Diagnostic

Laparoscopy
patient information from your surgeon & SAGES

Diagnostic Laparoscopy ■ 1
Diagnostic Laparoscopy
About conventional colon surgery:
Patients may be referred to surgeons because of an undiagnosed abdominal problem.
If your surgeon has recommended a diagnostic laparoscopy, this brochure will:
• Help you understand what laparoscopy is.
• Describe how laparoscopy helps diagnose a problem.
• Explain what complications can occur with the procedure.

About diagnostic laparoscopy

What is diagnostic laparoscopy?

A laparoscope is a telescope designed for medical use. It is connected to a high
intensity light and a high-resolution monitor. In order for the surgeon to see inside
your abdomen, a hollow tube (port) is placed through your abdominal wall, and the
laparoscope is inserted into the port. The image of the inside of your abdomen is then
seen on the monitor. In most cases, this procedure (operation) will be able to diagnose
or help discover what the abdominal problem is.

Why is diagnostic laparoscopy performed?

1. Abdominal pain
Laparoscopy has a role in the
diagnosis of both acute and chronic
abdominal pain. There are many
causes of abdominal pain. Some of
these causes include appendicitis,
adhesions or intra-abdominal
scar tissue, pelvic infections,
endometriosis, abdominal bleeding
and, less frequently, cancer. It is
used in patients with irritable bowel
disease to exclude other causes of
abdominal pain. Surgeons can often diagnose the cause of the abdominal pain and,
during the same procedure, correct the problem.
2. Abdominal mass
A patient may have a lump (mass or tumor), which can be felt by the doctor, the
patient, or seen on an X-ray. Most masses require a definitive diagnosis before
appropriate therapy or treatment can be recommended. Laparoscopy is one of the
techniques available to your physician to look directly at the mass and obtain tissue
to discover the diagnosis.

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3. Ascites
The presence of fluid in the abdominal cavity is called ascites. Sometimes the cause
of this fluid accumulation cannot be found without looking into the abdominal
cavity, which can often be accomplished with laparoscopy.
4. Liver disease
Non-invasive imaging techniques such as ultrasound, CT scan (computed
tomography) and MRI (magnetic resonance imaging) may discover a mass inside
or on the surface of the liver. If non-invasive imaging cannot give your physician
enough information, a liver biopsy may be needed to establish the diagnosis.
Diagnostic laparoscopy is one of the safest and most accurate ways to obtain tissue
for diagnosis. In other words, it is an accurate way to collect a biopsy to sample the
liver or mass without actually opening the abdomen.
5. “Second look” procedure or cancer staging
Your doctor may need information regarding the status of a previously treated
disease, such as cancer. This may occur after treatment with some forms of
chemotherapy or before more chemotherapy is started. Also, information may be
provided by diagnostic laparoscopy before planning a formal exploration of the
abdomen, chemotherapy or radiation therapy.
6. Other
There are other reasons to undergo a diagnostic laparoscopy, which cannot all be
listed here. This should be reviewed and discussed with your surgeon.

Preparation for the procedure

What tests are necessary before laparoscopy?

Ultrasound may be ordered by your doctor as a non-invasive diagnostic test. In many cases,
information is provided which will allow your surgeon to have a better understanding of
the problem inside your abdomen. This test is not painful, is very safe, and can improve the
effectiveness of the diagnostic laparoscopy.
CT Scan is an X-ray that uses computers to visualize the intra-abdominal contents. In
certain circumstances, it is accurate in making the diagnosis of abdominal disease. It will
allow your surgeon to have a “road map” of the inside of your abdomen. A radiologist may
use a CT scan to place a needle inside your abdomen. This is known as a CT guided needle
biopsy. This will often be done before a diagnostic laparoscopy to decide if laparoscopy is
appropriate for your condition. A MRI uses magnets and computers to view the inside
of the abdominal cavity. It is not required for most abdominal problems, but may be
necessary for some.
Routine blood test analysis, urinalysis, and possible chest X-ray or electrocardiogram
may be needed before diagnostic laparoscopy. Your physician will decide which tests are
necessary and will review the results of those tests, which have already been performed.

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What type of anesthesia is used?
Diagnostic laparoscopy is usually performed either under general anesthesia but may be done
under local anesthesia with sedation in selected cases. With your help, your surgeon and an
anesthesiologist will decide on a method of anesthesia to perform safe and successful surgery.
Local anesthesia can be injected into the skin of the abdominal wall to completely
numb the area and allow safe placement of a laparoscope. Most patients feel a short-
lived “bee sting” that lasts a second or two. Small doses of intravenous sedation are
given at the same time allowing the patient to experience what is known as “twilight”
sleep in which patients are arousable but asleep. Once an adequate depth of sleep is
reached and local anesthesia administered, gas is placed into the abdominal cavity. This
is called a pneumoperitoneum. The patient may experience a bloated feeling. The gas
is removed at the end of the operation. The two most common gases used are nitrous
oxide (“laughing gas”) or carbon dioxide. There is very little risk of ill-effects of the gas.
General anesthesia is given to those patients who are not candidates for “twilight”
sleep or who want to be completely asleep. General anesthesia may be preferable in
patients who are young, who cannot lie still on the operating table, or have a medical
condition that is safer to perform in this manner. Some patients end up having a
general anesthesia even though they prefer local anesthesia with sedation, as the
appropriate anesthesia for laparoscopy differs from patient to patient.

What preparation is required?

• After your surgeon reviews with you the potential risks and benefits of the
operation, you will need to provide written consent for surgery.
• Most diagnostic laparoscopy procedures are performed as an outpatient; meaning
you will go home the same day the procedure was performed.
• You should have nothing to eat or drink for a set time period before the procedure
which will be determined by your surgeon and anesthesiologist.
• Standard blood, urine, or X-ray testing may be required before your operative
procedure. This will depend on your age and medical conditions.
• It is acceptable to shower the night before or morning of the operation.
• Report to the hospital at the correct time, which is usually 1-2 hours earlier than
your scheduled surgery.
• If you take medication on a daily basis, discuss this with your surgeon prior to surgery
as you may need to take some or all of the medication on the day of surgery with a sip
of water. If you take aspirin, Vitamin E, blood thinners or arthritis medication, discuss
this with your surgeon so they can be stopped at the proper time before your surgery.
• You will need to ask your surgeon or his/her office staff what specifically is required
in preparation for your surgery.
You will most likely be sedated during the procedure and an arrangement to have someone
drive you home afterward is mandatory. Sedatives will affect your judgment and reflexes for
the rest of the day. You should not drive or operate machinery until the next day.

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What to expect during the procedure

What can be expected during diagnostic laparoscopy?

• The surgery is performed under anesthesia
(see above), so that you will not feel pain
during the procedure.
• A port (a narrow tube-like instrument) is
placed into the abdominal cavity in the
upper abdomen or flank just below the ribs.
• A laparoscope (a tiny telescope) connected
to a special camera is inserted through the
port. This gives the surgeon a magnified
view of the patient’s internal organs on a
television screen.
• Other ports are inserted which allow your surgeon to see the internal organs and
make a decision on the proper diagnosis or treatment.
• After the surgeon completes the operation, the small incisions are closed with
absorbable sutures or with surgical tapes.

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Expected outcomes

What should I expect after the operation?

Following the operation, you will be transferred to the recovery room, where you
will be monitored carefully until all the sedatives and anesthetics have worn off. Even
though you may feel fully awake, the effects of any anesthetic may persist for several
hours. Once you are able to walk and get out of bed unassisted, you may be discharged.
Because the effects of anesthesia can linger for many hours, it is necessary to have
someone accompany you to the office or hospital and drive you home after
the procedure.
You can expect some soreness around any incision site; this is normal. Your pain
should improve daily even though you may need to take a pain reliever. Your surgeon
will instruct you on the use of pain relievers and may give you a prescription for pain
medication.
Most patients are able to shower the day after surgery and begin all normal activities
within a week. Your surgeon can answer any specific restrictions that apply to you.
You should call and schedule a follow-up appointment within two weeks after
your procedure.

What complications can occur?

Any procedure may have complications associated with it. The most frequent
complications of any operation are bleeding and infection. There is a small risk of
other complications that include, but are not limited to, injury to the abdominal
organs, intestines, urinary bladder or blood vessels.
If you suffer with ascites, this ascites may leak from one of the operative sites,
temporarily, before stopping.
In a small number of patients the laparoscopic method cannot be performed. The
decision to perform the open procedure is a judgment decision made by your surgeon
either before or during the actual operation if the surgeon feels that it is safest to
convert the laparoscopic procedure to an open one, this is not a complication, but
rather sound surgical judgment. The decision to convert to an open procedure is
strictly based on patient safety.

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When to call your doctor
Be sure to call your surgeon or physician if you develop any of the following:
• fever above 101 degrees F (39 C)
• drainage from or redness any of your incisions
• continued nausea or vomiting
• increasing abdominal swelling
• bleeding
• chills
• persistent cough or shortness of breath
• inability to urinate
• pain not controlled by medication

This brochure is not intended to take the place of your discussion with your surgeon about
the need for a diagnostic laparoscopy. If you have questions about your need for a diagnostic
laparoscopy, alternative tests, billing or insurance coverage, or your surgeons’ training and
experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have
questions about the operation or subsequent follow-up, please discuss them with your surgeon
before or after the operation.

Color images: Atlas of Minimally Invasive Surgery, Jones DB, et al. Copyright 2006 Cine-Med.

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Additional instructions:

SOCIETY OF AMERICAN GASTROINTESTINAL

AND ENDOSCOPIC SURGEONS (SAGES)
11300 W. Olympic Blvd., Suite 600
Los Angeles, CA 90064
Phone: (310) 437-0544
Fax: (310) 437-0585
www.sages.org
This brochure was reviewed and approved by the Board of Governors of the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES), March 2015. It was prepared by SAGES Task
Force on Patient Information.