Norm of Laparoscopy (Peritoneoscopy)
Usage of Laparoscopy (Peritoneoscopy)
Ascites, biopsy, cholangiography, cirrhosis, complex renal stones, dysmenorrhea, ectopic pregnancy, endometritis, fever of undetermined origin, gallbladder disease, identification of abdominal cavity adhesions, infertility, jaundice, lymphoma staging, malignancy staging, pancreatic disease, and pelvic inflammatory disease (PID). Used in conjunction with ultrasound to stage pancreatic cancer. Enables accurate staging of gastrointestinal malignancies; superior to other imaging methods for detecting superficial liver metastases; provides a diagnostic route with access for therapeutic surgical interventions if abnormalities are identified. Also used therapeutically for surgical procedures, such as colectomy and nephrectomy.
Description of Laparoscopy (Peritoneoscopy)
Direct inspection of the surfaces of the internal organs such as the liver, gallbladder, pancreas, fallopian tubes, ovaries, uterus, and lymph nodes by use of a fiberoptic telescope inserted transabdominally into the abdominal cavity. Diagnostic laparoscopy prevents unnecessary surgical laparotomies by providing direct visualization inside of the abdominal cavity with a minimally invasive procedure. Surgical procedures such as cholecystectomy, biopsy, or tubal ligation may be performed by means of laparoscopy. Use of electronic power morcellators is a newer method for removal of tissue that reduces the risk of postprocedure hernia by minimizing fascia damage, but carries with it higher risk for internal organ damage. Other advances in technology include 3-dimensional views and high-resolution digital images.
Professional Considerations of Laparoscopy (Peritoneoscopy)
Consent form IS required.
Hemorrhage, infection, intestinal or organ puncture or damage, myocardial ischemia, peritonitis, respiratory acidosis, subcutaneous emphysema.
Advanced abdominal wall malignancy, anticoagulant therapy, bleeding disorders, chronic tuberculosis, intra-abdominal hemorrhage, multiple surgical adhesions, peritonitis, thrombocytopenia.
Use with caution during pregnancy. “The occurrence of a miscarriage, premature labor or fetal death appears to be related to the underlying pathology, independent of the operative intervention” (Al-Fozan and Tulandi, 2004). The use of CO2 insufflation has been associated with cardiorespiratory deterioration in clients with preexisting respiratory problems.
- Assess for allergies.
- Prepare the surgical site by removal of any hair.
- Insert an indwelling urinary catheter.
- Administer a cleansing enema 4 hours before the procedure.
- The client should void just before the procedure.
- Bandage inguinal and umbilical hernias.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- Anesthesia may be given. Regional anesthesia is associated with less postoperative side effects and a shorter recovery period than is general anesthesia.
- A small surgical incision is made in the abdomen just below the umbilicus.
- Carbon dioxide is used to insufflate the abdominal cavity so that the organs are easily visualized.
- The laparoscope is inserted and visualization begins.
- Surgical specimens may be taken using electronic power morcellators.
- The procedure takes about 30 minutes.
- Assess the surgical incision area for signs of infection for 24 hours.
- Assess for signs and symptoms of hemorrhage as the major complication. Signs may include bleeding at the dressing site, increasing abdominal pain and firmness, and hypotension.
- Monitor vital signs every 30 minutes × 4 and PRN.
- Provide analgesia for incisional pain and for the pain caused by the carbon dioxide gas remaining in the peritoneal cavity.
Client and Family Teaching
- Fast from food and fluids for 8–12 hours before the procedure.
- A common complaint after this procedure is shoulder, scapular, and general discomfort in the upper torso caused by referred pain from the carbon dioxide gas remaining in the abdomen. This pain can last for several days but should decrease in severity as each day passes. Pain medicine will be prescribed to help ease the pain.
- Avoid carbonated beverages for 1–2 days after the procedure because such beverages will add to the gas pains and may cause vomiting when added to the carbon dioxide left over from the procedure.
- Minimize physical activity for 3–7 days, as instructed by the physician.
- Notify the physician for increasing pain, redness, or drainage at the laparoscopy site.
Factors That Affect Results
- Equipment should be in good working order.
- Nausea, puncture of the intestinal loop, infection, hemorrhage, and subcutaneous emphysema are possible complications of laparoscopy.