Minimally Invasive Surgery for Rural Surgeons ...

9/30/2015

Courses: Minimally Invasive Surgery for Rural Surgeons Lesson 8 | mdCurrent India

For Doctors in India Only Search here

Profile Log Out

Search

Not a doctor? Click here! Home

Home: Doctors

Recent Articles

Cardiovascular

mdCommunity

Diabetes

mdBookStore

Infect. Disease

Neurology

About

Nutrition

Advisors

Ob/Gyn

Contact

Pediatrics

Pharmacology

Case Studies

Practice Management

Primary Care

More »

« Back to course page

Minimally Invasive Surgery for Rural Surgeons – Lesson 8 LowCost Diagnostic Laparoscopies Diagnosis of abdominal conditions is always a big challenge in rural areas. The modern diagnostic facilities like CT scans and MRI are not available to rural doctors. Even if the patients are willing to travel more than 100 kilometers to reach such centers where CT scans and MRI are available, they are out of reach of the poor patients due to their high cost. A survey of the operation registers of many mission hospitals (17 hospitals) belonging to the Emmanuel Hospital Association revealed that diagnostic laparotomies were a common surgical procedure in rural areas (1). Laparotomies are more invasive procedures and yet are more cost effective for rural patients, and hence they are carried out in rural hospitals. It is much more cost effective to have a good look and take biopsies from the suspicious lumps in a rural setting than to carry out noninvasive procedures like the CT scan or the MRI. Patients who have acute abdomen, especially in a rural area, are not willing to undergo major diagnostic surgical procedures. Very often, it is due to the financial constraints and it is difficult to convince them about the need for the surgical procedure. However, with this minimally invasive procedure, when the relatives actually see the need for the surgical procedure, like seeing pus in the abdomen, or the perforation in the duodenum, or blood in the abdominal cavity, they readily agree for the further surgical procedure. Laparoscopic surgical procedures, with their minimal access to the abdominal cavity, are associated with fewer postoperative adhesions compared to open surgery, although adhesion formations cannot be entirely prevented (2).

Would you like to write articles for doctors or patients in India? Click Here for Details

Diagnostic Laparoscopy with Cystoscope The laparoscopic surgery set might not be available in rural hospitals. However, a cystoscope is available in most of the mission or rural hospitals. It could be used for laparoscopic diagnosis (1). The cystoscope was passed through a small incision, and the incision was tightened around the cystoscope either by using a purse string suture or by holding with a towel clip, as shown in the Figure below.

The BP cuff or similar instrument was used for creating pneumoperitoneum. The working port of the cystoscope could be used for taking biopsies.

http://mdcurrent.in/courses/misforruralsurgeonslesson8/

1/3

9/30/2015


In cases of evaluation of infertility, it is a very useful tool. The patency of the tubes could be studied by injecting methylene blue dye. Pelvic inflammatory disease and adhesions could be diagnosed. Any ovarian pathology could be identified, too. In liver biopsies, it is better than the biopsy gun because only the superficial tissues are biopsied, and cauterization of bleeding point could be carried out using our locally made electrocauterisation probe. Diagnostic laparoscopy is a big problem when there is ascitis. However, it is often necessary because if tuberculosis is diagnosed, it is curable. Patients are often very sick and may not stand an open laparotomy or even a diagnostic laparoscopy using gas. The cystoscope is a great advantage in situations like this. It has been our experience that when diagnostic laparotomies are carried out for cancer of the stomach when the condition is inoperable, the patient always has a downhill course and often dies at the hospital. With a minimally invasive procedure using cystoscope, the recovery is fast, and some patients do well with chemotherapy and have enough time to go home and settle their affairs. The drawbacks of open surgical laparotomies are as follows: The morbidity of laparotomies has prevented its liberal use as a diagnostic tool. The patients are not happy to accept laparotomy as a diagnostic tool. The long hospital stay and convalescence make the procedure expensive. Some patients, especially those with inoperable malignancy, had a downhill course following laparotomies. The advantages of the use of minimally invasive diagnostic laparoscopy using a cystoscope are that the above disadvantages are overcome, and very useful diagnostic information is obtained. The following table lists the outcome of diagnostic laparoscopy with a cystoscope at Burrows Memorial Christian Hospital at Alipur in Northeast India, before the hospital acquired the laparoscopy equipment. Outcomes of Diagnostic Laparoscopies Carried Out with a Cystoscope at BMCH from April 2003 to March 2006 INDICATION

NO. OF PATIENTS

RESULTS

Infertility

18

Patent tubes in 13 patients

Ascitis

12

3 tuberculosis, 2 malignancies and 7 cirrhosis

Carcinoma Stomach

4

3 inoperable

Liver biopsy

4

One malignancy

Abdominal lumps

2

Ovarian malignancy and mucinous cystadenoma

Acute abdomen

4

2 acute appendicitis, 1 psoas abscess and 1 enteric perforation

REFERENCES 1. Diagnostic laparoscopies in rural areas: A different use for Cystoscope. J. Gnanaraj. Tropical Doctor 40: 3 July 2010 p 156. http://mdcurrent.in/courses/misforruralsurgeonslesson8/

2/3

9/30/2015


1. M. Schäfer, L. Krähenbühl, M.W. Büchler. Comparison of Adhesion Formation in Open and Laparoscopic Surgery. Digestive Surgery 1998;15:148152. 3. Gnanaraj J. Video: Diagnostic Laparoscopy the low cost method. mdCurrentIndia, April 2015. Available at: http://mdcurrent.in/surgery/videodiagnosticlaparoscopythelowcost method/ « Back to course page

Post a Comment Logged in as Dr. J. Gnanaraj Comment

Post Comment

Home | mdCommunity | About | Advisors | Contact | Sponsorship | Index | Privacy © 2012 2015 mdCurrent, LLC. All rights reserved. Most of the content on this site is professional in nature and is intended for physicians, except for the patient education section. All content is for informational purposes only, and it is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider.

http://mdcurrent.in/courses/misforruralsurgeonslesson8/

Back to Top

3/3