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.
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
Ectopic pregnancy (in which the fertilized egg develops outside of the
Pelvic inflammatory disease (an inflammation in the pelvic cavity)
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:
Abnormal union of body surfaces (such as adhesions following prior surgery)
Pelvic inflammatory disease
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.
Update Date: 7/14/2004
Updated by: Norman S. Kato, MD, Surgeon with the Cardiac Care Medical
Group, Encino, CA. Review provided by VeriMed Healthcare Network.
SAGES GUIDELINES FOR DIAGNOSTIC LAPAROSCOPY
This is one of a series of statements discussing the utilization of laparoscopy
in common clinical situations. This guideline was prepared by the Standards
of Practice Committee of the Society of American Gastrointestinal Endoscopic
Surgeons. Previous guidelines on this topic (SAGES Publication #0012)
were written in 1991. Since that time, new information has been released
that requires an update of this information and recommendations. In preparing
this update, a literature search was performed, and additional references
obtained from the bibliographies of the identified articles and from the
recommendations of expert consultants. As little data exists from well-designed
prospective trials, emphasis was given to the results from large series
and reports from recognized experts. Revision of this guideline may be
necessary as new data appear. Clinical consideration may justify a course
of action at a variance from these recommendations.
Diagnostic laparoscopy is minimally invasive surgery for the diagnosis
of a medical ailment. The procedure allows the direct visual examination
of intra abdominal organs including large surface areas of the liver,
gallbladder, spleen, peritoneum, pelvic organs and retroperitoneum.1,2
Biopsies, aspiration and cultures can be obtained and laparoscopic ultrasound
may be used. Laparoscopy allows a surgeon to diagnose and obtain information
about dissemination of disease and to diagnose patients with abdominal
Diagnostic laparoscopy is safe and well tolerated and can be performed
in an outpatient or inpatient setting under general anesthesia.5 There
may be unique circumstances where local anesthetic may be used. Diagnostic
laparoscopy should be performed by physicians trained in laparoscopic
techniques and who are able to recognize and treat common complications.
The physician should also be able to perform additional therapeutic procedures
when indicated. During the procedure, the patient should be continuously
monitored6 and resuscitation capability must be immediately available.
Laparoscopy must be performed using sterile technique along with a high
level disinfection of the laparoscopic equipment. Overnight observation
may be appropriate in some outpatients. There may also be unique circumstances
where office based diagnostic laparoscopy may be considered. These circumstances
should include only procedures where complications and the need for therapeutic
procedures through the same access are extremely unlikely.
Intra-abdominal/retroperitoneal masses: diagnostic laparoscopy can be
used to perform directed biopsies and stage intrabominal tumors7,8. Laparoscopic
ultrasound can be of use to identify masses.
Liver disease: Laparoscopy is indicated for cirrhotic patients when a
standard biopsy is inconclusive or not desired (e.g., small liver, large
volume ascites).9 Patients with liver disease are more prone to hemorrhage
following biopsy, but at laparoscopy, bleeding from the biopsy site can
be controlled using electrocoagulation or other techniques.
Ascites: When the etiology of ascites remains elusive, laparoscopy may
prove helpful, especially when the ascites are secondary to tuberculosis
Abdominal pain or acute abdomen: Laparoscopy can be helpful in diagnosing
acalculous cholecystitis, perforated viscus, acute appendicitis, mesenteric
ischemia or other surgical emergencies in patients who are critically
ill and have an equivocal abdominal exam.
Abdominal Trauma: Laparoscopy for specific problems (i.e., anterior and
lateral stab wounds, tangential gunshot wounds) may be helpful in avoiding
a full laparotomy.
Laparoscopy for blunt abdominal trauma is currently debated.10,11
Miscellaneous Conditions: Other indications where laparoscopy may be
helpful include a palpable abdominal mass, abdominal or pelvic pain of
unknown origin, acute and chronic abdominal pain in the elderly patient,
fever of unknown origin, and in patients with suspected congenital abnormalities.
Contraindications may include hemodynamic instability, mechanical or
paralytic ileus, uncorrected coagulopathy, generalized peritonitis, severe
cardiopulmonary disease, abdominal wall infection, multiple previous abdominal
procedures, and late pregnancy.12,13 However, the final decision is determined
not only by the clinical conditions, but also by the surgeon's judgement.
Instruments used in diagnostic laparoscopy should include but are not
limited to a laparoscope, trocar, grasping, biopsy, and retracting instruments
as needed. Most instruments range in size from 2-10 mm in diameter. Personnel
should include the laparoscopist and a trained assistant to monitor blood
pressure, pulse, respiratory rate, oxygen saturation, EKG and level of
sedation. Some patients requiring diagnostic laparoscopy can have the
procedure performed under local anesthesia with intravenous sedation as
necessary. When general anesthesia is necessary, a trained anesthetist
or anesthesiologist should be present.
