Diagnostic Laparoscopy : Overview | Indications | Process | Complications

Overview of Diagnostic laparoscopy

Diagnostic laparoscopy, also known as exploratory laparoscopy is a surgical procedure used to examine the organs inside the abdomen.

It provides a view of abdominal organs and the insides of the abdominal cavity. To achieve this, a laparoscope which has a light and camera at the end is inserted into the abdominal cavity, and the image recording by the camera is analyzed on a monitor.

This is used to find the cause of symptoms such as infertility problem, pelvic pain and other gynecological conditions which cannot be diagnosed in other clinical examination and imaging.

For, e.g. endometriosis ( a condition in which tissues of the endometrium, i.e. the tissues which line the inner side of the uterus, grow outside the uterus ) can be diagnosed with laparoscopy.

Laparoscopy is a low risk and minimally invasive surgery making only small incisions. It is the most commonly used method for many surgeries like appendectomy, cholecystectomy, adrenalectomy, splenectomy, etc.

It can be used to diagnose and treat as well as the cause of pelvic or abdominal pain. According to the aim of performing the procedure, it is divided into two types.

  • Diagnostic Laparoscopy: When laparoscopy is done only to view the insides or to take a biopsy, it is called diagnostic laparoscopy. It does not aim to treat the symptoms, it just diagnoses the cause of problems or symptoms.

  • Operative Laparoscopy: When laparoscopy is performed to treat a specific problem or to assist a particular surgery, it is called operative laparoscopy or laparoscopic surgery. It aims to treat the problem or relieve the symptoms.

    The benefit of operative laparoscopy is that it is less invasive as compared to conventional open Medical procedures.

Diagnostic laparoscopy also allow tissue biopsy, culture acquisition, laparoscopic ultrasonography (LUS)

This procedure is performed with the help of an instrument called a laparoscope. A laparoscope is a long thin tube having a high-resolution camera and high-intensity light at the front.

To insert a laparoscope, a small cut is made in the abdominal wall through the belly button, and the telescope is inserted via this cut. As the instrument moves inside, the camera sends the images of insides to the video monitor.

Laparoscopy is used to diagnose the source of pelvic or abdominal pain. During this procedure, a biopsy can also be done to obtain tissue samples.

Indications for Diagnostic laparoscopy

Laparoscopy can be used for diagnosis as well as operative purposes. Diagnostic laparoscopy is used to diagnose the cause of abdominal or pelvic pain.

This procedure is primarily used when other imaging techniques like X-ray, CT Scan, Ultrasound, MRI fail to diagnose the exact cause or are unable to provide enough information.

Laparoscopy provides a clear view of abdominal organs.it can be used for the analysis of appendix, gallbladder, liver, pancreas, small intestine, large intestine (colon), spleen, stomach, and reproductive organs.

Diagnostic laparoscopy can be used to detect:

  • Liver problems or diseases: For patients with abnormal liver function but the undetectable cause in a radiological examination, laparoscopy is used to obtain a biopsy.

    This procedure is mainly used in patients with liver cirrhosis, diffuse liver disease, liver masses, etc.

  • Effects Of Certain Treatments: as mentioned before laparoscopy provides the view of the inside of the abdominal organs. Laparoscopy can be used to examine if a particular treatment is curing the problem or worsening it.

  • Fluid In Abdominal Cavity: Due to some diseases like liver disease, cancer, congestive heart failure, and kidney failure, serous fluid accumulate in the abdominal cavity. Laparoscopy can diagnose the exact cause of the accumulation of fluid.

  • Growth Of Particular Cancer: Laparoscopy can diagnose the stage of intraabdominal cancer. Intraabdominal malignancy can be evaluated by staging laparoscopy.

  • Intra Abdominal Injuries: This process is used for evaluating a patient with blunt force trauma or penetrating injury. Laparoscopy can give an accurate diagnosis of intra abdominal injuries and depend on the extent of damage, therapeutic procedures can be performed.

  • Endometriosis: Diagnostic laparoscopy provides a direct view of the pelvic structures and hence can identify endometriosis.

