Diagnostic Laparoscopy

A laparoscope is a telescope designed for medical use. It is connected to a high intensity light and a high-resolution television camera so that Dr. Khosravi can see what is happening inside of you. The laparoscope is put into the abdominal cavity through a hollow tube and the image of the inside of your abdomen is seen on the television screen. In most cases, this procedure (operation) will be able to diagnose or help discover what the abdominal problem is.

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, you, 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.

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 X-ray imaging techniques (sonogram, CT scan and MRI) may discover a mass inside or on the surface of the liver. If the non-invasive X-ray 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 Dr. Khosravi.

Ultrasound may be ordered by your doctor as a non-invasive diagnostic test. In many cases, information is provided which will allow Dr. Khosravi 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 Dr. Khosravi 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.

MRI (magnetic resonance imaging) uses magnets, X-rays, 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.

Diagnostic laparoscopy is usually performed under general anesthesia. In select cases, a regional anesthesia such as spinal or epidural anesthesia can occasionally be used. With your help, Dr. Khosravi and an anesthesiologist will decide on a method of anesthesia to perform safe and successful surgery.

• After Dr. Khosravi reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• It is acceptable to shower the night before or morning of the operation.
• 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 six to eight hours before the procedure.
• 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 Dr. Khosravi 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 Dr. Khosravi so they can be stopped at the proper time before your surgery.
• You will need to ask Dr. Khosravi or his office staff what specifically is required in preparation for your surgery.

Since you will be given general anesthesia during your procedure you will need to make arrangements to have someone drive you home afterwards.

• The surgery is performed under anesthesia (see above), so that you will not feel pain during the procedure.
• A cannula (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 cannula. This gives Dr. Khosravi a magnified view of you’s internal organs on a television screen.
• Other cannulas are inserted which allow Dr. Khosravi to see the internal organs and make a decision on the proper diagnosis or treatment
• After Dr. Khosravi completes the operation, the small incisions are closed with absorbable sutures or with surgical tapes.

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. Dr. Khosravi 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. Dr. Khosravi can answer any specific restrictions that apply to you.

You should call and schedule a follow-up appointment within two weeks after your procedure.

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 Dr. Khosravi either before or during the actual operation. When Dr. Khosravi 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.

Be sure to call Dr. Khosravi 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