Laparoscopy Exploratory

(Other terms used for this type of procedure: Peritoneoscopy, Gynecologic Laparoscopy, Pelviscopy, Exploratory Laparoscopy)

Procedure overview

Laparoscopy is a procedure used to examine the organs of the abdominal cavity. Laparoscopy utilizes a laparoscope, a thin flexible tube containing a video camera. The laparoscope is placed through a small incision in the abdomen and produces images that can be seen on a computer screen. A similar procedure can be used to look at the organs of the pelvis (gynecologic laparoscopy or pelviscopy).

The advantage of laparoscopy is that it allows a direct view of the abdominal organs and structures without the need for major surgery. Laparoscopy may also be used to perform biopsies or surgical procedures, such as an appendectomy or cholecystectomy (removal of gallbladder). As laparoscopic techniques improve, more applications are being used. Robotically-assisted laparoscopy may be used for certain procedures. This technique requires specialized equipment and training, but may offer benefits for some patients and conditions.  Other related procedures that may be used to examine the abdomen include abdominal X-ray, computed tomography (CT scan) of the abdomen, abdominal ultrasound, and abdominal angiogram. Please see these procedures for additional information.

Reasons for the procedure

The abdomen contains organs of the gastrointestinal, urinary, endocrine, and reproductive systems. An abdominal laparoscopy may be performed to assess the abdomen and its organs for tumors and other lesions, injuries, intra-abdominal bleeding, infections, unexplained abdominal pain, obstructions, or other conditions, particularly when another type of examination such as physical examination, X-ray, or CT scan is not conclusive.

Laparoscopy may be used to determine the stage of cancer of the abdominal organs. It may also be used to evaluate abdominal trauma, including the depth and location of injury, and the extent of intra-abdominal bleeding.

Gynecologic laparoscopy may be used to assess pelvic pain and problems, ovarian cysts, and fibroids, and to evaluate the fallopian tubes in women experiencing infertility. Other uses include treating endometriosis and removing an ectopic pregnancy in the fallopian tube.

There may be other reasons for your doctor to recommend a laparoscopy.

Risks of the procedure

As with any surgical procedure, complications may occur. Possible complications of laparoscopy include, but are not limited to, bleeding from the site of insertion and misplacement of the gas used to help visualize the organs.

In certain situations, laparoscopy may be contraindicated. These situations include patients with advanced abdominal wall malignancies, chronic tuberculosis, thrombocytopenia (low blood platelet count) or other bleeding problems, multiple surgical adhesions, and patients taking blood thinning medication.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Certain factors or conditions may interfere with a laparoscopy. These factors include, but are not limited to, the following:

• Obesity

• History of multiple surgeries resulting in adhesions that prevent safe access to the abdomen with a laparoscope

• Blood from an intra-abdominal hemorrhage may prevent visualization with the laparoscope

Before the procedure:

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• In addition to a complete medical history, your doctor may perform a physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood or other diagnostic tests.

• You will be asked not to eat or drink anything for eight hours before the procedure, generally after midnight.

• If you are pregnant or suspect that you are pregnant, you should notify your doctor.

• Notify your health care provider if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).

• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

• Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

• The area of the abdomen where the incision is to be made may be shaved.

• A cleansing enema may be given a few hours before the procedure.

• You may receive a sedative prior to the procedure, depending on the type of procedure being done. If your procedure is to be done on an outpatient basis, you will need to have someone drive you home afterwards because of the sedation given prior to and during the procedure.

• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

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A laparoscopy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

A laparoscopy is generally performed while you are asleep under general anesthesia. However, your doctor will determine the type of anesthesia based on the reason for the procedure and your overall health status.

Generally, a laparoscopy follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.

2. You will be asked to remove clothing and be given a gown to wear.

3. An intravenous (IV) line will be inserted in your arm or hand.

4. An indwelling catheter may be inserted into the bladder to reduce the risk of bladder perforation.

5. You will be positioned on your back on the operating table.

6. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

7. The skin over the surgical site will be cleansed with an antiseptic solution.

8. If general anesthesia is not used, a local anesthetic may be injected into the incision site to numb the area. You will feel a needle stick and a brief stinging sensation.

9. A small incision will be made in the abdomen just below the navel, or belly button.

10. Additional incisions may be made so that other surgical instruments can be used during the procedure.

11. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that organs and other structures can be easily visualized.

12. If general anesthesia is not used, you may experience some discomfort in the abdomen and top of the shoulder as carbon dioxide is instilled and as instruments are manipulated.

13. The laparoscope will be inserted and the examination will be performed.

14. Once the examination and any additional procedures have been completed, the laparoscope will be removed.

15. The incision(s) will be closed with stitches, tape, or surgical staples.

16. A sterile bandage/dressing or adhesive strips will be applied.

After the procedure

After surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. As a laparoscopy procedure may be performed on an outpatient basis, you may be discharged home from the recovery room.

Once you are home, it is important to keep the surgical incisions clean and dry. Your doctor will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

You may experience shoulder pain from the carbon dioxide gas that remains in your abdomen. This pain may last for a few days but should become less intense each day. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Avoid drinking carbonated beverages for one to two days after the procedure. This will help minimize the discomfort associated with the carbon dioxide gas. In addition, drinking carbonated beverages may cause nausea.

You may be allowed to drink clear fluids within a few hours of the procedure. Your diet may gradually be advanced to more solid foods as tolerated.

You may be instructed to limit physical activity for several days after the procedure.

Notify your doctor to report any of the following:

• Fever and/or chills

• Redness, swelling, or bleeding or other drainage from the incision site(s)

• Increased pain around the incision site(s)

• Vomiting

• Difficulty with urinating

Following a laparoscopy, your doctor may give you additional or alternate instructions depending on your particular situation.