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To diagnose certain problems, a doctor needs to look directly into the abdomen and at the reproductive organs. This can be done with laparoscopy.
The word laparoscopy comes from the Greek words that mean "look into the abdomen." A laparoscope is a small telescope that is inserted into the abdomen through a small incision (cut). It brings light into the abdomen so the doctor can see inside.
Uses of Laparoscopy
There are several reasons why laparoscopy may be
recommended. Laparoscopy may be used if you have problems with infertility or if
you want to be sterilized. It is also used to check for ectopic pregnancy,
causes of pelvic pain and masses.
Diagnosis and Surgery
Laparoscopy is often used to diagnose
causes of abdominal pain. If the doctor finds that he or she can treat the
condition during the procedure, diagnostic laparoscopy can turn into operative
laparoscopy. This procedure is used to treat many health problems.
Endometriosis. Tissue like endometrium (the lining of the uterus) sometimes grows in places outside of the uterus. One way to be certain that endometriosis is present is by laparoscopy.
Adhesions. Sometimes tissues in the abdomen stick together and form scar
tissue called adhesions. Adhesions can cause pain. They often can be separated
during laparoscopy.
Fibroids. Fibroids are growths that form on the inside, outside or within
the wall of the uterus. Laparoscopy can diagnose some fibroids.
Ovarian cysts. Ovaries sometimes develop cysts (fluid-filled sacs). These cysts may be harmless, causing only mild pain.
Hysterectomy. The laparoscope can be used to assist in a vaginal hysterectomy (removal of the uterus through the vagina). The laparoscope is used to help the doctor see inside the abdomen during part of the surgery.
Infertility and Sterilization
Women who have trouble getting
pregnant may have laparoscopy to find problems like endometriosis or cysts.
Laparoscopy is also used for sterilization. In this operation, the doctor uses the laparoscope as a guide to block the fallopian tubes by cutting, clipping or burning them.
Ectopic Pregnancy
When a woman has pain in her lower abdomen
during early pregnancy, the doctor may suspect an ectopic pregnancy. An ectopic
pregnancy is one that may be located in the tube instead of the uterus. It may
rupture the tube and cause abdominal bleeding that may require emergency
surgery.
Benefits of Laparoscopy
In the past, most surgery involving
reproductive organs was done by laparotomy. Now, many of these same procedures
are done through the laparoscope. There are many benefits to laparoscopy — a
shorter hospital stay, smaller incisions and a shorter recovery.
The Procedure
The anesthesia used depends on the type of procedure,
your doctor's advice, and your personal choice. General anesthesia is usually
used so that you will not be awake.
After the anesthesia is given, a small cut is made below or inside the navel. A gas, such as carbon dioxide or nitrous oxide, is usually put into the abdomen. The gas swells the abdomen so the pelvic reproductive organs can be seen more clearly.
The laparoscope is placed through the cut. Another cut is often made above the pubic region. Through this cut, an instrument is used to move the organs into view.
Other surgical instruments can be inserted through the scope or through another small cut.
After the procedure, the instruments are removed and the gas released. The cuts are then closed, usually with stitches that dissolve. In a few hours you can go home. You should plan to have someone take you home and stay with you, at least for awhile.
Possible Problems
Although problems seldom occur with laparoscopy,
there can be some complications. You may have some bleeding, reactions to the
anesthesia, or injury to other organs.
Recovery
The recovery time from laparoscopy is much shorter than that
from regular surgery. It is safe to resume normal activities as soon as you feel
up to it, usually within a few days. If you are sexually active, talk with your
doctor about when you can have sex again.
Finally …
Laparoscopy can be useful in diagnosing and treating many
gynecologic problems. It has taken the place of surgery in some cases and offers
the benefits of fewer problems and shorter recovery.
TESTS: LIVER BIOPSY
In a liver biopsy, the physician examines a small piece of tissue from your liver for signs of damage or disease. A special needle is used to remove the tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An X-ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged.
Preparation
Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take, especially those that affect blood clotting, like blood thinners. One week before the procedure, you will have to stop taking aspirin, ibuprofen and anticoagulants.
You must not eat or drink anything for eight hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the procedure. Your physician will tell you whether to take your regular medications during the fasting period and may give you other special instructions.
Procedure
Liver biopsy is considered minor surgery, so it is done at the hospital. For the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot.
You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for five to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes.
Two other methods of liver biopsy also are available. For a laparoscopic biopsy, the physician inserts a special tube called a laparoscope through an incision in the abdomen. The laparoscope sends images of the liver to a monitor. The physician watches the monitor and uses instruments in the laparoscope to remove tissue samples from one or more parts of the liver. Physicians use this type of biopsy when they need tissue samples from specific parts of the liver.
Transvenous biopsy involves inserting a tube called a catheter into a vein in the neck and guiding it to the liver. The physician puts a biopsy needle into the catheter and then into the liver. Physicians use this procedure when patients have blood-clotting problems or fluid in the abdomen.
Recovery
After the biopsy, the physician will put a bandage over the incision and have you lie on your right side, pressed against a towel, for one to two hours. The nurse will monitor your vital signs and level of pain.
You will need to arrange for someone to take you home from the hospital since you will not be allowed to drive after having the sedative. You must go directly home and remain in bed (except to use the bathroom) for eight to 12 hours, depending on your physician's instructions. Also, avoid exertion for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site and possibly some pain in your right shoulder. This pain is caused by irritation of the diaphragm muscle (the pain usually radiates to the shoulder) and should disappear within a few hours or days. Your physician may recommend that you take Tylenol for pain, but you must not take aspirin or ibuprofen for the first week after surgery. These medicines decrease blood clotting, which is crucial for healing.
Like any surgery, liver biopsy does have some risks, such as puncture of the lung or gallbladder, infection, bleeding and pain, but these complications are rare.