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لاپاراسکوپی چیست و چه کاربردی دارد؟
لاپاراسکوپی چیست؟ در ادامه این مطلب به معنای لاپاروسکوپی یا لاپاراسکوپی ” laparoscopy ” پرداخته و روش این جراحی دقیق و مهم را شرح می‌دهیم. بطور خلاصه لاپارسکوپی عملیاتی است که با استفاده از یک دوربین و برش‌های کوچک (معمولاً به اندازه ۰٫۵–۱٫۵ سانتی‌متر) در ناحیه شکم یا لگن انجام می‌شود. لاپاروسکوپی با ایجاد شکاف‌های کوچک در ناحیه شکم، به تشخیص یا مداخلات درمانی کمک می‌کند.
به جراحی لاپاروسکوپی، جراحی با کمترین تهاجم (به انگلیسی: Minimally Invasive Surgery (MIS)) و همچنین جراحی سوراخ کلید (به انگلیسی: Keyhole Surgery) هم می‌گویند و جزو فنون نوین جراحی می‌باشد.
مقدمه‌ای بر لاپاراسکوپی چیست؟
در گذشت‌‌ای نه چندان دور تمامی عمل‌های جراحی شکم حتی جراحی چاقی با برش‌های بزرگ از زیر جناق تا پایین ناف (لااقل به طول ۳۰ سانتی متر) که به صورت طولی داده می‌شد، صورت می‌گرفت و بعد از عمل بیمار باتوجه به درد شدید نمی‌توانست به سرعت به فعالیت‌های روزمره خود بازگردد مضاف به اینکه جراحان همیشه نگرانی فتق محل جراحی و عفونت محل عمل را داشتند که این مشکلات در افراد چاق دو چندان می‌شد.
لاپاروسکوپی انقلاب بزرگ
بگذارید از نگاه یک جراح برایتان بگویم که اگر بیمار چاقی با آپاندیسیت حاد یا مشکل کیسه صفرا به او مراجعه کرده و نیاز به عمل داشت ناخودآگاه پیش خود فکر می‌کرد که باید با مشقت پوست و زیر جلد ضخیم و سپس فاشیا را برش داده تا به داخل شکم برسد سپس دو تکنیسین اتاق عمل با کشش زیاد دید مناسب محل عمل را برای او فراهم می‌کردند.
این مسئله در انجام چاقی مفرط نمود بیشتری پیدا می‌کرد چون ضخامت جدار شکم و سختی عمل بیشتر شده و به دنبال طولانی شدن زمان عمل احتمال خطراتی چون آمبولی ریه نیز بیشتر می‌شد.
اما کمک تکنولوژی به جراحی‌های گوارشی و داخل شکم به ویژه جراحی چاقی و کاهش وزن انقلابی بزرگی به اسم جراحی کم تهاجمی و یا جراحی لاپاروسکوپی را ایجاد کرد، در این تکنولوژی جدید که روز به روز روبه پیشرفت است شما از یک یونیت لاپاروسکوپی استفاده می‌کنید که شامل قسمتهای زیر است:
- مانیتور
- ویدئو پروسسور
- دوربین و لنز
- منبع نور سرد
- دستگاه دمنده گاز
روش جراحی لاپاراسکوپی
لاپاروسکوپی معمولا به صورت سرپایی انجام می شود؛ یعنی شما همان روز می‌توانید پس از جراحی به خانه برگردید. این جراحی ممکن است در بیمارستان یا در یک کلینیک جراحی سرپایی انجام شود.
معمولا برای این نوع جراحی، بیهوشی عمومی به کار برده می‌شود. شما در طول بیهوشی عمومی به خواب می‌روید و دردی احساس نمی‌کنید. یک سرم داخل وریدی به شما زده می‌شود که ماده‌ی بیهوشی و مایعات از طریق آن به بدن شما می‌رسند.
در این روش جراحی دیگر خبری از برش بزرگ جراحی نیست و با چهار تا پنج برش نیم تا یک سانتی لوله‌های پلاستیکی یا فلزی به نام تروکار وارد جدار شکم می‌شوند.
و شکم با شیلنگی که به یکی از این تروکارها متصل می‌شود با گاز دی اکسید کربن تا فشار ۱۴ میلی متر جیوه باد می‌شود و نور سرد به لنز و خرد باهم به دوربین متصل می‌شود و دوربین از تروکار مرکزی وارد شکم می‌شود.
و محیط شکمی که از قبل برای کار کردن متسع شده روشن شده و تصویر آن روی مانیتور نمایان می‌گردد…
ادامه…
… سپس از سه یا چهار تروکار باقی مانده ابزارهای ظریف و بلند کم تهاجمی از قبیل گرسپر، سوزن گیر، لیگاشور، کوتر یا قیچی وارد می‌شوند و جراح و کمک‌هایش در محیطی نورانی و با کیفیت و با بزرگ‌نمایی و بادقت بسیار بیشتر جراحی باز عمل می‌کنند.
در نتیجه خونریزی و نیاز به تزریق خون بسیار ناچیز شده و چون وسایل ظریف بوده و روده‌ها به دست برخورد نمی‌کنند احتمال چسبندگی و انسداد روده بعد از لاپاروسکوپی بسیار کمتر از جراحی باز می‌شود.
انواع جراحی‌های laparoscopy
در ادامه مطلب و در ذیل فقط با ذکر عنوان انواع جراحی‌هایی که با این روش انجام می شود آمده است؛
- جراحی چاقی
- رفلاکس معده به مری
- آشالازی
- کیسه صفرا
- مشاهده‌ی تومور در شکم
- بستن لوله‌های رحمی
- اهدای کلیه از یک فرد به دیگری
- فتق های دوطرفه کشاله ران و یا یک طرفه عود کرده
- آپاندیسیت و کیست تخمدان به ویژه در افراد چاق
- حذف یا ترمیم قسمت های معینی از روده بزرگ یا معده (سیستم گوارش)
- حذف یا ترمیم مثانه، میزنای یا حالب و کلیه ها (سیستم ادراری)
- حذف یا ترمیم اندام های تولید مثل زنان، مانند رحم و لوله های فالوپی
- روش‌های کاهش وزن مانند اسلیو یا بای پس
- مشاهده کبد و پانکراس به منظور بررسی وجود تومورهای سرطانی
- مشاهده‌ی اندام‌های شکمی برای بررسی علائم بیماری‌هایی که تشخیص آن ها دشوار است
- جراحی اکتشافی
- بررسی منبع درد شکمی یا حذف بافت اسکار یا زخم
مزیت‌های لاپاروسکوپی
این نوع جراحی چند مزیت نسبت به جراحی بازدارد. این مزایا شامل درد کمتر به علت ایجاد شکاف‌های کوچک‌تر، کم شدن خونریزی و دوره بهبود کوتاه‌تر می‌باشد. عنصر اصلی، استفاده از لاپاروسکوپ است که یک سامانه کابل تاری بلندی است که امکان مشاهده و اثرگذاری بر روی ناحیه موردنظر را دارا بوده و می‌توان آن را از ناحیه دورتری پیچ و تاب داده و کنترل کرد.
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