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A laparoscope is a telescope designed for medical use. It is connected to a high intensity light and a high-resolution (HD) television camera so that Dr. Toomari 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 surgery (operation) will be able to diagnose or help discover what the abdominal problem is.
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 inflamatory 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.
A patient may have a lump (mass or tumor), which can be felt by the doctor, the patient, 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 Dr Toomari to look directly at the mass and obtain tissue (biopsy) to discover the diagnosis.
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.
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 (liver biopsy). In other words, it is an accurate way to collect a biopsy to sample the liver or mass without actually opening the abdomen.
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.
There are other reasons to undergo a diagnostic laparoscopy, which cannot all be listed here. This should be reviewed and discussed with Dr. Toomari.
Ultrasound may be ordered by your doctor as a non-invasive diagnostic test. In many cases, information is provided which will allow your surgeon 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 your surgeon 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 sometimes be done before a diagnostic laparoscopy to decide if laparoscopy is appropriate for your condition.
MRI (magnetic resonance imaging) uses magnets, 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 typically performed under general anesthesia. With your help, Dr. Toomari and an anesthesiologist will decide on a method of anesthesia to perform safe and successful surgery. When GENERAL anesthesia is given, the patient will be completely asleep.
You will be sedated during the procedure and an arrangement to have someone drive you home afterward is imperative. Sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.
The surgery is performed under anesthesia (see above), so that the patient 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. Toomari a magnified view of the patient's internal organs on a television screen. Other cannulas are inserted which allow your surgeon to see the internal organs and make a decision on the proper diagnosis or treatment
After Dr. Toomari completes the operation, the small incisions are closed with absorbable sutures and skin glue 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 may experience forgetfullness and ask the same question repeatedly until the effects of the anesthesia ware off.
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. Toomari 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. Toomari and/or his staff 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. Additional risks can include allergic reactions to medications, blood clots, heart attacks, pneumonia, stroke, and even death.
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. Toomari either before or during the actual operation. When the surgeon 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 your physician, Dr. Toomari, and/or his staff if you develop any of the following: