Diagnostic Laparoscopy

What is a Diagnostic Laparoscopy?

A diagnostic laparoscopy is a procedure in which the doctor uses a laparoscope to look at the organs and tissues in your abdomen. A laparoscope is a thin metal tube with a light and tiny camera.

Laparoscopy literally means,"to look inside the abdomen". It is a surgical procedure sometimes referred to by patients as "belly-button surgery". The procedure involves placing a telescope-like instrument through a small, usually ½ inch, incision in the abdomen.

The laparoscope is then attached to a high-resolution TV monitor so that the surgeon and their assistants can complete the procedure. Laparoscopy is usually performed on an outpatient basis, which means that the patient can go home a few hours after the surgery. In addition, recovery times are much shorter than when large abdominal incisions are performed.

What is the purpose of Diagnostic Laparoscopy?

Diagnostic laparoscoy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. Many infertile patients require laparoscopy for a complete evaluation. Generally, the test is performed after the basic infertility screening tests, although the presence of pain, history of past infection or an abnormal ultrasound may signal the need to perform diagnostic laparoscopy sooner in the evaluation. In some women the fallopian tubes are blocked. This can prevent sperm and egg from coming together, causing infertility. With laparoscopy, a simple test confirms this possibility. A coloured fluid is injected through the uterus. If the tubes are open the fluid will flow out the ends of the tubes into the abdomen. The surgeon can see this through the laparoscope.

This procedure also allows us to determine whether there are any defects such as scar tissue (adhesions), endometriosis, ovarian cysts, ectopic pregnancy, tubal disease, genital tuberculosis, fibroid tumors and other abnormalities of the uterus. If any defects are found then they can often be corrected with operative laparoscopy which involves placing instruments through ports in the scope and through additional, narrow (5 mm) ports which are usually inserted at the top of the pubic hair line in the lower abdomen.

What are the benefits of Diagnostic Laparoscopy?

• More accurate diagnosis
  This minor surgical procedure may help the doctor make a more accurate diagnosis about the cause of infertility.
• No stitches
  The incision required is very small. It does not even need a stitch.
• Therapeutic benefit
  The doctor may be able to treat the cause during the laparoscopy
• Shorter recovery time
  Your stay at the hospital and time needed to recover will be much shorter than with more extensive abdominal surgery.
• Fewer post-op complications
  Most need little or no pain medicine.
• Less scarring
  The incisions for most kinds of laparoscopic surgery heal without noticeable scars.

How do I prepare for Diagnostic Laparoscopy?

• Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.
• You will need to shave your private parts prior to the procedure.
• You need to be accompanied by your spouse or another relative to help you in your post-op recovery period.

kind of anesthesia is used for Diagnostic Laparoscopy?

Laparoscopy is usually performed as an outpatient procedure, under general anesthesia, and with minimal discomfort.

How is Diagnostic Laparoscopy performed?

After anesthesia, a needle is inserted through the navel, and the abdomen is filled with carbon dioxide gas. As the gas enters the abdomen, it creates a space inside by pushing the abdominal wall and the bowel away from the organs in the pelivic area allowing a view of the reproductive organs. The laparoscope is then inserted through the same incision. It is connected to a tiny camera that send images to a television monitor. While looking at the monitor, the surgeon can see the uterus, fallopian tubes, ovaries, and nearby structures. A small probe is inserted through another incision just above the pubic region to move the organs into clear view. A device called a uterine manipulator may be placed in the uterus through the vagina to move the uterus during the procedure.

The monitor makes the images larger and easier for the doctor to see. These images are recorded for later viewing and a copy of the same will be given to you on a compact disc.

The doctor uses the laparoscope to see the following parts of the body.

• Uterus
• Fallopian tubes
• Ovaries
• Bladder
• Intestines
• Liver
• Spleen
• Appendix
• Surfaces of the abdominal cavities themselves

Additionally, a blue solution is injected through the cervix to determine if the fallopian tubes are open. The procedure usually takes about 15 to 20 minutes.

If no abnormalities are noted at this time, the instruments are removed and the gas released (If defects or abnormalities are discovered, one can proceed to operative laparoscopy).The cuts are then closed without stitches, using an adhesive dressing. You are kept in a recovery room for one to three hours while anesthesia wears off. In a few hours, you can go home.

What happens after Diagnostic Laparoscopy?

The anesthetic may cause sleepiness or grogginess for a while. You are allowed liquids after 4 hours and soft diet in the evening. The most common complaints after laparoscopy include

• Mild nausea from medication/anesthesia
• A sore throat if a breathing tube was used during anesthesia
• Discharge like menstrual flow for a few days
• Shoulder pain, caused from gas that has built up under the diaphragm
• Bloated feeling
• Pain at the incision sites
• Cramping
• Constipation

Most symptoms usually improve within 24 to 48 hours after surgery.

What are the risks associated with Diagnostic Laparoscopy?

Complications after laparoscopic surgery are rare. The incidence is about 3 of every 1,000 women who have diagnostic laparoscopy. However, the risks may be greater for people who are obese, smoke cigarettes, or have additional health problems.

• There may be some soreness near the incisions, especially when twisting or stretching the body.
• Since a breathing tube is used for the anaesthesia, some patients may have a mild sore throat.
• Laparoscopy requires general anaesthesia which carries certain risks. Modern general aneaesthesia, however, is safe and reactions are rare. You must be sure to tell the doctor if you have had a bad reaction to anaesthesia in the past, or if a close family member has experienced such a reaction.
• There may be discomfort in the abdomen, upper chest, shoulders, and neck area due to the carbon dioxide used to inflate the abdomen, but this disappears quickly.
• The abdominal organs, glands, intestines, or blood vessels may be damaged. The doctor may perform abdominal surgery to repair them at the time of the laparoscopy.
• The lining of the abdominal wall may become inflamed.
• A blood clot may break off, enter the bloodstream, and clog an artery in the lung, pelvis, or legs. Rarely, a clot may break off and clog an artery in the heart or brain, causing a heart attack or stroke.
• You may have infection or bleeding.
• You may have some pain after the procedure.
• You may have an allergic reaction to the fluid used during the procedure.

Most people recover quickly and resume their normal activities without problems.

should I call the doctor?

Call the doctor right away if

• You develop a fever over 100°F (37.8°C)
• You become dizzy and faint
• You experience nausea and vomiting
• You become short of breath, have chest pain or leg pain
• You have abdominal pain or swelling that gets worse
• An incision begins to bleed or leak fluid
• An incision becomes red, swollen or feels warm

Call the doctor during office hours if

• You have questions about the procedure or its result.
• You want to make another appointment.