CHAPTER 116

Diagnostic Laparoscopy

Standard Diagnostic Laparoscopy

Generally, a right-handed surgeon should stand to the left of the patient (Fig. 116–1). The assistant stands on the right, and the scrub nurse or technician stands in between the legs. After insertion of the primary trocars, the patient is placed in Trendelenburg’s position, and the peritoneal cavity is inspected to confirm that there is no contraindication to a laparoscopic procedure. If excrescences appear on the peritoneal surfaces or if an adnexal mass is present that is suspicious for malignancy, a laparotomy should be performed. If there is any active bleeding that is not clearly identified and easily controlled, a laparotomy should be performed.

It is difficult to perform a complete diagnostic evaluation without an accessory port. A suprapubic site is adequate for most diagnostic pelvic procedures. A suggested order of evaluation is:

Panoramic view of the pelvis (Fig. 116–2)

Cecum, appendix, and ascending colon (Fig. 116–3)

Liver, gallbladder, and right hemidiaphragm (Fig. 116–4)

Transverse colon, omentum, small bowel, and peritoneal surfaces (Fig. 116–5)

Stomach, left hemidiaphragm, and descending colon and spleen (Fig. 116–6)

Sigmoid and rectum (Fig. 116–7)

The spleen usually is not seen except in thin women or when traction is placed on the omentum.

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