The role of laparoscopy in the propaedeutics of gynecological diagnosis

Abstract

Purpose To evaluate agreement between pre- and post-laparoscopy gynecological diagnosis in order to demonstrate the rationality of this minimally invasive technique use in gynecological propaedeutics. Methods Retrospective chart review study conducted between March 2010 and October 2016 based on a convenience sample. 315 patients undergoing surgical laparoscopy at the Center of Gynecologic Endoscopy and Family Planning of Botucatu Medical School/UNESP. Pre- and postoperative diagnoses were compared by the diagnosis agreement test considering the proportions of events. Results Laparoscopy contributed to diagnosis in 59.6% of infertility cases (P>0.05), in 93.7% of chronic pelvic pain of undetermined origin (P<0.01) and conclusively elucidated the diagnosis of acute abdomen and the ruling out of tubo-ovarian abcess (P<0.05). Laparoscopy also increased the diagnosis of pelvic-abdominal adhesions in 76.7% (P>0.05). Conclusion The use of laparoscopy considerably contributed to diagnostic elucidation, especially in cases of undetermined chronic pelvic pain.

The Role of Diagnostic Laparoscopy in Chronic Pelvic Pain

“…The mean patient age in this study was (30.4±6.3), This goes with Argentino GL et al [8] that found the mean age of women with CCP was 35± 4.5 years. Most of the patient were overweight with mean BMI (28.9±3.1), this goes with Argentino GL et al [8] that found the mean BMI of women with CCP 26.94 ±5.52 .…”

“…In this study removal of endometrioma was (3.7%), this near from what Argentino GL et al [8] found (6.4%),but lower than of Brichant, G., et al [9 ( ] 41 . )% It is possible that more than one lesion could have been found in a patient and so more than one surgical procedure would then be carried out.…”

“…Those with negative findings in laparoscopy was (10%) patient, (33.3%) of them were diagnosed as negative by pelvic examination, there were miss diagnosis in (67%) of the negative patient and (11.1%) of positive diagnosed patient in a statically significant relation. These goes with Argentino GL et al [8] who found that laparoscopy contributed to correct diagnosis in 59.6% of infertility cases, 93.7% of chronic pelvic pain of undetermined origin, 87.5% of complex ovarian cyst cases , 40% of ovarian tumor cases , and 77.8% of adnexal mass of unknown etiology cases.…”

Evaluating the cost-effectiveness of laparoscopy in the acute abdomen

“…Abdomenul acut rămâne o urgență chirurgicală frecventă în activitatea medicilor, atât de profil chirurgical cât și terapeutic, reprezentând un spectru de patologii non traumatice sau traumatice, care necesită evaluarea imediată și diagnosticare rapidă în scopul argumentării tacticilor de tratament chirurgical sau medical [1,2,3]. Esenţială este diagnosticarea promptă a abdomenului acut chirurgical, asigurând evitarea întârzierii nejustificate a diagnosticului care influențează prognosticul pacientului [3,4,5,6]. Pe parcursul anului 2016, în Republica Moldova (RM) au fost înregistrate 15760 de cazuri de patologie chirurgicală acută, fiiind remarcată tendința stabilă de micșorare a incidenței abdomenului acut în comparație cu anii precedenți.…”

“…Conform datelor literaturii de specialitate, per total, în majoritatea intervenţiilor chirurgicale, laparoscopia reduce costurile comparativ cu intervenţiile clasice cu 20-30% [11,21,22]. În țările dezvoltate, 25-40% din costurile directe asigură remunerarea personalului medical [8,23].…”