eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Gynecologic Laparoscopy: Workup

Author: William W Hurd, MD, MSc, Professor of Reproductive Biology, Case Western Reserve University School of Medicine; Lilian Hanna Baldwin Chair in Gynecology and Obstetrics, Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center
Coauthor(s): Tommaso Falcone, MD, FRCSC, FACOG, Chairman, Professor of Surgery, CCLCM of Case Western Reserve University, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation; Howard T Sharp, MD, FACOG, Associate Professor, Department of Obstetrics and Gynecology, University of Utah School of Medicine; Chief, General Division of Obstetrics and Gynecology, University of Utah Medical Center; Vivian E Von Gruenigen, MD, Director of Robotic Surgery, University Hospitals Case Medical Center; Associate Professor of Reproductive Biology, Division of Gynecologic Oncology, Case Western Reserve University School of Medicine
Contributor Information and Disclosures

Updated: Nov 4, 2009

Workup

Laboratory Studies

  • Complete blood cell count
    • In general, one of the few required laboratory evaluations in a healthy patient is a complete blood cell count.
    • Anemia increases the risk of anesthetic complications and infections, both at the operative site and the skin incision. In addition, patients who are anemic have less of a safety margin in the uncommon case of significant operative blood loss. For elective surgery, every effort should be made to provide effectual treatment for anemia prior to surgery.
  • Pregnancy test
    • Many surgeons recommend routine pregnancy tests for all patients prior to elective surgery because both surgery and anesthesia should be avoided during pregnancy. Although the most commonly used anesthetics show little evidence of causing either teratogenicity or increased risk of spontaneous abortion, the medicolegal implications of electively performing surgery and administering anesthesia during pregnancy justifies establishing pregnancy status prior to surgery. Exceptions are usually made for patients who are surgically sterile or who are known to be pregnant.
    • A urine pregnancy test is adequate in most cases because these modern tests accurately detect beta-human chorionic gonadotropin levels of 50 mIU/mL or more, a level usually reached by 4 weeks from the last menstrual period. Because this type of pregnancy test can be performed in the presurgical area, delays related to waiting for results should be uncommon. Because no test can accurately determine very early pregnancy (prior to the expected next menstrual period), all patients should also be carefully questioned about whether they could be pregnant and about the date of their last menstrual period immediately prior to surgery.
    • An alternative to performing routine pregnancy tests prior to surgery is to schedule all elective surgery during the follicular phase (ie, within 2 wk of the last menstrual period). Not only does this minimize the risk of performing surgery during an undiagnosed pregnancy, but it also avoids manipulation of the endometrium and tubes around the time of ovulation and implantation.
  • Urinalysis
    • Many laparoscopists obtain a urinalysis prior to surgery. Urinalysis may help detect an unsuspected systemic disease, such as diabetes, which should be completely evaluated prior to elective surgery.
    • More commonly, urinalysis results may indicate the presence of a subclinical urinary tract infection that may be exacerbated by catheterizing the patient. Treating these infections prior to surgery may help avoid postoperative discomfort and potentially serious sequelae in susceptible patients.
  • Other laboratory evaluations
    • In patients with known health problems, other laboratory tests, such as liver function tests or electrolyte evaluations, may be indicated.
    • A thorough preoperative medical evaluation, including appropriate laboratory studies, is appropriate in anyone with significant medical problems.

Imaging Studies

  • Chest radiography
    • A routine preoperative chest radiograph (CXR) is probably unnecessary for patients with no risk factors.23
    • In patients with coexisting bronchopulmonary conditions, cardiac conditions, or abnormal clinical cardiopulmonary findings, a preoperative CXR certainly is important. CXR is also part of the basic workup for anyone who may have a gynecologic malignancy.
  • Intravenous pyelograph or kidney ultrasound
    • Radiographic or sonographic evaluation of the urinary tract is important in women with uterine anomalies, those known to have severe endometriosis, and those with an ovarian mass fixed in the pelvis. Women with uterine anomalies are at risk for concomitant urologic anomalies; thus, an intravenous pyelogram should be performed to determine kidney location and the state of the ureters.
    • In select cases of severe endometriosis or when a fixed pelvic mass is present, preoperative evaluation for possible ureteral involvement is also important. Hydronephrosis, indicating partial or complete obstruction of the ureter, can be excluded with the aid of a kidney ultrasound image in these cases.
  • Barium enema
    • Severe endometriosis can sometimes involve the colon. In patients with colonic symptoms, such as cyclic hematochezia or narrowing caliber of stool, a preoperative evaluation is important. However, most patients with bowel endometriosis will have normal study results. Therefore, the studies are performed to rule out other causes of the symptoms.
    • Alternatively, colonoscopy may be helpful in patients with these suggestive symptoms.

