezidambisi-zinhlungu. Imaski yerabha noma ye-silicone inamathiselwe ebusweni besiguli futhi ingxube yokuphefumula inikezwa ngemaski.
Ngemva kwemizuzwana, isiguli siyalala bese udokotela obulala izinzwa uyafafaza - ufaka ishubhu lepulasitiki eliboshwe ngendlela yomoya, afuthe futhi avikele indlela yokuphefumula. Ngesikhathi sokuhlinzwa, isiguli sithola umoya olawulwayo wamaphaphu okwenziwa.
I-laparoscopy, i-cavity yesisu igcwele igesi - ezimweni eziningi, i-carbon dioxide isetshenziselwa le njongo. Igesi ijovwa ukuze iphakamise udonga lwesisu lube yisimo sedome ngaphezu kwezitho futhi lunikeze ukubonakala okuhle nokufinyelela ezithweni. Abasizi nodokotela abahlinzayo baphatha isisu sonke sesiguli ngezixazululo ezibulala amagciwane ukuze sishintshe indlela esivula ngayo ukuhlinzwa futhi, ngokwemiyalo kadokotela obulala izinzwa, bafaka inaliti ende ye-Veress enkabeni. Yakhelwe ngomgogodla olayishwe intwasahlobo ukuze kuncishiswe ukulimala okungenzeka ezithweni zangaphakathi ezingaphansi ngesikhathi sokubhobozwa kwesisu. Ngemva kokuqinisekisa ngosizo lwezivivinyo eziningana ukuthi ngempela inaliti ingaphakathi emgodini wesisu, i-hose ye-insufflator ifakwe yenaliti. Le mishini kagesi eyinkimbinkimbi ivumela ukuhlinzeka nge-carbon dioxide emgodini futhi igcine ngokuzenzakalelayo ukucindezela okukuyo ngokunemba okungu-1 mmHg.
Ngemva kokuba umfutho wegesi emgodini ufinyelela ku-10-16 mmHg (kuye ngokuthi udokotela ohlinzayo ukhethani), inaliti ye-Veress iyasuswa futhi i-trocar yokuqala ifakwe ngenkaba - ishubhu lensimbi noma lepulasitiki lapho kufakwa khona i-trihedral noma i-tapered probe. Ngemva kokubhoboza udonga, i-stylet iyasuswa futhi ifakwe nge-cannula (ishubhu) ku-endoscope kanye ne-laparoscope. I-laparoscope iyishubhu yensimbi eyi-10, 5 noma 2 mm (kusetshenziswa i-micro laparoscope) enesistimu ye-lens eyinkimbinkimbi kanye nomhlahlandlela wokukhanya. Ngamakhamera wevidiyo anamathiselwe anesisindo esingamagremu angu-50-100 kanye nemithombo yokukhanya ye-halogen noma i-xenon enamandla (izikhanyisi), lonke ithimba elisebenzayo lingakwazi ukubona ukuqhubeka komsebenzi esikrinini sokuqapha.
Ngemva kokwethula i-laparoscope, hlola umgodi wesisu bese ufaka ama-trocars angu-2-4 ngaphezulu ngaphansi kokulawula okubonakalayo. Iphuzu lesingeniso se-trocar lincike esithweni esiqhutshwayo kanye nohlobo lokungenelela - ku-cholecystectomy, i-trocar ifakwe endaweni engaphezulu yesisu ngaphansi kwe-costal arch, ekuhlinzeni kwezifo zabesifazane - ngaphansi kwesisu.
Eqinisweni, izinsimbi ezinobude obungu-30-40 cm nobubanzi obungu-2 kuya ku-12 mm zingenza yonke imisebenzi efanayo namasu okuhlinzwa avamile. Ukugcinwa, ukuthunjwa ohlangothini, ukuthunjwa kwesitho ngeziqeshana, ukukhululwa kanye nokuhlukaniswa kwesitho kusuka ezicutshini ezizungezile (i-dissection) ngokusebenzisa ama-dissectors, isikelo se-endoscopic kanye nezinsimbi zokuhlinzwa ngogesi, ngosizo lwe-coagulation, ukunqamuka okuhlobene nokopha kwemikhumbi emincane. I-Coagulation - amaprotheni agoqa ngaphansi kwethonya lamanje elishintshashintshayo le-high-frequency, ngakho i-lumen yomkhumbi wegazi iyavala. Ukopha emikhunjini emikhulu kungamiswa ngokusikwa (kusetshenziswa iziqeshana ze-titanium), ukubopha nge-suture material, nokuthunga nge-endoscopic stapler.
Ama-staplers e-Endoscopic adlala indima ebaluleke kakhulu ekuhlinzeni i-endoscopic - lokhu kungase kubonakale kungavamile, kodwa esikhundleni se-scalpel udokotela ohlinzayo ubambe isibambi senaliti isikhathi eside - Inqubo yokuthunga, ukuthunga, nokubopha ithatha isikhathi esiningi kunokukhishwa kwezicubu. Udokotela ohlinzayo onekhono angabopha amafindo okuphepha angaba ngu-60 ngomzuzu, noma ifindo elilodwa ngomzuzwana. Khonamanjalo, ekuhlinzweni kwe-endoscopic, izandla zikadokotela ohlinzayo zithathelwa indawo amathuluzi azacile okunzima kakhulu ukuwabopha. Ngakho-ke, isibonelo, i-European Association of Physicians and Surgeons ibeka indinganiso - bopha ifindo eliphindwe kathathu ngemizuzwana engu-40. Ngakho-ke lokhu kwaba uguquko olusha olwadlala indima ebaluleke kakhulu ekwandiseni ububanzi bokungenelela kwe-endoscopic, ama-staplers. Odokotela abahlinzayo bangenza ama-inter enteric anastomoses ngokunyakazisa isandla esisodwa, badlule ngokuvaleka emathunjini, emithanjeni yokopha, njll., esikhundleni se-endoscopic suturing ende futhi kwesinye isikhathi cishe engenakwenzeka. Sekungenzeka ngokobuchwepheshe ukwenza noma yikuphi ukuhlinzwa ngokuhlinzwa kwe-endoscopic ngosizo lwe-stapler.