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Laparoscopy

by Walter W. Chan, MD, MPH

Diagnostic laparoscopy is a surgical procedure used to evaluate intra-abdominal or pelvic pathology (eg, tumor, endometriosis) in patients with acute or chronic abdominal pain and operability in patients with cancer. It also is used for lymphoma staging and liver biopsy.

Absolute contraindications include

  • A coagulation or bleeding disorder

  • Poor patient cooperation

  • Peritonitis

  • Intestinal obstruction

  • Infection of the abdominal wall

Relative contraindications include severe cardiac or pulmonary disease, large abdominal hernias, multiple abdominal operations, and tense ascites.

CBC, coagulation studies, and type and Rh testing are done before laparoscopy. X-rays of the chest and abdomen (kidneys, ureters, and bladder) are also taken. Laparoscopy is done with sterile technique in an operating room or a well-equipped endoscopy suite. The patient is given local anesthesia plus IV sedation and analgesia with an opioid and short-acting sedative (eg, midazolam, propofol).

The procedure involves insertion of a pneumoperitoneum needle into the peritoneal cavity and infusion of nitrous oxide to distend the abdomen. After the opening is enlarged, a peritoneoscope is inserted into the abdomen and the abdominal contents are examined. Surgical instruments for biopsy and other procedures are inserted through separate openings. When the procedure is completed, the nitrous oxide is expelled by the patient with a Valsalva maneuver and the cannula is removed. Complications can include bleeding, bacterial peritonitis, and perforation of a viscus.

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  • DIPRIVAN

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