Diagnostic Laparoscopy

Diagnostic laparoscopy is a type of minimally invasive surgery, which is employed to inspect the organs within an abdomen and pelvis. It assists physicians in making diagnoses for unexplained conditions, confirming suspected diseases, and in making treatment choices.

The surgeon instead of making a large incision pushes a small instrument known as a laparoscope (a thin tube with a camera and light) through a small opening at the abdominal wall. This gives a clear picture of the organs of the abdomen and pelvis in a video monitor.

The important aspects of Diagnostic Laparoscopy include:

• Purpose: To determine the cause of abdominal or pelvic pain, infertility, internal bleeding, infections, or growths (as tumors or cysts).
• Organs to be examined include liver, gallbladder, pancreas, intestines, appendix, uterus, ovaries, fallopian tubes, and lymph nodes.

Common Uses:

• Explaining the reasons of abdominal or pelvic pain.
• Ruling out endometriosis, fibroids or pelvic inflammatory disease (PID).
• The evaluation of unexplained infertility.
• The diagnosis of cancers, abdominal tuberculosis, or liver disease.
• Diagnostic- Rule out appendicitis or gallbladder disease.

Diagnostic Laparoscopy Procedure

The Diagnostic Laparoscopy Procedure has been broken down into a step wise manner as follows:

Preparation

• The patient is exposed to preoperative examinations (blood tests, imaging, ECG, etc.).
• It normally requires 6 -8 hours of pre-operative fasting.
• General anaesthesia is done to make sure that the patient is asleep and free of pain.

Positioning and Cleaning

• The patient is placed in the operating table where he usually lays on his back.
• To minimize the risk of infection, the abdomen is wiped with antiseptic solution.

Incision and Access

• Some little puncture (approximately 0.5-1 cm) is made close to the belly button.
• An entry point is made with a hollow needle (Veress needle) or trocar.

Insufflation

• The gas of carbon dioxide (CO 2) is slowly injected into the abdominal cavity.
• This distends the abdomen, allowing the surgeon to view organs clearly and manipulate the tools without any difficulties.

Insertion of Laparoscope

• Through the incision, the laparoscope (thin tube containing light and camera) is inserted.
• The camera sends live images to the pelvic and abdominal organs to a monitor.

Examination

• The surgeon examines the organs with care including the liver, gallbladder, stomach, intestines, appendix, uterus, ovaries, and fallopian tubes.
• Cysts, adhesions, tumors, endometriosis, infections, or internal bleeding are some of the abnormalities that can be identified.

Additional Ports (if needed)

• This is sometimes accompanied by one or two additional smaller incisions to place instruments to enable a closer examination or minor surgery (e.g., biopsy, removal of adhesions).

Completion

• The instruments are disinvested after examination (and possible minor intervention).
• The abdomen releases the CO 2 gas.
• The tiny cuts are sealed with stitches or adhesive tapes and anatomically bound with a dressing.

Recovery

• The patient is taken to recovery room where he is monitored until he is fully awake.
• The findings and the overall health of the patients can allow most of them to go home the same day or within 24 hours.

Diagnostic Laparoscopy for Infertility

Diagnostic laparoscopy is a minimally invasive operation used to diagnose infertility, in which a doctor is able to directly inspect the pelvic organs of a woman (uterus, ovaries, and fallopian tubes) that could be the cause of the difficulty in conceiving. When there is no clear answer based on less invasive tests (such as ultrasound or HSG - hysterosalpingography) it is usually suggested.

The reasons of Diagnostic Laparoscopy in infertility

It assists in the identification of underlying factors of infertility that otherwise cannot be observed in regular scans and they include:

• Obstructed fallopian tubes (unilateral and bilateral)
• Endometriosis (the hypotrophy of uterine tissue)
• Obstructing tissue (pelvic adhesions/ scar tissue) in the previous surgery or infections.
• Ovarian cysts or tumors
• Fibroids that impact fertility.
• Pelvic inflammatory disease (PID) or tuberculosis of the genitals.
• Uterine malformations or malformations of neighboring organs.

Procedure

• This is accomplished by general anaesthesia of the patient.
• A minor cut is done around the belly button.
• A better view of the abdomen is gained by inflating it with carbon dioxide gas.
• A laparoscope (camera) is put in to see the organs of the pelvis.

A dye test (chromopertubation) can be conducted:

• The cervix is passed through with a colored dye (methylene blue or indigo carmine) into the uterus and fallopian tubes.
• And in the event of open tubes, the dye leaks into the abdomen and is seen through the laparoscope.
• When clogged, none of the dye is transmitted, which proves the blockage of tubes.
• The surgeon can also perform biopsies or cure minor illnesses in the same procedure (e.g. remove adhesions, treat endometriosis).

Advantages to Infertility Evaluation

• Gives first-hand observation of reproductive organs.
• Identifies minor anomalies which can be overlooked in imaging tests.
• Ability to do diagnosis and treatment during the same sitting (e.g., unblock tubes, remove adhesions, and cauterize endometriosis).
• Assists in the extraneous fertility therapy such as IVF or IUI in case of no natural conception.

Recovery

• Typically a day-care (in less than 24 hours).
• Light-headed pain, bloating, or pain in the shoulder a few days.
• In the majority of cases, women come back to usual routine in 3-7 days.

