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Abstract
Role of diagnostic laparoscopy in the management of pelviabdominal masses The history of the abdominal mass in the medical literature is ancient, dating back to the Egyptians.
The varied differential diagnosis of such masses was discussed in the Papyrus Ebers(ca. 1500 B.C.).
Egyptian medical scholars kept detailed notes chronicling conditions encountered and describing methods of abdominal examination that were based on studies of basic anatomy and embalming practices { Wilbur ….. et al ..2002}Abdominal masses are commonly addressed by surgeons, as well as by members of many clinical subspecialties.
In terms of clinical importance, abdominal masses cover a broad spectrum: some have few or no apparent consequences, others significantly impair quality of life, and still others represent severe conditions that are associated with poor outcomes and high mortalities.
For each patient, therefore, it is essential to formulate a management approach that is tailored to the particular clinical situation.
Effective decision-making in this regard involves establishing the correct diagnosis, introducing an effective treatment plan, eliminating risks and complicating factors, initiating preventive measures, and determining the prognosis.
{Wilbur ….. et al ...2002}Laparoscopy is used today as a diagnostic and staging tool; to sample tissue and search for metastases; to provide palliative care(eg, to create a bypass in patients with unresectable disease) and alleviate symptoms (eg, in patients with bowel obstructions); and to remove masses and perform other surgical interventions with curative intent.{ David …2006 }Recent reports have suggested that laparoscopy can play a role in the staging of abdominal malignancy .
Laparoscopic examination can visualize the primary tumor, identify hepatic metastases, diagnose regional nodal metastases, and detect small-volume peritoneal disease unappreciated by other noninvasive staging modalities such as computerized tomography,magnetic resonance imaging, or ultrasonography. { KEVIN and EMERY…. 1997 }The goal of clinical staging is to accurately define the extent of disease, direct appropriate therapy, and avoid unnecessary intervention. Despite an increasingly sophisticated radiological diagnostic armamentarium, many patients with gastric, hepatic, or pancreatic malignancy continue to have the diagnosis of unresectable or metastatic disease made at exploratory laparotomy.
For those who do not require a palliative procedure,exploration confers little benefit and may be associated with significant morbidity and mortality affecting both the quality and duration of their survival. { KEVIN and EMERY…. 1997 } So one of the roles of laparoscopic staging is in identifying those patients with imaging occult unresectable disease and thus in preventing the morbidity of unnecessary laparotomies; the reviewed literature suggests that many of patients can be spared an unnecessary laparotomy. { Stefanidis ….et al .. 2005 }So, Staging laparoscopy can be performed successfully in the vast majority of patients and is associated with minimal morbidity and faster recovery compared with open exploration.
In addition, the procedure does not influence negatively the oncologic outcome of cancer patients and, if inappropriate technique is used, wound recurrences are very uncommon. { Stefanidis ….et al .. 2005 }Nowadays, laparoscopic biopsy is going to be a very important method of gaining biopsy from abdominal masses for example lymph nodes.
As, laparoscopic biopsy represents a minimally invasive method of obtaining tissue from enlarged abdominal nodes present in locations unsuitable for IGNB(image guided needle biopsy), when tissue obtained by IGNB is inadequate and when previously unsuspected lymph adenopathy is identified during diagnostic laparoscopy.
This method allows a surgeon experienced in laparoscopic technique to obtain adequate-sized biopsy specimen under visual control from lymph nodes in almost any intraabdominal location. With its easy availability, early and judicious use of laparoscopic biopsy should be considered in the algorithm {Bhandarkar, .... et al… 2006 }.