Pelviscopy

A traditional pelvic laparoscopy, or pelviscopy, procedure is used to examine the organs of the abdominal cavity. During a pelviscopy, a small incision is made in the abdomen through which your doctor will use a laparoscope; a thin flexible tube containing a video camera, to generate images that can be seen on a computer screen. A gynecologic laparoscopy or pelviscopy is used to specifically examine the organs of the pelvis.

Pelviscopy allows a direct view of the abdominal organs and structures without the need for major surgery, and often gives a better view of the internal organs that related procedures like abdominal X-ray, computed tomography (CT scan), ultrasound and angiogram.

Reasons for a Pelviscopy

Pelviscopy is often used when physical examinations, X-ray or CT scans are inconclusive. Pelviscopy can be used to assess pelvic pain and problems, ovarian cysts and fibroids, and to evaluate the fallopian tubes in women experiencing infertility. Other uses include treating endometriosis and removing an ectopic pregnancy in the fallopian tube.

Pelviscopy may also be performed to assess the abdomen and its organs for tumors and other lesions, injuries, intra-abdominal bleeding, infections, unexplained abdominal pain, obstructions or other conditions.

Risks of a Pelviscopy

As with any surgical procedure, complications may occur. Possible complications of pelviscopy include, but are not limited to, bleeding from the site of insertion and misplacement of the gas used to help visualize the organs.

Certain factors or conditions may interfere with a laparoscopy. These factors include:

• obesity
• history of multiple surgeries resulting in adhesions that prevent safe access to the abdomen
• blood from an intra-abdominal hemorrhage which may prevent visualization with the laparoscope

In certain cases, patients are not eligible for pelviscopy. These situations can include patients with conditions like:

• advanced abdominal wall malignancies
• chronic tuberculosis
• thrombocytopenia (low blood platelet count) or other bleeding problems
• multiple surgical adhesions
• patients taking blood thinning medication

There may be other risks depending on your specific medical condition. Discuss any concerns with your doctor prior to the procedure.

Before the Pelviscopy procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your doctor may perform a physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood work or other diagnostic tests.
• You will be asked not to eat or drink for eight hours before the procedure, generally after midnight.
• If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
• Notify your doctor if you are sensitive to or are allergic to any medications like iodine, latex, tape and anesthetic agents (local and general).
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications like aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• A cleansing enema may be given a few hours before the procedure.
• You may receive a sedative prior to the procedure, depending on the type of procedure being done. If your procedure is to be done on an outpatient basis, you will need to arrange for someone to drive you home afterwards because of the sedation given prior to and during the procedure.
• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A pelviscopy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures vary depending on your condition and your doctor's practices. A laparoscopy is generally performed while you are under general anesthesia.

Generally, a pelviscopy follows this process:

• You'll be asked to remove any jewelry or other objects that may interfere with the procedure.
• You'll be asked to remove clothing and be given a gown to wear.
• An intravenous (IV) line will be inserted in your arm or hand.
• A catheter may be inserted into the bladder to reduce the risk of bladder perforation.
• You will be positioned on your back on the operating table.
• The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing and blood oxygen level during the surgery.
• If there is excessive hair at the surgical site, it may be removed.
• The skin over the surgical site will be cleansed with an antiseptic solution.
• If general anesthesia is not used, a local anesthetic may be injected into the incision site to numb the area. You will feel a needle stick and a brief stinging sensation.
• A small incision will be made in the abdomen just below the belly button.
• Additional incisions may be made so that other surgical instruments can be used during the procedure.
• Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that organs and other structures can be easily visualized.
• If general anesthesia is not used, you may experience some discomfort in the abdomen and top of the shoulder as carbon dioxide is instilled and as instruments are manipulated.
• The laparoscope will be inserted and the examination will be performed.
• Once the examination and any additional procedures have been completed, the laparoscope will be removed.
• The incision(s) will be closed with stitches, tape or surgical staples.
• A sterile bandage or dressing or adhesive strips will be applied.

After the procedure

After surgery, you'll be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia used. Once your blood pressure, pulse, and breathing are stable and you are alert, you'll be taken to your hospital room or discharged to your home if your procedure was performed on an outpatient basis.

Once you're home, it's important to keep the surgical incisions clean and dry. Your doctor will give you specific bathing instructions. If stitches or surgical staples are used, a medical professional will remove them during a follow-up office visit. If adhesive strips are used, they will generally will fall off within a few days.

You may experience shoulder pain from the carbon dioxide gas that remains in your abdomen. This pain may last for a few days but should become less intense over time. A pain reliever for soreness may be taken as recommended by your doctor. Aspirin or other pain medications may increase the chance of bleeding, so be sure to take only recommended medications.

Avoid drinking carbonated beverages for one to two days after the procedure to help minimize the discomfort associated with the carbon dioxide gas and prevent nausea. You may be allowed to drink clear fluids within a few hours of the procedure. Your diet will gradually include more solid foods as tolerated.

You may be instructed to limit physical activity for several days after the procedure.

Notify your doctor to report any of the following:

• fever and/or chills
• redness, swelling, or bleeding or other drainage from the incision site(s)
• increased pain around the incision site(s)
• vomiting
• difficulty urinating

Following a pelviscopy, your doctor may give you additional or alternate instructions depending on your particular situation.