Diagnostic Laparoscopy Recovery Time

The recovery period of diagnostic laparoscopy is normally fast because it is a minimally invasive surgery. Nevertheless, recovery may also be different depending on the general health of the individual and the type of treatment performed (e.g., just diagnosis or some minor correction procedures, e.g. the removal of adhesions, cysts, or even treatment of endometriosis) during the same surgery.

Typical Recovery Timeline

First 24 hours:

• Patient could be anaesthetically groggy.
• Light abdominal pain, bloating, or pains in the shoulders tip (due to the CO 2 gas that is used in the procedure).
• Vaginal bleeding may be light, which can be experienced by women.
• Majority of the patients are discharged during the same day or within 24 hours.

2–3 days after surgery:

• Pain decreases with the help of painkillers.
• Patients are typically able to walk, have light meals and resume routine activities.

1 week after surgery:

• The majority of individuals are able to get back to work and normal day activities.
• Strenuous work, heavy lifting or intensive exercise must not be performed.

2–3 weeks:

• Complete recovery in simple cases.
• Assuming that minor surgical procedures (such as the removal of endometriosis, adhesiolysis, etc.) were performed, recovery can take up to 3 weeks.

Factors Affecting Diagnostic Laparoscopy Cost

The price of the diagnostic laparoscopy may be diverse depending on the medical and hospital-related as well as patient-related factors. The following are the major factors that determine the total cost:

• Hospital or Clinic Type
• Doctor’s Expertise
• Purpose of Laparoscopy
• Type of Anaesthesia
• Hospital Stay
• Diagnostic Tests and Imaging
• City or Location
• Consumables and Equipment
• Additional Procedures

Best Hospitals for Diagnostic Laparoscopy

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Benefits of Diagnostic Laparoscopy

The following is an outline of the advantages of diagnostic laparoscopy:

Accurate Diagnosis

• Offers first hand visualization of abdominal and pelvic organs and is more reliable than assessing the same through imaging (such as ultrasound, CT, or MRI).
• Helps identify subtle or hidden disorders like small adhesions, mild endometriosis or early infections that cannot be detected using scans.

Dual Purpose Diagnosis and Treatment

• In case abnormality has been detected, minor surgeries (e.g., cyst removal, adhesiolysis, cauterization of endometriosis, biopsy) are sometimes possible during the same session.
• Conserves time, expense and numerous procedures.

Minimally Invasive

• Minimal incisions (0.5–1 cm) rather than a great incision.
• The amount of pain, speed of healing and scarring is less than that in open surgery.

Faster Recovery

• The majority of patients are discharged on the same or a 24-hour basis.
• Get back to normal operations within approximately 5-7 days; this is far faster than open exploratory surgery.

Infertility Evaluation

• Gold standard to examine fallopian tube obstructions (with dye test), endometriosis, pelvic adhesions and other infertility causes.
• Enhances the possibility of natural conception or contrives the assisted reproductive therapies (IUI/IVF).

Guides Treatment Planning

• Gives meaningful information on the choice of medication, surgery, or assisted reproductive methods.
• Assists in the pretending of diseases such as cancers or abdominal tuberculosis.

Minimized Complication Risk

• Reduced chance of infection, blood loss and postoperative complications in contrast to the traditional open exploratory surgery.

Economical in the Long-term

• It may not be cheap initially, but the fact that both diagnosis and treatment are performed in a single minimally invasive procedure will minimize the necessity of performing repeat procedures and spending prolonged hospitalization.

Conclusion

Diagnostic laparoscopy is a safe, minimally invasive and highly effective technique of examining abdominal and pelvic organs directly. It is important in the detection of insidious causes of disorders like chronic abdominal pain, infertility, endometriosis, adhesions, and unexplainable medical issues that otherwise might not have been noticed with the routine imaging tests. Its greatest benefit is that it can be used as a diagnostic and a therapeutic option in the same session- where the doctor does not only identify abnormalities in a patient but also remedies them at the same time. Diagnostic laparoscopy has become a gold standard in the modern medicine due to its small incisions, quick recovery, minimal scarring, and high precision, as well as its ability to assess the health of the abdomen and the reproductive system.

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FAQ

1. What is the purpose of diagnostic laparoscopy?

• It is also involved in diagnosing conditions of the abdominal and pelvis organs like unexplained abdominal pain, infertility, endometriosis, pelvic adhesions, cysts, fibroids or suspected internal infections.

2. Does laparoscopic diagnosis cause pain?

• No, it is done under general anaesthesia and therefore the patients do not experience any pain in the process of surgery. The gas of carbon dioxide used may cause some mild pain, bloating, or even the shoulder-tip pain following the procedure.

3. What is the duration of the procedure?

• An average laparoscopic diagnosis procedure lasts 30 to 60 minutes, although it might require more time in case of other procedures (such as cyst removal or adhesion).

4. How long is the hospital stay?

• The majority of the patients are discharged during the same day or in 24 hours, depending on their condition and minor surgical treatment carried out.

5. When will I be able to resume a normal lifestyle?

• The recovery process can happen within 5-7days and light activities can be resumed within 2-3days. Rigorous physical activity and heavy lifting are to be avoided during a period of 2-3 weeks.

6. Is diagnostic laparoscopy useful in dealing with infertility?

• Yes. It is talked of as the gold standard when diagnosing the causes of infertility which may be blocked fallopian tubes, endometriosis, ovarian cysts, adhesions or fibroids. A dye test (chromopertubation) frequently is performed to test tubal patency.