Video: GLLS Diagnostic Laparoscopy

Diagnosis is a big challenge in rural areas where diagnostic facilities like CT scan and MRI are not available. Even if the patients are willing to travel more than 100 kilometers to reach such centers where CT scans / MRI are available they are out of reach of the poor patients due to their high cost.

EMERGENCY DIAGNOSTIC LAPAROTOMIES = 125 – 150 PER 100,000 POPULATION
DIAGNOSTIC LAPAROSCOPY NEED ESTIMATE = 200 PER 100,000 POPULATION

Estimates show that the need for emergency diagnostic laparotomy is about 125 to 150 per 100,000 population especially for blunt abdominal trauma. In addition to these emergencies laparotomies are indicated for elective surgeries like the following

  1. Evaluation of infertility that could be combined with tubal patency testing
  2. Staging of GI malignancies
  3. Diagnosis and Biopsies of abdominal masses
  4. Evaluation of chronic and acute abdominal pain
  5. Conditions like abdominal tuberculosis are still common and post-operative adhesion causing sub – acute intestinal obstructions could be diagnosed and treated.

The acceptance of patients is much higher for diagnostic laparoscopies compared to conventional laparotomies and it is here that the Gas Less Laparoscopic surgeries have great advantage:

  • They are possible under the easily available spinal anesthesia
  • Traditional instruments could be used for biopsies and surgeries
  • Most of the time surgeries are possible with single incision

In rural areas patients worry a lot about finances and give consent for surgeries after they are shown the pus in the peritoneal cavity with DU perforation or appendicitis etc.

Diagnostic laparoscopies were so important that we started doing them even before we got the regular laparoscopic surgical equipment. We used the cystoscope for diagnosis.

In conclusion the diagnostic laparoscopies with GLLS is a great boon to the rural surgeons as it would help with diagnosis and treatment and is well accepted by the patients and would add about 200 to 300 surgeries per 100,000 populations in rural areas without much of investment.

gnanaraj Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.
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