Introduction: Diagnostic laparoscopy is able to provide substadial information in the diagnosis of liver and peritoneal diseases. When performed under conscious sedation, patients may have discomfort and furthermore, albeit low, trocar site complications maybe related to the diameter of the trocar. Aim: Because of the perceived notion of discomfort and trocar site complications being related to the diameter of standard trocars (5mm and 10mm), we evaluated the safety and efficacy of smaller 2 mm laparoscope. Patient add Methods: 17 patients (10 males and 7 females, ages 36-71) underwent diagnostic laparoscopy over a six month period using a 2mm laparoscope. These procedures were performed under conscious sedation and local anesthesia in an endoscopy suite A 150 mm long Verres needle was rtroduced into the abdominal cavity through a disposable 2 mm trocar (140 mm long introducer) and a pneumoperitoneum was created with nitrous oxide. The trocar (introducer) is equipped with a built-in anchoring mechanism to the abdomnal wall and a side port for maintaining pneumoperitoneum. After removing the Verres needle, the 2 mm external diameter laparoscope with 0° optic lens (Auto Suture Company, Norwalk, CT) was rtroduced into the peritoneal cavity and the liver and peritoneum were evaluated. Results: b 9 of 17 patients good visualization of all liver segments was accomplished, m these patients a second 2mm introducer was used for liver biopsy needle, palpation probe and then to inspect trocar entry site using the same 2 mm laparoscope interchangeably. Inability to properly visualize liver lesions, especially those located in segments II, IV and VIII, led to the placement of a second 5mm or 10mm trocar and laparoscope (8 patients) at another site. This was attributed to the fact that with 0° lens it was not possible to evaluate appropriately these segments from a tangential approach. In one obese patient the introducer was not long enough (only 90 mm in free length through abdominal wall) to penetrate and remain anchored in the peritoneal cavity and the procedure was converted to conventional laparoscopy. The small size puncture sites did not require sutures. All laparoscopies with liver biopsy were performed in 10-30 minutes. All patients tolerated procedure well and were discharged home the day after procedure Conclusions: 1 Two mm minilaparoscope provides a safe and simple way to access the peritoneal cavity for the evaluation of liver diseases. 2 .There is a need for an oblique viewing minilaparascope to accomplish visualization of all segments of the liver that is comparable to the standard 5mm or 10mm laparoscope.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging