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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 is also used for lymphoma staging and liver biopsy. Absolute contraindications include a coagulation or bleeding disorder, poor patient cooperation, peritonitis, intestinal obstruction, and 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 obtained before laparoscopy. X‑rays of the chest, kidneys, ureters, and bladder are also obtained. Laparoscopy is performed 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 or 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.
Last full review/revision November 2005
Content last modified November 2005
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