Patient-Assisted Laparoscopy

With the development of better optics, laparoscopes of small diameter now give the surgeon the same view as large 10-mm laparoscopes. This in turn, allows laparoscopy to be performed with local rather than general anesthesia. Because the response to procedures done under local anesthesia varies from patient to patient depending on pain tolerance and anxiety, the approach must be flexible. One method is local infiltration of 1% lidocaine alone or in combination with a systemic sedative and analgesic. In an extremely anxious woman, 1- to 2-minute induction with one-tenth the normal dose of propofol allows time to introduce the laparoscope and probe, if necessary, before she becomes fully alert. Once the diagnosis is made, the operation may be terminated, or general anesthetic administered for definitive therapy. By remaining awake during the diagnostic procedure, the patient can direct the surgeon to the area of pain. Furthermore, she gains insight into the disease that is causing the pain, such as endometriosis or adhesions, and the need for appropriate therapy. With local anesthesia, elective diagnostic laparoscopy can be performed in the office or clinic. It also can be done in the emergency room to diagnose an acutely ill patient, thus freeing up the main operating room.