The role of diagnostic laparoscopy in gynecology

Abstract

CONTEXT AND OBJECTIVES: Laparoscopy is a diagnostic method that is currently becoming consolidated for therapeutic use. It consists of endoscopically viewing the abdominal cavity. The aim here was to evaluate the indications for diagnostic videolaparoscopy and the intraoperative findings in an endoscopic gynecology clinic at a tertiary-level hospital over the last five years. DESIGN AND SETTING: Retrospective descriptive study on all diagnostic videolaparoscopy procedures of the last five years carried out in the endoscopic gynecology clinic of a tertiary-level hospital. METHODS:The medical records of 618 women who underwent diagnostic laparoscopy between 2008 and 2012 were analyzed. The clinical characteristics of these women, the indications for videolaparoscopy and the intraoperative findings were evaluated. RESULTS: The women's mean age was 32 ± 6.4 years. Most of the women had already undergone at least one previous operation (60%), which was most frequently a cesarean. The indications for performing videolaparoscopy were infertility in 57%, chronic pelvic pain in 27% and others (intrauterine device, adnexal tumor, ectopic pregnancy or pelvic inflammatory disease) in 16%. The main laparoscopic findings were tubal alterations in the group with infertility (59.78%) and peritoneal alterations in the group with chronic pelvic pain (43.54%). CONCLUSION:The main indications for videolaparoscopy in gynecology were infertility and chronic pelvic pain. However, in most procedures, no abnormalities justifying these complaints were found. RESUMO CONTEXTO E OBJETIVOS:A laparoscopia é um método diagnóstico que atualmente se consolida como terapêutico e se caracteriza pela visão endoscópica da cavidade abdominal. O objetivo foi avaliar as indicações de videolaparoscopia diagnóstica e os achados intraoperatórios no serviço de videolaparoscopia ginecológica de um hospital terciário nos últimos cinco anos. DESENHO E LOCAL: Estudo retrospectivo descritivo com todos os procedimentos videolaparoscó-picos diagnósticos dos últimos cinco anos realizados no serviço de ginecologia endoscópica de um hospital terciário. MÉTODOS: Foram analisados 618 prontuários de mulheres submetidas à laparoscopia diagnóstica entre os anos de 2008 a 2012. Foram avaliadas as características clínicas dessas mulheres, bem como as indicações da videolaparoscopia e os achados intraoperatórios. RESULTADOS: As mulheres tinham em média 32 ± 6.4 anos. A maioria das mulheres já tinha feito pelo menos uma cirurgia anterior (60%), sendo que a mais frequente foi a cesárea. As indicações para a realização da videolaparoscopia foram 57% por infertilidade, 27% por dor pélvica crônica e 16% outras (dispositivo intrauterino, tumor anexial, gravidez ectópica e doença inflamatória pélvica). Os principais achados laparoscópicos foram alterações tubárias no grupo com infertilidade (59.78%) e alterações peritoneais no grupo com dor pélvica (43.54%). CONCLUSÃO: As principais indicações da videolaparoscopia em ginecologia são infertilidade e dor pélvica crônica; mas...

The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients

“…They found that the agreement between the two modalities was 74% [13]. Agrawal et al [18] and Tognil et al [19] found the probability of tubal occlusion on hysterolaparoscopy to be very low while HSG was normal. Similar results were found in the present study in that no patient showed tubal blockage on chromopertubation when HSG was reported to have tubal spillage of dye.…”

Approach to Pain in Endometriosis Patients: Systematic Literature Review

“…On the other hand, laparoscopy has been the gold standard surgical method performed in patients with endometriosis. It allows the definitive diagnosis, through evaluation of the lesions at a macro and microscopic level [40], classifying them according to their severity [41], in addition to being a quick, efficient and minimally invasive procedure, which generally does not involve major complications [40]. Its indication has been reported mainly for women with chronic pelvic pain and infertility, cases in which empirical treatment has not had an effect, cases of drug intolerance and for immediate diagnosis/resolution of the disease [6].…”

“…There are several surgical procedures. However, it is noteworthy that, although these procedures do not involve major risks, they still exist; with emphasis on infections, hemorrhages and injuries in abdominal pelvic organs (intestine and bladder) [41]. Thus, a thorough clinical analysis is feasible to avoid performing undue procedures, which are relatively invasive and costly.…”

Laparoscopic Management of Tubal Ectopic Pregnancy: Single-Port Versus Conventional Multi-Port Laparoscopy.

“…Laparoscopy provided a diagnostic method that is currently becoming consolidated for therapeutic use (7) , and is becoming the gold standard in gynecological surgery (8) . The laparoscopic approach in acute abdomen of gynecologic origin in comparative studies was found to be non-inferior to open surgery (9) .…”