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.

Alternative Names

Laparoscopy - diagnostic

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, very rarely, 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 inserts 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 abdominal area. A tiny video camera (laparoscope) goes through this tube and is used to see the inside of your 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 given general anesthesia, you will feel no pain during the procedure, although the surgical cuts may throb and be slightly painful afterward. Your doctor may prescribe medicine to relieve pain.

With local anesthesia, you may feel a prick and a burning sensation when the local anesthetic is given. The laparoscope may cause pressure, but there should be no pain during the procedure. Afterward, you may also feel soreness at the site of the surgical cut. A pain reliever may be prescribed by your doctor.

You may also have shoulder pain for a few days, because the gas used during the procedure can irritate the diaphragm, which shares some of the same nerves as the shoulder. You may also have 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 is done after other, noninvasive tests.

Laparoscopy may detect or diagnose the following conditions:

• Appendicitis
• Cancer, such as ovarian cancer
• Ectopic pregnancy
• Endometriosis
• Inflammation of the gallbladder (cholecystitis)
• Pelvic inflammatory disease

The procedure may also be done instead of open surgery after an accident to see if there is any injury to the abdomen.

Major procedures to treat cancer, such as surgery to remove an organ, may begin with laparoscopy to rule out the presence of cancer spread (metastatic disease), which would change the course of treatment.

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

Abnormal results may be due to a number of different conditions, including:

• Adhesions
• Appendicitis
• Cholecystitis
• Endometriosis
• Ovarian cysts
• Pelvic inflammatory disease
• Signs of injury
• Spread of cancer
• Tumors
• Uterine fibroids

What the risks are

There is some risk of infection. Antibiotics may be given to prevent this complication.

There is a risk of puncturing an organ, which could cause leakage of intestinal contents, or bleeding into the abdominal cavity. Such a complication could lead to immediate open surgery (laparotomy).

Special considerations

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References

Maa J, Kirkwood KS. The appendix. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 49.

Postier RG, Squires RA. The acute abdomen. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 45.