Diagnostic Laparos

Diagnostic Laparoscopy
Electronic Eye Inside Abdomen R.K. Mishra
World Laparoscopy Hospital Essentials of Laparoscopic Surgery

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
dog.
 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
team
•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
STOMACH L.T
GB LIVER
R.LIVER SPLEEN
R.COLON L.COLON
CAECUM P.CAVITY

Systemic plan of inspection
 Patient in steep trendelenberg position

Hepatic flexure Start
Right side
of Structure just below
ascending umbilicus
colon
Cecum & Appendix

Systemic plan of inspection
 Reverse the Trendelenberg tilt

Right lobe of the Telescope should Transverse left lobe of
liver and gall then be withdrawn colon the liver.
bladder a little to cross
falciform ligament
Spleen
Walk over to Small Desce
Intestine nding
colon
Sigmoid
colon
Inspection of Pelvis
 Trendelenberg position
Fallopian tube
from cornu to fimbriae
+
TPT if necessary
The round ligament
Anterior cul de sac
Uterus

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
mass

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
Liver
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


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Diagnostic Laparoscopy

Electronic Eye Inside Abdomen R.K. Mishra

World Laparoscopy Hospital Essentials of Laparoscopic Surgery

World Laparoscopy Hospital Essentials of Laparoscopic Surgery

 The Image of the liver, stomach,

World Laparoscopy Hospital Essentials of Laparoscopic Surgery