Initial entry into the abdomen can be obtained by the Veress needle or
cut down technique. The abdomen is appropriately insufflated and additional
trocars inserted as needed. Insufflation pressure should be limited to
10 mm Hg in a spontaneously breathing patient. Routine laparoscopic examination
of the abdomen may include evaluation of peritoneal surfaces, diaphragm,
liver, spleen, gallbladder, stomach, small intestine, colon, pelvic organs,
and retroperitoneal tissues and organs. Appropriate biopsies, cytology,
intraoperative ultrasound, cultures and fluid analysis may be performed
as necessary and / or other imaging modalities may be useful.
Complications may occur during creation of the pneumoperitoneum, trocar
insertion, or during the diagnostic exam. These complications include
but are not limited to, cardiac arrhythmias, hemodynamic instability due
to decreased venous return, bleeding, bile leak, perforation of a hollow
viscus, laceration of a solid organ, vascular injury, gas embolism, and
subcutaneous or extraperitoneal dissection of the insufflation gas. Wound
infection or leakage of ascites may occur postoperatively. Failure to
accurately diagnose the extent of intra-abdominal pathology is another
Diagnostic laparoscopy is useful for patients in whom the diagnosis or
extent of the disease is unclear or the abdominal findings are equivocal.
It can be performed safely in an inpatient or outpatient setting, potentially
expediting diagnosis and treatment.
Boyce HW. Laparoscopy. In: Schiff L, Schiff ER (eds.), Diseases of the
Liver. Philadelphia: JB Lippincott 1982; 333-348.
Berci G, Cuschieri A. Practical Laparoscopy. London: Bailliere Tindall,
Mansi C, Savarino V., Picciotta A, et al. Comparison between laparoscopy,
ultrasonography and computed tomography in widespread and localized liver
disease. Gastrointestinal Endoscopy. 1982; 28:83.
Gandolfi L, Rossi A, Leo P, et al. Indications for laparoscopy before
and after the introduction of ultrasonography. Gastrointestinal Endoscopy.
Sleeman D, Sosa JL, Almeida J, et al. Bedside laparoscopy in critically
ill patients. Critical Care Medicine. 1995; 21 (2 suppl.):A237.
Monitoring of Patients Undergoing Gastrointestinal Endoscopic Procedures.
Guidelines for Clinical Applications. American Society for Gastrointestinal
Coupland G, Townsend D, Martin C. Peritoneoscopy - Use in assessment of
intra abdominal malignancy. Surgery. 1981; 89:645-649.
Bogen GL, Manino AT, Scott-Conner C. Laparoscopy for staging and palliation
of gastrointestinal malignancy. Surgical Clinics of North America. 1996;
Brugera J, Rodas P, Rodas J. A comparison of accuracy of peritoneoscopy
and liver biopsy in the diagnosis of cirrhosis. Gut. 1974; 15:799.
Poole GV, Thomas KR, Hauser CJ. Laparoscopy in trauma. Surgical Clinics
of North America. 1996; 76(3):547-556.
Ivatury RR, Simon RJ, Stahl WM. A critical evaluation of laparoscopy in
penetrating abdominal trauma. Journal of Trauma. 1993; 34(6):823-828.
Halpern NB. Laparoscopic cholecystectomy in pregnancy: A review of published
experiences and clinical considerations, Seminars in Laparoscopic Surgery,
5(2), June, 1998.
Gurbuz AT, Peetz ME. The Acute Abdomen in the Pregnant Patient. Is there
a role for Laparoscopy? Surgical Endoscopy. 1997; 11(2): 98-102.
For further information regarding privileges for laparoscopic general
surgery, please consult SAGES guidelines (1997) for GRANTING OF PRIVILEGES
FOR LAPAROSCOPIC GENERAL SURGERY.
This statement was reviewed by the Board of Governors of the Society
of American Gastrointestinal Endoscopic Surgeons (SAGES), March 2002.
It was prepared by the SAGES Committee on Standards of Practice with the
assistance of previous documents written by the Standards of Practice
Committee of the American Society for Gastrointestinal Endoscopy.
Request for reprints should be sent to:
Society of American Gastrointestinal Endoscopic Surgeons
11300 West Olympic Blvd., Suite 600
Los Angeles, CA 90064
(310) 437-0544FAX: (310) 437-0585
This is a revision of SAGES publication #0012 originally printed 10/91