Elective diagnostic laparoscopy

Article Abstract:

Laparoscopy is a procedure carried out using a special endoscope, a tube with an illuminated optic system, which is inserted into a body cavity. If large diaphragmatic or abdominal hernias are present, laparoscopy is not recommended; inguinal hernias should be identified before the procedure so that a scrotal support can be used during to prevent postoperative scrotal emphysema (distention of tissue). Laparoscopy usually can be performed under intravenous sedation, but children, the elderly, or overly anxious patients may require general anesthesia. The procedure requires that the abdominal cavity be distended by gas, usually carbon dioxide, which is followed in insertion of a telescope into the cavity. The telescope may be attached to a television camera that produces images on a color monitor. Often during a diagnostic laparoscopy, definitive therapy can be carried out such as obtaining a biopsy, performing aspiration, and removal of cysts. In cancer patients, diagnostic laparoscopy can be used to determine the degree of disease spread, obtain tissue samples for disease staging, and assess the possibility of operation. Other conditions that benefit from diagnostic laparoscopic investigation include: enlarged liver, ascites (fluid collection in the abdomen), enlarged spleen, abdominal masses, fever of unknown origin, abdominal pain, and gastrointestinal bleeding. Laparoscopy can be cost-effective by eliminating the need for many expensive tests such as computed tomographic scans. Laparoscopy is a safe procedure which provides accurate, useful information, with limited complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Emergency laparoscopy

Article Abstract:

Laparoscopy, a procedure in which a tube with illuminated optic system is inserted into a body cavity, is frequently used by gynecologists. The recent development of laparoscopic cholecystectomy (gallbladder removal) has created great interest among general surgeons. Surgeons trained in the use of laparoscopy have begun to use this procedure diagnostically in difficult cases of abdominal trauma and cancer staging. Unnecessary exploratory abdominal operations can be avoided by using laparoscopy for patients with blunt abdominal trauma or acute abdomen of undetermined cause. Often it is difficult to determine an accurate, early diagnosis in patients with blunt abdominal injury. Laparoscopic examination of the abdomen may be performed in such emergencies. A mini-laparoscopy can be conducted in the emergency room, intensive care unit, or operating room, and usually requires only local anesthesia with sedation. One institution has reported 150 such laparoscopies performed without major complications. The findings were negative in 56 percent; surgery corroborated the laparoscopic findings in 19 percent. In all but one patient, the source of bleeding or organ damage was identified by laparoscopy, thereby avoiding unnecessary operation. Laparoscopy can identify acute appendicitis or organ perforation. It is concluded that laparoscopy is a safe and effective diagnostic tool, particularly in difficult to diagnose emergency situations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surgical emergencies

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