6. DIAGNOSTIC LAPAROSCOPY - Dx LAP:
A diagnostic laparoscopy is a procedure which permits a direct look at the internal reproductive organs. It is a minor operative procedure which is done on an out-patient basis. There are a number of conditions that may not be detected by any of the tests previously discussed within this booklet, however, which will show up by laparoscopy. Some of these conditions may be suggested by history or previous testing, while other conditions may offer no other hint. An example of the first is the woman with significant pelvic pain during menstruation caused by pelvic endometriosis. The only way to positively diagnose this is by laparoscopic examination. An example of the second type of condition is adhesion formation which prevents the ends of the fallopian tubes from coming into close enough proximity to the ovary to allow for proper egg pickup.
The timing of a diagnostic laparoscopy is ordinarily 2-3 days prior to the time your period will presumably begin and is generally performed along with the endometrial biopsy (D and C). The diagnostic laparoscopy is performed under light general anesthesia (asleep). An incision approximately one-third of an inch long is made inside the fold of the navel at the lower edge. Carbon dioxide gas is then pumped into the abdominal cavity to raise the belly wall away from the intestines inside. The laparoscope, which is simply a small telescope with an internal light, is then inserted through the incision. The entire pelvic contents are readily visible. A video camera is usually used with the laparoscope to make a tape for you to view at home after the procedure. I will talk to you on this tape during the procedure so that you will have a better understanding of what you are seeing. Please remember to bring this tape with you to the follow-up visit. This is very important as the copy you have is the original and only copy. A second instrument is inserted through a one-fourth inch incision just at the pubic hair line and is used to pick up and move the tubes, ovaries, etc. to allow for a more detailed view. A colored dye will be injected through the tubes similar to the tubal x-ray so that you can see for yourself that the tubes are open. If there are any adhesions within your pelvis, I may clip these through the laparoscope if I feel this course of action is prudent. In addition, I may take a biopsy of any spots or lesions that I think will have a bearing on your case. At this point the procedure is complete. The laparoscope and probe will be removed, the gas will be allowed to escape, and 2-3 stitches are taken in the first incision and one stitch in the second incision.
After leaving the operating room, about 30-60 minutes will be spent in the recovery room before going to an arm-chair room where you will spend another hour prior to discharge home. Someone must accompany you to drive you home. Because of the effects of the anesthesia, the hospital will not allow you to drive home on your own or even to take a taxi.
After going home, you can gauge your activity in accordance to how you feel. By and large, you can do anything you feel like doing. There are several things you should not do. Because of the effects of the anesthesia, you should not drive an automobile, operate any type of machinery or participate in any activity which requires full concentration and/or good coordination. Also avoid making any significant life decisions as your thought processes may be somewhat cloudy. Do not get the incision wet for 3 to 4 days. You can take a shower if you cover the incision with Saran wrap or plastic and then tape the edges of the wrap to your skin. A tub bath should be avoided for 3 to 4 days until the incision is sealed. Do not have intercourse, douche, or use tampons for the next 3-4 days. The purpose of this is to help prevent infections from starting after the cervix has been manipulated. You may have a brownish discharge, bloody discharge or even a light menstrual flow for 2-3 days following the procedure. Dont worry ... this is not unusual. Occasionally, the incision may become infected. It may become quite red or even have a small amount of pus visible. If this happens, you should put some warm soaks with a wash cloth on the incision for 20-30 minutes, three times each day. After the soak, dry the incision and then pour a small amount of fresh hydrogen peroxide (obtain at the drug store) on the incision. Dry the incision with clean gauze and cover with a Band-Aid. The incision may feel a bit sore for 4 or 5 days or so, but this is to be expected. If you should run a fever of 100.4 degrees Fahrenheit or greater, please call the office.
(If a biopsy is taken or any other tissue is removed through the laparoscope, you will receive a separate bill from Jewish Hospital for preparing the slides and another bill from Louisville Pathology Associates, PSC., the pathology group that interprets the slides.)