Page 16 - Journal of Laparoscopic Surgery

WJOLS

Meenakshi E Yeola et al. 10.5005/jp-journals-10033-1338
ORIGINAL RESEARCH

Diagnostic Laparoscopy as an Effective Tool in Evaluation

of Intra-abdominal Malignancies

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1 Meenakshi E Yeola, Dilip Gode, Akshay K Bora
2
ABSTRACT (MRI), A diagnosis of unresectable, metastatic diseases
Accurate diagnosis and staging are crucial in defining an has been made at exploratory laparotomy for many
effective plan of management in intra-abdominal malignan- patients with gastric, hepatic, pancreatic malignancy.
cies. Despite the availability of a wide array of imaging tech- Visualization of primary tumors, identification of hepatic
niques, a high incidence of nontherapeutic procedures have metastasis, regional nodal metastasis and intra-peritoneal
been observed. Laparoscopy finds its utility in reducing this
discrepancy by an accurate assessment of the extent of the metastasis, which at times may not be efficiently spotted
disease. This review article explores applications of laparos- by imaging modalities, are possible with laparoscopy. 1
copy in the staging and diagnosis of abdominal malignancy If laparoscopic finding results in an unresectable
and its comparative advantages against imaging studies and disease, then further management can be planned, such
conventional laparotomy.
as neoadjuvant chemotherapy, radiotherapy, etc. It will
Keywords: Diagnostic laparoscopy, Gastrointestinal tract, give a tissue diagnosis and can have a biopsy where the
Gynaecology, Malignancy, Metastasis, Staging. definitive treatment or surgery is not possible. Thus, it is
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How to cite this article: Yeola ME, Gode D, Bora AK. Diag- recommended that diagnostic laparoscopy for a staging
nostic Laparoscopy as an Effective Tool in Evaluation of Intra- of abdominal malignancy be performed at the time of
abdominal Malignancies. World J Lap Surg 2018;11(2):68-75.
planned laparotomy or in cases where in spite of preop-
Source of support: Nil erative imaging resectability is in doubt. 3
Conflict of interest: None Many authors have stressed the importance of laparo-
scopic ultrasonography during diagnostic laparoscopy for
INTRODUCTION abdominal malignancy since it gives the surgeon valuable
information that would be difficult to obtain from a little
Unresectable tumors are undesirable diagnostic surprises laparoscopic visual exploration.
during laparotomies for surgeons. A well-staged diag- Since the introduction of laparoscopic staging, lavage
nosis and an assessment of resectability in abdominal of the peritoneal cavity has been added to the procedure
malignancies are necessary determinants for the defini- for identification of early peritoneal seeding and eventual
tion of an effective treatment strategy since laparotomies metastases, with free cancer cells found in the peritoneal
in patients with improperly staged, and non-resectable lavage fluid as an effective indicator.
tumors will increase mortality and morbidity, cost as well Unnecessary surgery, diagnostic delays, ineffective
as reduce the quality of life in the remaining lifetime. So treatment leading to prolonged operative and in-patient
laparoscopy can play a complementary role in diagnosis stay which may affect the quality of life, in the long run,
and staging of abdominal malignancy and its extent. 1 can be avoided by effectively using diagnostic laparos-
The last three decades have witnessed tremendous copy. It finds its utility and efficacy as a preoperative
improvements in laparoscopic equipment and technique, tool for timely diagnosis, accurate staging, assessment,
which has now led to a wider application of laparoscopy and evaluation of intra-abdominal malignancies as a
and an increasing interest in the use of laparoscopy as determinant of standard treatment for more regular use.
a staging tool. 2
Despite ever evolving, sophisticated radiological diag- BACKGROUND
nostic modalities like (CT), magnetic resonance imaging
Diagnostic laparoscopy is a minimally invasive modality
for the diagnosis of intra-abdominal diseases through
direct visual inspection. Tissue biopsies, acquisition of
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1 Professor, Professor and Vice Chancellor, Resident culture, peritoneal lavages along with a variety of thera-
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1-3 Department of Surgery, Jawaharlal Nehru Medical College, peutic interventions are possible during the procedures. 4,5
Wardha, Maharashtra, India The main advantages of diagnostic laparoscopy over
Corresponding Author: Meenakshi E Yeola, Professor, traditional open laparotomy are as follows:
Department of Surgery, Jawaharlal Nehru Medical College, • Reduced morbidity
Wardha, Maharashtra, India, e-mail: drmeenu7@rediff.com
• Reduced postoperative pain
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