Diagnostic Laparoscopy Laparoscopy ... Video showing diagnosis and management of ... World...

World Laparoscopy Hospital Essentials of Laparoscopic Surgery

Diagnostic Laparoscopy

Electronic Eye Inside Abdomen R.K. Mishra

Definition

Diagnostic laparoscopy is a minimal access surgical procedure that allows the visual examination and documentation of intra abdominal organs in order to detect pathology.

Importance

The Image of the liver, stomach,

intestines, gallbladder, spleen,

peritoneum, and pelvic organs

can be viewed.

Manipulation and biopsy of the

viscera is possible by introducing

forceps through additional ports.

History

Diagnostic laparoscopy was

first introduced in 1901 by

Kelling, He performed it on

A Swedish internist named

Jacobaeusc is credited with

performing the first

diagnostic laparoscopy on

human in 1910 for ascitis.

Kelling 1901

Indication

Non-traumatic, non-gynaecologic

acute abdomen like:

Appendicitis

Diverticulitis

Duodenal perforation

Mesenteric adenitis.

Intestinal adhesion

Omental necrosis.

Intestinal infarction.

Complicated Meckel’s diverticulum.

Bedside Laparoscopy in the ICU.

Torsion of intra-abdominal testis.

Indications

Gynaecological abdominal

emergencies like:

Ovarian cysts.

Pelvic inflammatory

diseases.

Acute salpingitis.

Ectopic pregnancy.

Endometriosis.

Perforated uterus due to

criminal abortion

Salpingitis

Abdominal trauma:

Anaesthesia

Lignocain injection over inferior crease of umbilicus

Position Of Surgical Team

Surgeon stand left to the patient and camera person

right to the surgeon

Port position and Surgical

•Diagnostic Laparoscopy should

always be performed by two ports

technique

•Surgeon should hold camera and

instrument himself to perform

Diagnostic Laparoscopy

•Ideally the working port should

be in left iliac fossa

Port Position

Systemic plan

P.CAVITY

SPLEEN

L.COLON

CAECUM

R.COLON

R.LIVER

STOMACH

Systemic plan of inspection

Patient in steep trendelenberg position

Cecum & Appendix

Right side

ascending

Hepatic flexure

Structure just below

umbilicus

Systemic plan of inspection

Reverse the Trendelenberg tilt

Right lobe of the

liver and gall

bladder

Telescope should

then be withdrawn

a little to cross

falciform ligament

left lobe of

the liver.

colon Sigmoid

Transverse

Spleen

Walk over to Small

Intestine

Inspection of Pelvis

Trendelenberg position

Uterus

Anterior cul de sac

The round ligament

Fallopian tube

from cornu to fimbriae

TPT if necessary

Normal Pelvis

Appendicitis

T.B. Abdomen

Video demonstration of miliary tuberculosis

Cirrhosis of Liver

Video of cirrhotic liver with enlarged lymph node

Carcinoma & Haemangioma liver

Carcinoma of liver secondary to GB CA

Small bowel Lymphoma

Carcinomatosis

Metastasis of Gastric Carcinoma

Video demonstration of Metastasis of Gastric carcinoma

Duodenal Perforation

Video showing Duodenal Perforation

Intestinal Obstruction

Diagnostic Laparoscopy for Intestinal obstruction

Trauma

Video showing rupture diaphragm after RTA

Trauma

Video showing laceration of liver after RTA

Hemorrhagic Pancreatitis

Video showing diagnosis and management of

hemorrhagic pancreatitis

Endometriosis

Common site of Endometriosis is

Uterosacral ligament

Endometriosis

Chocolate Cyst Video of Tubo-ovarian Mass after

Endometrioma

Ectopic pregnancy

Unruptured Ectopic Pregnancy

Ectopic pregnancy

Unruptured tubal pregnancy Small ruptured tubal pregnancy

Small Ruptured Ectopic

pregnancy

Small ruptured tubal pregnancy of right side

Ectopic Pregnancy

Hematoma after ruptured ectopic pregnancy

Pathology

Tubo-ovrian

Fimbrioplasty

Bicornuate uterus

Bicornuate uterus can be easily diagnosed during diagnostic laparoscopy

Ovarian Drilling with PCOD

Needle

Polycystic ovary

Over drilled

polycystic overy

Ovarian Cyst

Torted Ovarian Cyst

Torted ovarian cyst with start of gangrene of fallopian tube

Torted Ovarian Cyst

Torted ovarian cyst

Follicular Cyst

Hydrosalpinx

Adhesion

Flimsy adhesion can be removed with the help of scissors

Gangrene fallopian tube

Gangrene of Fallopian tube can be seen occasionally

Fibroid

Sub serous and intramural fibroid

Fibroid

After proper consent Myomectomy can be performed if

gynecologist has sufficient suturing skill

Huge cyst of liver

Hydatid cyst of liver can be managed laparoscopically nicely

Lymphangioma of Mesentery

Infertility

Video demonstrating severe adhesion after Chronic PID

Meckels Diverticulum

Impalpable Testes

Adhesiolysis

Video demonstration of adhesiolysis with the help of scissors and Bipolar hook

Adhesiolysis with Harmonics

Staging for Oncology

Lymphomaa

End of Surgery

Specimen is

collected for

Cytology and Biopsy

Therapeutic

Laparoscopy can be

performed if consent

of patient is there

Video demonstrating dissection and

retrieval of tissue for biopsy

Thank You

Prof. Mishra with trainees of Advanced course September 2006

Diagnostic Laparoscopy Laparoscopy ... Video showing diagnosis and management of ... World...

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