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exploratory laparoscopy, laparoscopyToday many people are familiar with the laparoscopy as the "three-hole surgery": that is, they identify it with certain surgeries, such as laparoscopic cholecystectomy or appendectomy, that being minimally invasive for the patient allow a rapid postoperative course, with reduced hospitalization and convalescence time.

The birth of exploratory lararoscopy

In fact, laparoscopy was born, and takes many of its steps, as a method of diagnosis: only in the last 30 years has it become ubiquitous as a surgical access modality. 

Although it is certainly a more invasive method of diagnosis than other sophisticated techniques we have today (CT, MRI...), generally needing an operating room and general anesthesia, exploratory laparoscopy has definite areas and goes where other methods do not go: for example, it allows differential diagnosis when the diagnostic suspicion is vague and the therapeutic course of action uncertain (typical case: right flank pain in a young woman with negative tests, will it be appendicitis, an ovarian problem, inflammation of the last segment of the small intestine, a diverticulum... ?), to take biopsy samples, to proceed to surgery immediately if necessary. 

 

Exploratory laparoscopy: a "gentle" access to the abdomen

Surgical access to the abdomen to explore it, when it is otherwise impossible to reach a diagnosis, is a practice as old as surgery; until recently, this access conditioned the performance of cuts of conspicuous size on the abdominal surface, the so-called exploratory laparotomies, which are still widely used. But today we have very sophisticated laparoscopic equipment, which allows access to the abdominal cavity with very small wounds (5 mm or less); therefore, the invasiveness of the procedure is truly minimized, so much so that exploratory laparoscopy should be held in contemplation, instead of the now outdated exploratory laparotomy, by all physicians.

The indications for exploratory laparoscopy

  • exploratory laparoscopyAcute abdominal pain: this is one of the main reasons for access to the emergency areas of hospitals. In 30-40% of cases, however, despite the performance of hematochemical and radiological tests, the diagnosis remains unclear. These cases are usually labeled as "nonspecific abdominal pain". In a proportion of them, however, exploratory laparoscopy may enable a definition of the cause of pain and often its treatment.
  • Trauma: In patients without posttraumatic hemodynamic problems and when it is indicated but difficult to access other diagnostic modalities (such as CT), exploratory laparoscopy may be indicated.
  • Staging of intra-abdominal cancers, such as colon, stomach, liver, and biliary tract cancers, lymphomas... laparoscopy allows a much magnified view of the abdominal organs, and allows the detection of small lesions that even the most refined radiological techniques cannot depose.
  • Diagnosis of chronic abdominal conditions, including liver disease, cryptorchidism, chronic pelvic pain , and infertility.

 

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