Laparoscopic observation of the diaphragm undersurface in the staging of peritoneal carcinomatosis: comparison of three optical systems.
OBJECTIVE
Endoscopy is a key tool in the diagnosis and management planning of peritoneal carcinomatosis. The aim of this study was to determine which type of endoscope is the most efficient for comprehensive staging of the upper abdomen peritoneal surface.


METHODS
From April 2010 to February 2011, endoscopies were performed on five human female fresh-frozen cadavers. Three endoscopes (rigid 0°, 30° and flexible) were used consecutively and compared.


RESULTS
The diaphragmatic areas explored with the flexible endoscope were significantly larger than those with the other two. On average, 135 (range 66-225), 168 (range 96-306), and 201 (range 128-399)cm(2) were observed using the 0°, 30°, and flexible laparoscopes, respectively. The p value obtained using the exact Wilcoxon test for paired data was 0.0019 between the 0° and 30° endoscopes and between the 30° and flexible endoscopes. The 30° endoscope was consistently better than the 0° endoscope for the observation of the diaphragm and spleen undersurface.


CONCLUSIONS
Flexible endoscopy seemed to be the most efficient for the evaluation of peritoneal carcinomatosis. However, due to a poorer image, the need for considerable practice, and the high equipment and maintenance cost of the flexible endoscope, the rigid 30° endoscope seems to be the best compromise.
Centre de lutte contre le cancer Claudius Regaud, 20-24 rue du pont Saint Pierre 31052 Toulouse Cédex 3, France. lebrunjf@hotmail.fr
Jean-François
JF
Le Brun
Gwenael
G
Ferron
Charlotte
C
Vaysse
Martin
M
Baujat
Pierre
P
Leguevaque
Thomas
T
Filleron
Denis
D
Querleu
D003964:Diaphragm / Q000473:pathology*; D019723:Endoscopes; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000473:pathology