Pelvic Laparoscopy

 Definition

Laparoscopy permits visualization of the peritoneal cavity by the insertion of a small fiber-optic telescope (laparoscope) through the anterior abdominal wall. This surgical technique may be used diagnostically to detect abnormalities, such as cyst, adhesions, fibroids, and infection. It can also be used therapeutically to perform procedures, such as adhesion lysis; ovarian biopsy; tubal sterilization; removal of ectopic pregnancies, fibroids, hydrosalpinx, and foreign bodies; and fulguration of endometriotic implants.

Laparoscopy has largely replaced laparotomy because it requires a smaller incision, is faster, and reduces the risk of postoperative adhesions. Potential risks of laparoscopy include a punctured visceral organ, causing bleeding or spilling of intestinal contents into the peritoneum.

Purpose
  • To identify cause of pelvic pain.
  • To detect endometriosis, ectopic pregnancy, or pelvic inflammatory disease (PID).
  • To evaluate pelvic masses.
  • To evaluate infertility.
  • To stage a carcinoma.
Procedure
Preparation
  1. Explain the procedure to the patient, and tell her that laparoscopy is used to detect abnormalities of the uterus, fallopian tubes, and ovaries.
  2. Instruct the patient to fast for at least 8 hours before surgery.
  3. Tell the patient who will perform the procedure and where it will take place.
  4. Tell the patient whether she’ll receive a general anesthetic and whether the procedure will require an outpatient visit or overnight hospitalization.
  5. Warn the patient that she may experience pain at the puncture site and in the shoulder.
  6. Make sure that the patient or a responsible family member has signed an informed consent form.
  7. Check the patient’s history for hypersensitivity to the anesthetic.
  8. Make sure laboratory work is completed and results are reported before the test.
  9. Instruct the patient to empty her bladder just before the test.
Implementation
  1. The patient is anesthetized and placed in the lithotomy position.
  2. The doctor catheterizes the bladder and then performs a bimanual examination of the pelvic area to detect abnormalities that may contraindicate the test and to ensure that the bladder is empty.
  3. The doctor makes an incision at the inferior rim of the umbilicus. He inserts a special needle into the peritoneal cavity and insufflates 2 to 3 liters of carbon dioxide or nitrous oxide.
  4. The doctor then removes the needle and inserts a trocar and sheath into the peritoneal cavity.
  5. After removing the trocar, the doctor inserts the laparoscope through the sheath to examine the pelvis and abdomen.
  6. To evaluate tubal patency, the doctor infuses a dye through the cervix and observes the fimbria (the fingerlike extremity of the fallopian tube) for spillage.
  7. After the examination, he may perform minor surgical procedures such as ovarian biopsy.
  8. The doctor may insert a second trocar at the pubic hairline to provide a channel for inserting other instruments.
Nursing Interventions
  1. Instruct the patient to resume his usual diet.
  2. Instruct the patient to restrict activity for 2 to 7 days.
  3. Explain that abdominal and shoulder pain should disappear within 24 to 36 hours.
  4. Provide analgesics.
  5. Monitor vital signs.
  6. Monitor the patient for adverse reactions to anesthetic.
  7. Monitor intake and output.
  8. Watch for bleeding and signs and symptoms of infection.
Interpretation
Normal Results
  • The uterus and fallopian tubes are of normal size and shape, free form adhesions, and mobile.
  • The ovaries are of normal size and shape; cysts and endometriosis are absent.
  • Dye injected through the cervix flows freely from the fimbria.
Abnormal Results
  • A bubble on the surface of the ovary suggests a possible ovarian cyst.
  • Sheets of strands of tissue suggest possible adhesions.
  • Small, blue powder burns on the peritoneum or serosa suggest endometriosis.
  • Growths on the uterus suggest fibroids.
  • An enlarged fallopian tube suggests possible hydrosalphinx.
  • An enlraged fallopian tube suggests a possible ectopic pregnancy.
  • Infection or abscess suggests possible pelvic inflammation disease.
Precautions
  • Be aware that laparoscopy is contraindicated in the patient with advanced abdominal wall cancer, advanced pulmonary or cardiovascular disease, intestinal obstruction, palpable abdominal mass, large abdominal hernia, chronic tuberculosis, or a history of peritonitis.
  • During the procedure, check for proper catheter drainage.
Interfering Factors
  • Adhesions or marked obesity which may obstruct to visualization.
  • Tissue or fluid becoming attached to the lens that may also obstruct to visualization.
Complications
  • Punctured visceral organ.
  • Peritonities.