Laparoscopy

What is a laparoscopy?

Laparoscopy is a procedure used to examine the organs in the belly (abdomen). It can also examine a woman’s pelvic organs.

Laparoscopy uses a thin lighted tube that has a video camera. The tube is called a laparoscope. It is put into a tiny cut (incision) in your belly. The video camera images can be seen on a computer screen.

One benefit of laparoscopy is that it's minimally invasive. That means it uses a very small cut in the belly. Laparoscopy usually takes less time and has a faster recovery than open surgery.

Laparoscopy may be used to take a small tissue sample for testing (a biopsy). It can also be used to remove organs, such as the appendix (appendectomy) or the gallbladder (cholecystectomy).

Why might I need a laparoscopy?

An abdominal laparoscopy can be done to examine the abdomen and its organs for:

• Tumors and other growths

• Injuries

• Bleeding inside the belly

• Infections

• Pain that can’t be explained

• Blockages

• Other conditions

A laparoscopy is often done when the results of a physical exam, X-ray, or computed tomography (CT) scan aren't clear.

Laparoscopy may be used to determine a stage of cancer for an abdominal organ. It may also be used to find where and how deep an abdominal injury is. It can also see how much internal bleeding you have.

For women, a gynecologic laparoscopy may be used to check:

• Pelvic pain and problems

• Ovarian cysts

• Fibroids

• The fallopian tubes

Laparoscopy can also be used to diagnose and treat endometriosis. This is when tissue that normally lines the uterus grows outside it. Laparoscopy may be done to treat an ectopic pregnancy or to do a tubal ligation (tie the fallopian tubes) to permanently prevent pregnancy.

Laparoscopy can also be used to do bariatric surgery, such as gastric bypass or gastric sleeve. These procedures have become more common in treating obesity.

There may be other reasons for your provider to suggest a laparoscopy.

What are the risks of a laparoscopy?

Possible complications may include bleeding from the incision, injury to the organs in the abdomen, or the carbon dioxide gas going into places other than the abdomen.

Sometimes a laparoscopy isn't advised. This may be the case if you:

• Have advanced cancerous growths on your abdominal wall

• Have long-term (chronic) tuberculosis

• Have a bleeding problem, such as low blood platelet count (thrombocytopenia)

• Have a lot of scar tissue (adhesions) from other surgeries

• Are taking blood-thinning medicine

There may be other risks based on your health condition. Talk about any concerns with your provider before the procedure.

Certain conditions may stop a laparoscopy from working well. These include being obese or having bleeding inside your abdomen.

How do I get ready for a laparoscopy?

• Your healthcare provider will explain the procedure to you. Ask them any questions you have.

• You'll be asked to sign consent forms that gives permission for the laparoscopic procedure and use of anesthesia. Read the forms carefully and ask questions if anything isn't clear.

• Your provider will ask questions about your past health. They may also give you a physical exam. This is to make sure you're in good health before the procedure. You may also need blood tests and other diagnostic tests.

• You must not eat or drink for 8 hours before the procedure. This often means no food or drink after midnight.

• Tell your provider if you're sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).

• Tell your provider about all the medicines you take. This includes over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.

• Tell your provider if you have a history of bleeding disorders. Let your provider know if you're taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

• Tell your provider if you're pregnant or think you may be pregnant.

• You'll need to remove any piercing jewelry near your naval (belly button).

• Depending on the surgery, you may be asked to take an oral laxative to cleanse your bowel before the surgery. Or you may have a solution put into your rectum and lower intestine (a cleansing enema) a few hours before the procedure.

• You may be given an antibiotic to prevent infection.

• You may be given a special scrub to use on your body before surgery.

• You may be given a medicine to relax you (a sedative) before the procedure. This depends on the type of laparoscopy being done. If this is an outpatient procedure, someone must drive you home.

Your provider may have other instructions for you based on your medical condition.

What happens during a laparoscopy?

A laparoscopy may be done on an outpatient basis or as part of your stay in a hospital. The way the test is done may vary. It will depend on your condition and your healthcare provider's practices.

A laparoscopy is generally done while you're asleep under general anesthesia. Your provider will choose the type of anesthesia based on the procedure and your overall health.

Generally, a laparoscopy follows this process:

1. You'll be asked to take off any jewelry or other objects that may interfere with the procedure.

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

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

4. You'll be placed on your back on the operating table.

5. The anesthesiologist will continually watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

6. If there's too much hair at the surgical site, it may be shaved off.

7. The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.

8. If general anesthesia isn't used, a local anesthetic will be shot (injected) into the incision site. This will numb the area. You'll feel a needle stick and a brief sting.

9. A small tube (urinary catheter) may be put into your bladder to drain urine.

10. A small cut or incision will be made in your belly just below the belly button.

11. More small cuts may be made so that other surgical tools can be used during the procedure.

12. Carbon dioxide gas will be put into your belly so that it swells up. This makes it easier to see organs and other structures.

13. If general anesthesia isn't used, you may feel some mild pain in your belly and the top of your shoulder. This may happen as the carbon dioxide is injected and surgical tools are moved around.

14. The laparoscope will be put in and the procedure will take place.

15. Once the laparoscopy and any other procedures are done, the laparoscope and other surgical tools will be taken out.

16. The cuts will be closed with stitches, tape, skin glue, or surgical staples.

17. A sterile bandage, dressing, or adhesive strips will be applied.

What happens after a laparoscopy?

After surgery, you'll be taken to the post anesthesia care unit (PACU). Your recovery process will vary depending on the type of anesthesia you had. You'll be watched closely. Once your blood pressure, pulse, and breathing are stable and you're alert, you'll be taken to your hospital room. Or you may be sent home if this was an outpatient procedure.

When you're home, you must keep the cut clean and dry. Your healthcare provider will give you instructions on how to bathe. Any stitches or surgical staples will be taken out at a follow-up office visit. If adhesive strips were used, they should be kept dry. They'll often fall off in a few days.

You may feel pain from the carbon dioxide gas still in your belly. This pain may last for a few days and may be felt in your shoulders. It should feel a bit better each day. You may take a pain medicine as directed by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Only take medicines that your provider has approved.

Use a bowel regimen, if advised, to keep your bowels moving. This is especially important if you're taking pain medicines, which sometimes cause constipation.

Don’t have any carbonated drinks for 1 or 2 days after the procedure. This will help reduce the mild pain from the carbon dioxide gas. Also, carbonated drinks may upset your stomach.

You may be allowed to drink clear fluids a few hours after the procedure. You may slowly move on to more solid foods as directed. Tell your healthcare provider if you have nausea or vomit.

You may be told to limit your physical activity for a few days.

Call your provider right away or get immediate medical care if you have any of the following:

• Fever or chills

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

• More pain around the incision site

• Vomiting

• Trouble urinating

• Leg swelling

• Trouble breathing

Your provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you're having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you're to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you didn't have the test or procedure

• Any alternative tests or procedures to think about

• When and how you'll get the results

• Who to call after the test or procedure if you have questions or problems

• How much you'll have to pay for the test or procedure