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 merely numbs the area affected by the surgery and allows the patient to stay awake.

A small incision is made below the navel, a needle is inserted into the incision, and carbon dioxide gas is injected to elevate the abdominal wall, creating a larger space to work in. This allows for easier viewing and manipulation of the organs. A tube called a trocar is inserted through the incision, which allows passage of a tiny video camera into the abdomen.

The laparoscope is then inserted so that the organs of the pelvis and abdomen can be examined. Additional small incisions may be made for instruments that allow the surgeon to move organs for a clearer view.

In the case of gynecologic laparoscopy, dye may be injected through the cervical canal to make the fallopian tubes easier to view.

Following the examination, the laparoscope is removed, the incisions are closed, and bandages are applied.

How to prepare for the test

Do not consume any food or fluid for 8 hours before the test. You must sign a consent form.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

     
  • Infant test/procedure preparation (birth to 1 year)  
  • Toddler test/procedure preparation (1 to 3 years)  
  • Preschooler test/procedure preparation (3 to 6 years)  
  • Schoolage test/procedure preparation (6 to 12 years)  
  • Adolescent test/procedure preparation (12 to 18 years)

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.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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