In laparoscopy, a rigid viewing tube (called a laparoscope) is inserted through a small incision in the abdomen, just below the navel. Fiberoptic cables permit a doctor to visually inspect the abdominal and pelvic organs for abnormalities. In addition, various instruments may be passed through the scope or inserted through other incisions to obtain fluid or tissue samples for laboratory examination or to perform therapeutic procedures.
Purpose of the Laparoscopy
- To determine the cause of acute or chronic abdominal or pelvic pain or fluid accumulation in the abdomen
- To detect and evaluate abnormalities affecting the female reproductive organs in the pelvis; these include endometriosis (invasion of endometrial tissue, which lines the uterus, outside of the uterine cavity), ectopic pregnancy, pelvic inflammatory disease, and abnormal growths (tumors, cysts, adhesions, or fibroids)
- To detect and evaluate problems affecting the abdominal organs, such as tumors and cysts
- To detect pelvic abnormalities that prevent pregnancy and test for patency of the fallopian tubes as part of an infertility evaluation
- To obtain a tissue biopsy in order to confirm suspected cancer of an abdominal or pelvic organ or to assess the severity of diagnosed cancer
- Used therapeutically to perform procedures including appendectomy (removal of the appendix), tubal ligation (cutting and tying off of fallopian tubes), removal of the gallbladder, and hernia repair.
Who Performs Laparoscopy
- Depending on the purpose of the procedure, laparoscopy may be performed by a gynecologist, a gastroenterological surgeon, or a general surgeon.
Special Concerns about Laparoscopy
- The procedure may not be possible in people who have had multiple abdominal surgeries. Scar tissue may have formed, making it difficult to perform the procedure safely.
- Suspected internal bleeding (hemorrhage) may be a reason to postpone laparoscopy. Blood can obscure the view through the scope.
- Certain laparoscopic procedures can be performed with local anesthesia, but most require the use of general anesthesia (especially if extensive surgery is anticipated).
Before the Laparoscopy
- Other tests, such as an electrocardiogram and a chest x-ray, may be ordered to ensure that general anesthesia is safe for you.
- Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). You may be instructed to discontinue them for 1 to 2 weeks before the procedure.
- Do not eat or drink anything after midnight on the day before the procedure.
- Shower or bathe the night or morning before the operation and remove any nail polish.
- Do not smoke after midnight on the day before the procedure.
- You will be asked to disrobe and put on a hospital gown.
- Empty your bladder just before the test.
- If local anesthesia is being used, you may be given a sedative before the test to relax you.
- If general anesthesia is required, the medication is administered through an intravenous (IV) needle or catheter inserted into a vein in your arm.
What You Experience during Laparoscopy
- You will lie on your back on an operating table.
- The hair surrounding your navel is shaved (if necessary) and the area is cleansed with an antiseptic. (If applicable, a local anesthetic is injected.)
- A small incision is made below the navel and a hollow, blunt-tipped needle is inserted through the incision into the abdominal cavity. Gas (carbon dioxide or nitrous oxide) is pumped through the needle to distend the abdominal walls so that the organs within are easier to see. The needle is withdrawn.
- The laparoscope is inserted through the incision. Magnifying devices permit the doctor to directly inspect the abdominal cavity and pelvic area, and images of the area may also be transmitted onto a TV screen. Photographs may be taken for later examination, and the scope may be moved to different locations as needed. (If you are conscious, you may be asked to perform certain simple maneuvers to improve the view of certain structures.)
- Following this visual inspection, the doctor may insert surgical instruments through the scope or through other small incisions to remove tissue or fluid samples for laboratory analysis or to perform therapeutic measures.
- The laparoscope is withdrawn, the insufflated gas is allowed to escape, and the incision is closed with stitches or staples.
- Depending on the extent of the procedure, laparoscopy may take from 30 minutes to several hours.
Risks and Complications of Laparoscopy
- Most patients experience temporary pain or cramping in the abdomen and referred pain in the shoulder (as a result of the instilled gas) for 24 to 36 hours.
- Rare complications include infection, inadvertent perforation of the bowel (which requires surgical repair), and bleeding. Call your doctor if you experience severe pain, fever, redness, swelling, burning, urgency or frequency of urination, bleeding from the incision, persistent nausea and vomiting, or if you become dizzy,faint or short of breath.
- If general anesthesia is necessary, the procedure carries the associated risks.
After the Laparoscopy
- You will remain in the hospital until you recover from the effects of anesthesia. (Usually an overnight stay is not required, but overnight admission may be considered if extensive surgery was performed.) During this time, your vital signs will be monitored and you will be observed for any signs of complications.
- You may be given a pain reliever, if needed, to relieve any postoperative pain in the abdomen or shoulder.
- You may return home. After general anesthesia, you should arrange for someone else to drive you.
- You may resume your regular diet. However, your doctor may recommend that you avoid carbonated beverages for a few days, since they may adversely interact with the gases that were pumped into the abdominal cavity during the procedure.
- Your doctor may instruct you to restrict your activity for 2 to 7 days.
- During the visual inspection of your abdominal cavity and pelvic region, the doctor will note any abnormalities. Any photographs taken during the procedure will later be reviewed.
- If tissue or fluid samples were taken, specimen containers may be sent to several different laboratories for examination. For example, biopsied tissue may be inspected under a microscope for the presence of unusual cells, or may be cultured for infectious organisms.
- This test usually results in a definitive diagnosis. Your doctor will recommend appropriate medical or surgical treatment, depending on the specific problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media