Diagnostic flexible laparoscopy: A single incision procedure

Objective of the study: Diagnostic laparoscopy is a minimally invasive method which enables the direct inspection of intra-abdominal organs. Simple additional procedures, such as histological or cytological sampling, fluid aspiration and intraperitoneal lavage can be carried out by positioning additional trocars.

The aim of this technique is to reduce the number of percutaneous trocars required to complete the procedure, by using a flexible endoscope for this purpose.

Methods and procedure: After positioning a percutaneous 12 mm trocar and inducing CO2 pneumoperitoneum, a flexible endoscope was introduced through the trocar to inspect intra-abdominal organs. Simple procedures were performed utilizing the working channel of the endoscope.

Results: The procedure was performed in six patients for diagnosis of chronic abdominal pain or for tumor staging. No complications were reported after a median follow-up of 5 months. It was possible to inspect the intra-abdominal organs, including the surface of the liver, the gallbladder, the stomach, the intestine, the pelvic organs and the free intraperitoneal fluid. It was possible to perform also simple procedures through the working channel, without positioning additional trocars: histological and cytological sampling, removal of simple adhesions, cyst puncture and intraperitoneal lavage.

Conclusions based on the results: Using a flexible endoscope through a single percutaneous trocar makes it possible to perform a diagnostic laparoscopy during which simple therapeutic and diagnostic procedures can be carried out with the same sterility and organ integrity as that provided by a standard laparoscopy.