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Diagnostic laparoscopy
Definition Diagnostic laparoscopy is a procedure that allows a health care provider to look directly at the contents of a patient's abdomen or pelvis, including the fallopian tubes, ovaries, uterus, small bowel, large bowel, appendix, liver, and gallbladder. The purpose of this examination is to actually see if a problem exists that has not been found with noninvasive tests. Inflammation of the gallbladder (cholecystitis), appendix (appendicitis), pelvic organs (pelvic inflammatory disease), or tumors of the ovaries may be diagnosed laparoscopically. Additionally, the provider may wish to exclude abdominal trauma following an accident by using laparoscopy rather than a large abdominal incision. Major procedures to treat cancer, such as surgery to remove an organ, may begin with laparoscopy to exclude the presence of additional tumors (metastatic disease), which would change the course of treatment. How the test is performed The procedure is usually done in the hospital or outpatient surgical center under general anesthesia (while the patient is unconscious and pain-free). However, this procedure may also be done using local anesthesia, which numbs only the area affected by the surgery and allows you to stay awake. A surgeon makes a small cut below the belly button (navel) and inserted a needle into the area. Carbon dioxide gas is passed into the area to help move the abdominal wall and any organs out of the way, creating a larger space to work in. This helps the surgeon see the area better. A tube is placed through the cut in your belly area. A tiny video camera goes thru this tube and is used to see the inside of your body. Next, a laparoscope is passed into the area so they doctor can see the pelvis and abdomen. Additional small cuts may be made if other instruments are needed to get a better view of certain organs. In the case of gynecologic laparoscopy, dye may be injected into your cervix area so the surgeon can better see your fallopian tubes. After the exam, the laparoscope and instruments are removed, and the cuts are closed. You will have bandages over those areas. How to prepare for the test Do not eat or drink anything for 8 hours before the test. You must sign a consent form. How the test will feel If you are under general anesthesia, you will feel no pain during the procedure, although the incisions may throb and be slightly painful afterward. A pain reliever may be given by your physician. With local anesthesia, you may feel a prick and a burning sensation when the local anesthetic is given. Pain may occur at the incision site. The laparoscope may cause pressure, but there should be no pain during the procedure. Afterward, the incision site may throb for several hours and may be slightly painful. A pain reliever may be given by your physician. Additionally, you may experience shoulder pain for a few days, because the carbon dioxide can irritate the diaphragm, which shares some of the same nerves as the shoulder. You may also experience an increased urge to urinate, since the gas can put pressure on the bladder. Why the test is performed The examination helps identify the cause of pain in the abdomen and pelvic area. It may detect the following conditions: - Endometriosis (tissues normally found in the uterus growing in other areas)
- Ectopic pregnancy (in which the fertilized egg develops outside of the uterus),
- Pelvic inflammatory disease (an inflammation in the pelvic cavity)
- Cancer
- Cholecystitis
- Appendicitis
Normal Values There is no blood in the abdomen, no hernias, no intestinal obstruction, and no cancer in any visible organs. The uterus, fallopian tubes, and ovaries are of normal size, shape, and color. The liver is normal. What abnormal results mean The procedure may detect the following: - Ovarian cysts
- Abnormal union of body surfaces (such as adhesions following prior surgery)
- Endometriosis
- Uterine fibroids
- Tumors
- Pelvic inflammatory disease
- Appendicitis
- Cholecystitis
- Metastatic cancer
- Signs of trauma
What the risks are There is a risk of puncturing an organ, which could cause leakage of intestinal contents, or bleeding into the abdominal cavity. These complications may result in the conversion of laparoscopy to open surgery (laparotomy). There is also some risk of infection. However, antibiotics are usually given as a precaution. Review date: 7/14/2006 Reviewed By: J.A. Lee, M.D., Division of Surgery, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.
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