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       Dr Gonzalo E. Díaz M  - Ultrasound - Telemedicine             

 
     

 

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Endometriosis diagnosis: Ultrasound versus Laparoscopy

Description

Gynecologic Laparoscopy Ultrasonography
It's a surgical endoscopic procedure to visualize the pelvic structures and perform limited surgery. It is a procedure that records ultrasound waves as they are reflected from anatomic structures.

 

The echoes are digitalized and converted into 2-d images (3-d on experimentation) of the examined area.

Preparation

Gynecologic Laparoscopy Ultrasonography
  1. no solid food for eight hours before surgery
  2. no liquids for six hours before surgery
  3. physical examination and a history before surgery
  4. blood tests
  5. urinalysis
  6. preoperative medication
  7. enema before surgery
  8. laxatives before surgery
  9. vaginal irrigations before surgery
  10. general anesthesia ultrasound before surgery
  1. partial bladder filling

Technique (very brief description)

Gynecologic Laparoscopy Ultrasonography
  1. bladder catheterization
  2. 10 mm stab within the umbilicus
  3. needle insertion into the peritoneal cavity
  4. 2 liters of gas are introduced into the abdomen
  5. trocar and cannula insertion
  6. the trocar is replaced by the laparoscope
  7. a small suture is applied after finishing
  1. We apply a transducer to the skin over the area to examine.

    A monitor displays images from the body's structures.

    The traducer's surface is covered with a special gel

Side effects

Gynecologic Laparoscopy Ultrasonography
  1. postoperative pain (frequent)
  2. postoperative abdominal distension (frequent)
  3. small permanent scars (always)
none

Complications

Gynecologic Laparoscopy Ultrasonography
  1. vaginal bleeding
  2. uterine perforation due to the uterine cannula insertion
  3. endometritis
  4. tubo-ovarian abscess and other pelvic infections
  5. wall abscesses
  6. internal bleeding
  7. peritonitis
  8. urinary infections
  9. subcutaneous emphysema
  10. pre- and retroperitoneal emphysema
  11. epiploon and mediastinum emphysema
  12. embolism
  13. respiratory problems
  14. arrhythmia
  15. heart attack
  16. bowel perforation
  17. cysts perforation
  18. vessel perforation
  19. stomach perforation
  20. dead
none

Contraindications

Gynecologic Laparoscopy Ultrasonography
  1. previous abdominal surgery
  2. pelvic infections
  3. many cardiac and pulmonary diseases
  4. obesity
  5. diaphragmatic hernia
  6. gestation
none

 

Ultrasound reveals inner structural characteristics while laparoscopy just shows structures' surface. So, ultrasound can detect adenomyosis, cervical endometriosis, renal implants, etc., where lesions cannot be reached with the laparoscope.

Neither laparoscopy nor ultrasound let us do any histopathological diagnosis. We need a biopsy to do it. Biopsy is not advisable because we could spread new implants.

When we need to remove any cyst, we would advise to perform a sonogram before the laparotomy rather than a laparoscopy. Risk and cost are different but results are equivalent.

We could extend ultrasound examinations to other organs and structures like pleura, bladder, kidney, liver, cervix, etc., and do it as often as needed. Ultrasound let us detect extraperitoneal endometriosis implants and we can safely do it as much as we want.

One of the main goals to practice laparoscopy has been to correct anatomy distortions due to endometriosis. But endometriosis has systemic effects where laparoscopy has nothing to do.

Let us think about this: laparoscopy lets us diagnose endometriosis; bronchoscopy, bronchitis; cystoscopy, cystitis; endoscopy, gastritis, etc., however we do not use those procedures whenever we suspect those problems.

From Investigaciones Médicas # 48, by Gonzalo E. Díaz MD