  • Chronic Pelvic Pain: Chronic pelvic pain could be due to problems like endometriosis, pelvic inflammatory disease, adhesions, cysts, etc. these all problems can be diagnosed by laparoscopy.

  • Infertility: Infertility is one of the major indications for diagnostic laparoscopy. To diagnose the cause of infertility, pelvic laparoscopy is performed. It can be used to examine the uterus, fallopian tubes, ovaries, etc.

How Diagnostic laparoscopy is performed?

Pre-procedure

Before the procedure of laparoscopy, the doctor provides some instructions to get prepared for the process.

Doctor asks the detail of medications that the patient takes and go through medical history. The doctor instructs the patient when to stop or start taking medicines like, blood thinners, anti-inflammatory drugs, medications that affect blood clottings and herbal or dietary supplements.

A pregnancy test should always be performed before laparoscopy so that the doctors take precautions and reduce the risk of harm to the growing baby.

Before laparoscopy, various tests and scans are performed. These include a blood test, Urine test, Electrocardiogram (ECG), X-ray, Ultrasound, CT Scan, and MRI. These tests and imaging are conducted to better understand the available abnormality.  These tests improve the effectiveness of the laparoscopy as it provides a guide of the inside of the abdomen.

The patient is instructed not to eat or drink anything for at least 8 hours before laparoscopy.

Procedure

Diagnostic laparoscopy is an outpatient procedure, and the patient can leave the hospital the same day after surgery. It is performed in the following steps:

This process is performed under general anesthesia. First of all, general anesthesia is given to the patient.

General anesthesia causes complete unconsciousness, i.e. the patient will remain asleep during the procedure and will not feel any pain during the process. An anesthesiologist intravenously gives anesthesia as well as fluid to keep the patient hydrated.

In some cases local anesthesia is used, it numbs the area of treatment and the patient is awake during the process but will not feel any pain.

During laparoscopy, the doctor makes a small incision below the belly button and inserts a cannula in it. A cannula is used to inflate the abdomen with carbon dioxide gas (CO2). This allows the doctor to see the abdominal organs clearly.

After inflating the abdomen, the surgeon inserts the laparoscope through the incision. The camera of laparoscope record the images of the inside of the abdominal cavity and transfer it to the video monitor.

More than one incisions are made to insert other instruments as in the case of biopsy, surgical instruments are inserted to extract a tissue sample. The number and size of cuts vary according to the expected disease to exclude or confirm it. Generally, number of incisions ranges between 1 to 4.

Post Procedure

After the procedure, instruments are removed and, incisions are closed with stitches and covered with bandages.

The patient is observed for several hours, vital signs such as heart rate and breathing are monitored until the patient is awake.

Throbbing and pain in incisions will be there, so painkillers are given to the patient to relieve the pain.

When the patient is awake, a cup of water or tea is offered, and light food is given before release. The release time of the patient depends upon some factors like physical health, type of anesthesia used, etc.

In cases where biopsy is performed, the tissue sample is analyzed by a pathologist and the test report can be obtained within a few days.

Complications of Diagnostic laparoscopy

Most common risks associated with laparoscopy are:

  • Infection: There is a chance of infection after laparoscopy. The patient should contact the surgeon if, signs of infections are observable. Signs of infection are fever, redness/ swelling/ bleeding of incision, nausea or vomiting, abdominal pain, breathing problem, problems in urinating and persistent cough.

  • Damage to abdominal organs: there is a risk of puncture or injury to an organ. If this happens blood and other fluids may leak in your body. In such a case, additional surgery is required to repair the damage.

  • Internal bleeding: Blood clots may be formed inside the body, which can travel to legs, pelvis or lungs.

  • Pain in incisions: for a few days after laparoscopy, the patient will feel pain and throbbing in the incisions. Usually, this pain fades away with time. Doctors prescribe some pain medications to deal with it.

  • Shoulder Pain: This is commonly seen after the procedure. This happens due to the carbon dioxide used to inflate the abdomen. This causes irritation to the diaphragm which affects the shoulder nerves.

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