Other Tests

  • Electrocardiogram
    • A routine preoperative electrocardiogram (ECG) prior to laparoscopy is not indicated in a young, healthy woman. A preoperative ECG should be considered in all women older than 50 years because the risk of heart disease increases at this time. Although this often depends on the local requirements.
    • In addition, any woman with a history of cardiac disease or any physical finding or disease history that puts her at increased risk of cardiac disease (eg, diabetes mellitus, hypertension, thromboembolic diseases, stroke, renal impairment, chronic pulmonary disease) should have a preoperative ECG regardless of age.

More on Gynecologic Laparoscopy

Overview: Gynecologic Laparoscopy
Workup: Gynecologic Laparoscopy
Treatment: Gynecologic Laparoscopy
Follow-up: Gynecologic Laparoscopy
Multimedia: Gynecologic Laparoscopy
References
Further Reading
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Further Reading

Hurd WW, Duke JM, Falcone T. Chapter 29. Gynecologic laparoscopy. In: Falcone T, Hurd WW, eds. Clinical Reproductive Medicine and Surgery, New York: Elsevier, 2007.

Sharp HT, Falcone T, Hurd WW. Chapter 40. Complications of laparoscopic surgery. In: Falcone T, Hurd WW, eds. Clinical Reproductive Medicine and Surgery, New York: Elsevier, 2007.

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Keywords

gynecologic laparoscopy, endoscopy, celioscopy, ectopic pregnancy, endometriosis, tubal ligation, laparoscopic gynecology, endometriosis, pelvic adhesion lysis, diagnostic laparoscopy, tubal fulguration, hysterectomy, incontinence procedures, gynecologic malignancy, bilateral tubal sterilization, BTL, adnexal torsion, pelvic pathology, gynecologic pathology

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Contributor Information and Disclosures

Author

William W Hurd, MD, MSc, Professor of Reproductive Biology, Case Western Reserve University School of Medicine; Lilian Hanna Baldwin Chair in Gynecology and Obstetrics, Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center
William W Hurd, MD, MSc is a member of the following medical societies: Alpha Omega Alpha, American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American College of Physician Executives, American College of Surgeons, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Society for Gynecologic Investigation, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Tommaso Falcone, MD, FRCSC, FACOG, Chairman, Professor of Surgery, CCLCM of Case Western Reserve University, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation
Tommaso Falcone, MD, FRCSC, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Society of Laparoendoscopic Surgeons, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

Howard T Sharp, MD, FACOG, Associate Professor, Department of Obstetrics and Gynecology, University of Utah School of Medicine; Chief, General Division of Obstetrics and Gynecology, University of Utah Medical Center
Howard T Sharp, MD, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Medical Association, and Utah Medical Association
Disclosure: Nothing to disclose.

Vivian E Von Gruenigen, MD, Director of Robotic Surgery, University Hospitals Case Medical Center; Associate Professor of Reproductive Biology, Division of Gynecologic Oncology, Case Western Reserve University School of Medicine
Vivian E Von Gruenigen, MD is a member of the following medical societies: Gynecologic Cancer Foundation
Disclosure: Intuitive Surgical Honoraria Surgical Proctor

Medical Editor

Thomas Michael Price, MD, Associate Professor of Reproductive Endocrinology, Director of Reproductive Fellowship Training Program, Duke University Medical Center
Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Phi Beta Kappa, and Society for Gynecologic Investigation
Disclosure: Clinical Advisors Group Consulting fee Consulting; MEDA Corp Consulting Consulting fee Consulting; Gerson Lehrman Group Advisor  Consulting fee Consulting; Roche/GSK Spokesperson  Consulting fee Consulting; Abbott Pharmaceuticals Grant/research funds PI; Adiana Grant/research funds PI

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gail F Whitman-Elia, MD, Professor, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine
Gail F Whitman-Elia, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Clinical Endocrinologists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Medical Women's Association, American Public Health Association, American Society for Reproductive Medicine, Endocrine Society, and South Carolina Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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