Laparoscopy

Test Overview

Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs . Laparoscopy is used to find problems such as cysts, adhesions, fibroids , and infection. Tissue samples can be taken for biopsy through the tube (laparoscope).

In many cases laparoscopy can be done instead of laparotomy surgery that uses a larger incision in the belly. Laparoscopy can be less stressful and may have less problems and lower costs than laparotomy for minor surgeries. It can often be done without needing to stay overnight in the hospital.

Why It Is Done

Laparoscopy is done to:

• Check for and possibly take out abnormal growths (such as tumors) in the belly or pelvis.
• Check for and treat conditions such as endometriosis, ectopic pregnancy, or pelvic inflammatory disease (PID).
• Find conditions that can make it hard for a woman to become pregnant. These conditions include cysts, adhesions, fibroids, and infection. Laparoscopy may be done after initial infertility tests do not show the cause for the infertility.
• Do a biopsy.
• See whether cancer in another area of the body has spread to the belly.
• Check for damage to internal organs, such as the spleen, after an injury or accident.
• Do a tubal ligation.
• Fix a hiatal hernia or an inguinal hernia. See a picture of an inguinal hernia .
• Take out organs, such as the uterus, spleen, gallbladder (laparoscopic cholecystectomy), ovaries, or appendix (appendectomy). Partial removal (resection) of the colon also can be done.
• Find the cause of sudden or ongoing pelvic pain.

How To Prepare

You will be asked to sign a consent form before having laparoscopy. Talk to your doctor about any concerns you have about the need for the surgery, its risks, how it will be done, or what the results will mean.

Tell your doctor if you:

• Have allergies to any medicines, including anesthesia.
• Have any bleeding problems or are taking any blood-thinning medicines, such as aspirin or warfarin (Coumadin).
• Are or might be pregnant.

Before laparoscopy:

• Do not eat or drink for 12 hours. An empty stomach helps lower the chance of vomiting during or after the surgery. If you take daily medicines, ask your doctor if you should take them the day of the laparoscopy.
• Leave your jewelry at home. Any jewelry you wear will need to be taken off before the laparoscopy.
• Remove your glasses, contacts, and dentures or a removable bridge before the laparoscopy. These will be given back to you as soon as you wake up after the surgery.
• Arrange for someone to drive you home after the laparoscopy.

You may be asked to use an enema several hours before or the day before the surgery to empty your colon.

The hospital or surgery center may send you instructions on how to get ready for your laparoscopy or a nurse may call you with instructions before your surgery.

How It Is Done

Laparoscopy is done by a surgeon or a doctor of women's health (gynecologist). General anesthesia is generally used, but other types of anesthesia, such as spinal anesthesia, may be used. Talk with your doctor about what choice is best for you.

About an hour before the surgery, you will empty your bladder. You will get fluids and medicine through an intravenous (IV) in a vein in your arm. You may get a medicine (sedative) to help you relax.

Several procedures may be done after you get your anesthesia and are relaxed or asleep.

• An airway will be placed in your throat to help you breathe if you get general anesthesia.
• A thin flexible tube (urinary catheter) may be put through your urethra into the bladder.
• Some of your pubic hair may be shaved.
• Your belly and pelvic area will be washed with a special soap.
• For women, your doctor may do a pelvic exam before putting a thin tube (cannula) through your vagina into the uterus. The cannula lets your doctor move your uterus and ovaries to get a better look at the belly organs.

During laparoscopy, a small incision is made in the belly. More than one incision may be made if other tools will be used during the surgery. A hollow needle is put through the first incision and gas (carbon dioxide or nitrous oxide) is slowly put through the needle to inflate the belly. The gas lifts the abdominal wall away from the organs inside so your doctor can see clearly.

A thin, lighted tube (laparoscope) is then put through the incision to look at the organs. Other tools can be used to take tissue samples, fix damage, or drain cysts. A laser may be attached to the laparoscope to help with the surgery.

After the surgery, all the tools will be removed and the gas will be released. The incisions will be closed with stitches and covered with a bandage. The scar will be very small and will fade over time.

Laparoscopy takes 30 to 90 minutes, depending on what is done, but can take longer if a condition (such as endometriosis) is found and treated. After the laparoscopy, you will go to the recovery room for 2 to 4 hours. You can usually do your normal activities the next day, but do not do any strenuous activity or exercise for about a week.

How It Feels

If general anesthesia is used, you will be asleep and feel nothing. After you wake up, you will feel sleepy for several hours. You may be tired and have some pain for a few days after a laparoscopy. You may have a mild sore throat from the tube in your throat to help you breathe. Use throat lozenges and gargle with warm salt water to help your sore throat.

If you have other types of anesthesia, you may have pain for a few days when the initial numbness wears off.

Risks

There is a small chance for problems from a laparoscopy.

• Bleeding from the incisions
• Infection
• Damage to an organ or blood vessel. This may cause more bleeding that needs another surgery to repair.

A laparoscopy may not be done because of a higher chance for problems if you have:

• Abdominal cancer.
• An abdominal hernia.
• Had abdominal surgeries in the past.

After the surgery

Right after surgery, you will be taken to a recovery room where nurses will care for and watch your vital signs (temperature, blood pressure, oxygen level, and heart rate). You will stay in the recovery area for 2 to 4 hours, and then you will go home. Your nurse will explain any special instructions from your doctor. You will probably go home with a sheet of care instructions and who to call if you have a problem.

You may have some bloating. There may be bruising around the incisions for a few days. You may have some pain around the incisions. Do not drink carbonated beverages for 1 to 2 days after the laparoscopy to lower your chance of gas pains and vomiting.

The gas used during the laparoscopy can irritate your diaphragm for a few days. You may have some pain or achiness in your shoulder for a couple of days after the laparoscopy.

Some of the gas in your belly may leak into your skin and cause a crackling sound if you rub the skin surrounding the stitches. This is not serious and will go away in a few days.

Call your doctor immediately if you have:

• A large area of redness or swelling around the incisions.
• Bleeding or drainage from the stitches.
• Fever.
• Severe belly pain.
• Hoarseness in your voice that lasts more than a few days or gets worse.

Results

Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs . Your doctor may talk to you about the surgery once you are fully awake. He or she may call you at home later to talk to you about the results. Results of any lab tests on tissue samples may not be available for several days.

What Affects the Test

Reasons you may not be able to have the surgery or why the results may not be helpful include:

• If you are obese, which may make the laparoscopy harder to do.
• If you have scar tissue from another surgery or an injury.
• If a tissue sample is taken for a biopsy, but the results are not clear about what the problem is.

What To Think About

• People who are obese or who have had other belly surgeries may need to have a larger incision in the belly for the surgery. This is called open laparoscopy.

References

Other Works Consulted

• Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.

• Fischbach FT, Dunning MB III, eds. (2004). Manual of Laboratory and Diagnostic Tests, 7th ed. Philadelphia: Lippincott Williams and Wilkins.

• Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.

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