This answer was posted on Quora by: Liang-Hai Sie, Retired general internist, former intensive care physician. when I trained in the early to mid seventies, our Associate Professor was well versed in diagnostic Laparoscopy, at that time usually performed by gynecologists, so we as residents in Internal medicine (at that time also including Gastroenterology and Hepatology) were taught how to perform a diagnostic Laparoscopy to view the liver, gallbladder, the lining of the abdominal cavity we call the Peritoneum and take a Biopsy when needed. At that time we performed the laparoscopy without general anesthesia, just local anesthesia and i.v. valium sedation in a small side room, not the OR, under sterile conditions. We started by inserting the special Veress needle through a small superficial cut in the belly, pushing it through the peritoneum by feeling it go through a resistance, after that inflating the Peritoneal cavity with CO2 to make room to insert the Trocarthrough a bigger cut in the belly, also pushing until we felt it passing the peritoneum, after which we inserted the optical laparoscope through the trocar and started looking upwards and downwards so inspecting the whole abdomen, but could not see the Pancreas since at that time we didn't cut through structures like the Omentum. We would feel more than a bit tense when for the first time inserting the Veress needle blindly just judging by the resistance if we had passed the needle into the peritoneal cavity, and inflating the peritoneal cavity guided only by the gas pressures: if to high the tip was either lodged in the omentum, or hadn't yet passed into the peritoneal cavity yet, so needed manipulation to correct the position, after inflation we would tense up when pushing the trocar into the tensely inflated gas filled peritoneal cavity, well aware that the trocar had a sharp pointed end so we would be very wary not to go too deep (overshoot) and damage the underlying internal organs necessitating an operation to repair it. After that when inserting the laparoscope and seeing all was well positioned, relaxing and start doing the examination. The first time was more tense, but those two moments were always the tense moments during the procedure. As a resident we always had a second resident present to help us out with practical advice or doing something if needed. We had to be self confident, like when learning to perform a lot of other medical procedures, or we wouldn't be able to learn to do any procedure. At that time for these minor procedures it was see one, do one, teach one as often still is. I gave up performing diagnostic laparoscopy when CT scanners became widely available in the late eighties. This shows a normal brownish liver with a sharp edge and underneath it the blue-white gall gladder This show a liver Cirrhosis with the typical irregular "bumpy" surface: Peritonitis carcinomatosa, tumor spread seen as white irregularities on the peritoneum: Nowadays laparoscopy isn't performed by internists or gastro-enterologists anymore, but by gynecologist and by surgeons, who with the present day equipment have digital camera's at the top of their laparoscopes and perform minimally invasive surgery during laparoscopy. A view of the team in the operating room during laparoscopic surgery Source
