Page 7 - WJOLS - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Evaluation of Abdominal Malignancies by Minimal Access

Surgery: Our Experience in a Rural Setup in Central India

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Meenakshi E Yeola , Dilip Gode , Akshay K Bora
AbstrAct
Introduction: A diagnostic surprise or finding a tumor unresectable at laparotomy is an undesirable situation for every surgeon. A surgeon
should never regret for having done a laparotomy on a patient which otherwise was avoidable. Many surgeons worldwide have had challenging
experiences of facing an uncertain diagnosis or staging of abdominal malignancies. History-taking, physical examination, laboratory tests, and
advanced noninvasive imaging studies might provide some help but are insufficient for accurate diagnosis and staging of abdominal tumors.
Aim: To assess the role of diagnostic staging laparoscopy in abdominal malignancies.
Objectives: To evaluate the role of laparoscopy as a diagnostic tool in abdominal malignancies. To compare the findings of laparoscopy with
noninvasive imaging modalities. To assess the efficacy of laparoscopy as a definitive tool in the evaluation of staging and operability before
definitive intervention.
Materials and methods: This is a prospective observational study with a sample size of 250 patients. The study duration was 3.5 years from July
2013 to October 2016 and was conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi (Meghe), Wardha.
Results: Due to the use of diagnostic laparoscopy, out of 250 cases of abdominal malignancies, in 120 (48%) patients, nontherapeutic laparotomy
could be avoided.
Conclusion: This study highlights the emphatic utility of diagnostic laparoscopy procedures in staging and management of abdominal
malignancy. Laparoscopic evaluation of a patient with intra-abdominal malignancies is a desirable tool against imaging modalities in improving
the detection of metastatic disease and accurate staging of the disease process.
Keywords: Diagnostic, Laparoscopy, Metastatic, Nontherapeutic laparotomy, Unresectability.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1350

IntroductIon 1–3 Department of Surgery, Jawaharlal Nehru Medical College, Wardha,
A proper diagnosis, pretherapeutic staging for assessment of Maharashtra, India
resectability in abdominal malignancy, is important to select the Corresponding Author: Meenakshi E Yeola, Department of Surgery,
patient for appropriate treatment strategies. Identifying tumors that Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, Phone:
are not surgically resectable is the most important issue at hand. +91 9822189896, e-mail: drmeenu7@rediff.com
Performing laparotomies in patients with nonresectable abdominal How to cite this article: Yeola ME, Gode D, et al. Evaluation of
tumors may increase mortality and morbidity, and cost as well as Abdominal Malignancies by Minimal Access Surgery: Our Experience
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affect quality of life in the remaining lifetime. in a Rural Setup in Central India. World J Lap Surg 2018;11(3):115–120.
The magnified view offered by the laparoscope enables Source of support: Nil

the surgeon to detect small liver, peritoneal, and omental Conflict of interest: None

metastases that are not visible with current noninvasive imaging
modalities.
If the distance between the tip of the telescope and object is malignancy. Ultrasonography during laparoscopy gives the
5 cm, we get a six times magnification. If it is 15 cm, the magnification surgeon information that otherwise would not be obtained from
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is 2.2 times, and if it is 33 cm, we can see the same size object. laparoscopic visual exploration. Lesions deep in the parenchyma
If laparoscopic findings result in an unresectable disease, of an organ, especially solid organs such as the liver and pancreas,
then further management can be planned, such as neoadjuvant can be identified by ultrasonography. Invasion of a tumor into
chemotherapy, radiotherapy, etc. Laparoscopy can give a tissue other structures, such as major vessels, can also be evaluated,
diagnosis and include a biopsy where the definitive treatment or thus determining that the tumor is not resectable in a patient who
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surgery is not possible. Obtaining biopsies of organs, lymph nodes, otherwise might undergo laparotomy.
and suspicious lesions during laparoscopy is an important part of Since the introduction of laparoscopic staging, lavage of the
the diagnosis and staging of malignancies. peritoneal cavity has been added to the procedure. Free cancer
Thus, it is recommended that diagnostic laparoscopy for cells found in the peritoneal lavage fluid are thought to induce
staging of abdominal malignancy be performed in cases where or indicate early peritoneal seedling with subsequent peritoneal
resectability is doubtful in spite of preoperative imaging, or at the metastases.
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time of planned laparotomy. Diagnostic laparoscopy can be beneficial to the patient in
Many authors have stressed the importance of laparoscopic avoiding unnecessary surgery, unnecessary delay in diagnosis and
ultrasonography during diagnostic laparoscopy for abdominal treatment, and in shortening the operative and hospitalized periods.

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