Needle Laparoscopy Under Conscious Sedation

Twenty-two patients underwent needle laparoscopy between July 5, 1995, and February 13, 1996, for diagnostic and operative laparoscopy. They were given the choice of local versus general anesthesia for the procedure. Eight women chose conscious sedation and 10 requested general anesthesia. The various combinations of conscious sedation were midazolam, fentanyl, intravenous ketorolac, and field block with 1% lidocaine infraumbilically and in the midsuprabubic region. A 2-mm needle laparoscope was inserted intraabdominally. Pressure was maintained at 12 mm Hg, and volume of gas at 3 L. Operative laparoscopic procedures included drainage of ovarian cysts and lysis of adhesions with 2-mm microinstruments. In two women the procedure was converted to conventional laparoscopy for lysis of extensive pelvic adhesions and salpingectomy. One large bowel perforation which occurred during needle laparoscopy was repaired by minilaparotomy with no consequences. All patients who requested conscious sedation tolerated the procedure well, including one who underwent lysis of adhesions. No complications resulted from conscious sedation. Needle laparoscopy can be performed effectively under conscious sedation in properly selected patients, but not all women are candidates for the procedure. Proper patient selection and counseling are important.