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Inside Tract - Minimal scope. Maximum view
Inside Tract Winter 2011
Minimal scope. Maximum view
Date: January 3, 2011
An endoscopy trinity: Patrick Okolo, Tony Kalloo (seated) and Zhiping Li head Hopkins’ new mini-laparoscopy service that is unique in this country.
photo by Keith Weller
Clinicians knew that Anthony White* suffered from a liver ailment but knowing what it was had become a puzzle. The 52-year-old had elevated liver enzymes and progressive weakness. He was profoundly tired and slightly jaundiced. And it depressed him that nobody seemed to be able to pinpoint what he had. Two liver biopsies revealed only that White had mild steatosis. “He was, in short, a prime candidate for mini-laparoscopy,” says Patrick Okolo, a specialist in GI endoscopy.
Brought to East Baltimore from Germany two years ago, mini-laparoscopy lets endoscopists visualize the peritoneum and its contents via a small, streamlined scope fed into a single port. “It’s an extremely nimble technique,” Okolo explains, “because the ports are only a few millimeters wide and we can put them anywhere in the abdomen that it’s safe to do that.” After the procedure, the opening is simply covered with a Band-Aid.
The process is a significant advance over traditional laparoscopy, which requires making 5- to 10-millimeter long holes in the abdomen, as well as general anesthesia.
Okolo performed White’s peritoneoscopy—the formal term—in an outpatient setting, using only local anesthesia. White returned home after an hour’s recovery.
“Now we can extend many procedures that we used to do via ultrasound, using only surface landmarks,” says Okolo. He cites liver biopsies as an example. “Traditionally, we had to hope that the tissue we’d taken represented what was ailing that organ. And we knew that until a disease process became diffuse and uniform, sampling error was a real drawback,” he explains. Studies confirm a great degree of sampling error in traditional laparoscopic biopsies—sometimes as much as a 60 percent discrepancy in showing tumors or other infiltrative disorders or the degree of fibrosis in the liver.
The new laparoscopy, however, lets Okolo and colleagues Tony Kalloo and Zhiping Li explore liver topography and catch focal points of disease. That’s what revealed that White’s problem was sarcoidosis. The whitish plaques and nodules were clearly scattered over his liver, and the endoscopically biopsied tissue confirmed it. The concerned patient was saved an exploratory laparotomy. He has now recovered.
Not surprisingly, the technique is proving its usefulness for primary peritoneal disease and for exploring all organs within the peritoneum. There’s much more information for cancer staging and for diagnosis, as mini-laparoscopy enables larger tissue samples than needle biopsy.
* not his real name