DIAGNOSTIC

LAPAROSCOPY
 Diagnostic laparoscopy remains one of the
most prevalent surgical procedure in
gynaecologic practice.
 The longevity of the technique can be
attributed to the high quality visualization
of the pelvic and abdominal viscera with a
minimally invasive but safe surgical
approach.
 Common indications include; evaluation of
acute peritoneal signs, unexplained
infertility, chronic pelvic pain, and second-
look surgery after debulking of ovarian
cancer.
 The differential diagnosis of a reproductive
age women who present with with acute
onset of pelvic pain and peritoneal signs
are extensive
 Ruptured ovarian cyst
 Torted adnexia
 Ectopic pregnancy
 Pelvic inflammatory disease
 The access of diagnostic laparoscopy to
the peritoneal cavity facilitate surgical
intervention for any discovered pathology.
 Pelvic abnormalities have been
demonstrated in 30-40% of women with
infertility.
 Direct visualization of the abdomen and
pelvis with laparoscopy provides
informations regarding adhesions, tubal
 Common findings include adhesions from prior
salpingitis , endometriosis, and anatomical
abnormalities.
 Even 25% 0f infertile patients with negative
radiographic findings have abnormalities.
 Pelvic pain represent 40% of indications od
diagnostic laparoscopy
 Approximately 60-70% of diagnostic laparoscopy
for chronic pelvic pain have abnormal findings.
 Endometriosis, pelvic adhesions, chronic pelvic
inflammatory diseases and ovarian cysts are the
most common findings.
 Approximately 65-80% of women with positive
findings at laparoscopy have clinical
improvement after operative management.
 Procedure
 Although Diagnostic laparoscopy is not unique to
gynaecology, it has it’s one modalities and
difficulties.
 The cul-de-sac hide some pathologies which are
difficult to visualize, thus the uterine manipulator
is of a great help.
 Chromotubation is another important aspect of
gynaecological diagnostic laparoscopy
 Diluted methylene blue solution is infused into
the uterine cavity and tubal lumen to evaluate
patency.
 Chromotubation has as well a therapeutic benefit
, since the rate of fertility is significantly
 Steps of diagnostic laparoscopy
 Starts with uterine manipulator
 Patient prepped and draped for vaginal
acess
 Foley catheter is placed
 Speculum placed to visulized os
 Bimanual examination and probing of
the uterine cavit preceed the procedure
to avoid perforation
 A single-tooth tenaculum is placed on
the anterior lip of cervix to facilitate
placement of the uterine manipulator
UM.
 Now drping of the abdomen for
 Pneumoperitonium initiated
 Repeated scopy if needed necessitate usin
Tenckhoff cath.
 Midline sheath is placed next for pelvic organ
manipulation
 If extensive pathology found another two
paramedian sheaths may be required.
 Landmarks identification in midline before
placement of paramedian trocars.
 The urachus running superiorly in the midline.
 The oliterated umblical arteries run lateral to the
urachus.
 Inferior epigastric arteries are often not visible in
the peritoneum, usually run superiorly1-2 cm
lateral to the umbilical artery.
 A systemic approach to surveying the
abdomen and pelvis is the best method to
ensure pathology is not ovelooked.
 Befor the patient is placed in trendilenburg
position, the upper abdomen and
diaphragm should be visulaized.
 The anterior cul-de-sac is inspected first ,
then the uterus is elevated..., this will give
excellent view of the fallopian tubes.
 Placing a prob into the ovarian fossa…
 Chromotubation is then performed.
 According to the aim of the procedure ,
the small bowel and the appendix should
be inspected