A laparoscopy, also known as peritoneoscopy, is visualization of the abdominal cavity with the use of a laparoscope that is inserted through a small incision in the anterior abdominal wall. It may be performed for diagnosing and staging of cancer, evaluating cause of ascites and unexplained abdominal pain, and examination of the abdomen with ultrasound probes. Biopsies of abdominal and lymph node masses and hepatic lesions can also be done using a core needle biopsy, wedge biopsy using electrocautery, or cup forceps biopsy.

Pelvic laparoscopy, also known as pelviscopy, is performed to diagnose cysts, adhesions, fibroids, malignancies, inflammatory processes, or infections in persons with pelvic and abdominal pain. Evaluation of the fallopian tubes can be done for infertile patients. These procedures also provide a means to release adhesions, to obtain biopsy specimens, to do select operative procedures such as tubal ligations, or to perform laser treatments for endometriosis. Laparoscopic procedures are commonly performed under general anesthesia as a same-day surgical procedure.

Fertiloscopy is a combination of different procedures to examine the entire female reproductive system. The procedures include transvaginal hydrolaparoscopy, which utilizes water to inspect the pelvic organs, the dye test, which evaluates tubal patency, salpingoscopy and microsalpingoscopy, which examines tubal mucosa, and hysteroscopy, which examines the uterine cavity and allows for removal of abnormalities or obtaining biopsies. These procedures are performed transvaginally to diagnose infertility and replaces laparoscopic tests done to diagnose infertility. Local anesthetics are used. Future applications include testing to rule out ovarian cancer, biopsy of the ovary, and drainage of cysts.

1. Start an IV line and use for administration of sedation alone or in combination with analgesic agents. These medications are given to achieve a state of conscious sedation. Resuscitation equipment must be available.

2. Perform continuous monitoring of the patient’s vital signs, cardiac rhythm, and oxygen saturation (via pulse oximetry).

3. Position the patient supine or in a lithotomy position depending on the procedure.

4. Laparoscopy steps include:

   1. Cleanse the skin and, if the procedure is to be performed under local anesthesia, inject a local anesthetic into areas where the scope will be introduced. Otherwise, prep the patient as for an abdominal procedure under general anesthesia. Maintain a sterile field.

   2. Place an IV line so that medications may be given intravenously as needed.

   3. Place an indwelling catheter into the bladder to reduce the risk for bladder perforation, as ordered.

   4. Make a small incision near the umbilicus through which a trocar is introduced, followed by passage of the laparoscope. Sometimes, more than one puncture site will be made so that accessory instruments can be used during the procedure. Carbon dioxide introduced into the peritoneal cavity causes the omentum to rise away from the organs and allows for better visualization. A few stitches or Steri-Strips are usually needed to close the incisions. Apply adhesive bandages as dressings.

5. Fertiloscopy steps include:

   1. Hydrolaparoscopy: Inject approximately 200 mL os saline transvaginally through the posterior fornix. A telescope is introduced to inspect an underwater examination of the pelvic organs.

   2. Dye test: Inject concentrated methylene blue into uterine cavity to evaluate tubal patency.

   3. Salpingoscopy and microsalpingoscopy: Examine the tubal ostium after introducing a scope into the fallopian tubes to explore the tubal mucosa. Provide low-rate irrigation during the examination.

   4. Hysteroscopy: Inject gas or fluid to visualize the uterine cavity and obtain biopsies or treat endometrial dysfunctions.

6. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Abnormal findings may reveal the following conditions:

1. Endometriosis

2. Ovarian cysts

3. Pelvic inflammatory disease

4. Metastasis stage of cancer

5. Uterine fibroids

6. Abscesses

7. Tumors (benign and malignant)

8. Enlarged fallopian tubes (hydrosalpinx)

9. Ectopic pregnancy

10. Infection

11. Adhesions or scar tissue

12. Ascites

13. Cirrhosis

14. Liver nodules (often an indication of cancer)

15. Engorged peritoneal vasculature (correlates with portal hypertension)

Pretest Patient Care

1. Complete laboratory tests and other appropriate diagnostic modalities before these procedures.

2. Bowel preparation may be required and include an enema or suppository.

3. Explain the test purpose and procedure and the type of anesthesia chosen (general, spinal, or local) as well as postoperative expectations such as activity, deep breathing, and possible shoulder pain.

4. Ensure that a properly signed and witnessed consent form is obtained and in the patient’s medical record (see Chapter 1).

5. Confirm that the patient has fasted for the required length of time, as ordered.

6. Maintain sensitivity to cultural, sexual, and modesty issues as an important part of psychological support.

7. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Normal

• Intra-abdominal examination: Normal liver, gallbladder, spleen, and greater curvature of the stomach

• Pelvic examination: Normal size, shape, and appearance of uterus, fallopian tubes, and ovaries