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Surgical treatments of endometriosis: laparoscopic surgery SURGICAL TREATMENTS OF ENDOMETRIOSIS: LAPAROSCOPIC SURGERY
Laparoscopic surgery for endometriosis is any surgery that attempts to remove or destroy endometrial implants, cysts and adhesions during a laparoscopy.
Laparoscopy was originally only used as a means of diagnosing endometriosis but over the years it has been used increasingly as a way of surgically treating the condition. It is now common for some laparoscopic surgery to be performed at the time of a diagnostic laparoscopy - assuming the woman agrees and laparoscopic treatment is appropriate.
In the early days of laparoscopic surgery only simple procedures were performed but as experience with the technique has increased surgeons have treated increasingly severe cases and performed more complex procedures. The complexity of the procedures that your gynecologist will attempt will depend on his or her level of training and experience.
Who is suitable for laparoscopic surgery?
Laparoscopic surgery is generally only suitable for women with minimal or mild endometriosis, though in some cases it may also be appropriate for women with moderate disease.
Things to discuss before laparoscopic surgery
Before your operation you should discuss with your gynecologist what he intends to do during the operation and what should be done if more extensive surgery is necessary.
What happens with laparoscopic surgery?
The basic routine for laparoscopic surgery is the same as that described for a diagnostic laparoscopy except that in addition to inspecting the pelvic organs, one or more of the treatment procedures outlined below will be performed.
Procedures that may be performed include the removal or destruction of superficial implants and small cysts, the removal of adhesions, the removal or destruction of endometriomas and the removal of an ovary. Few gynecologists are able to perform the latter two procedures but it is possible that in the future more surgeons will be able to do so.
Any superficial implants and small cysts on the peritoneum and ovary will usually be destroyed by cauterization. Cauterization involves the use of a heat source or electrical current to destroy or 'burn' the implants or cysts. As the depth of the burn cannot be precisely controlled cauterization is not used if there is any danger of damaging any important underlying organs, such as the fallopian tubes, bowel or bladder. It is not always possible to destroy all the implants and cysts present. Larger cysts may be removed by cutting them out.
Adhesions can be removed by cutting or cauterization but again it may not be possible to remove all the adhesions present.
Effectiveness of laparoscopic surgery
Laparoscopic surgery has several advantages over conservative laparotomy because being minor surgery as opposed to major surgery it is associated with fewer risks and complications, causes less discomfort and has a shorter recovery period. It can also readily be done at the time of diagnosis which means that only one bout of surgery, one hospital stay and one recovery period are needed.
It is not possible to compare the results of laparoscopic surgery with other forms of treatment as there are no reliable figures available at present. The impression of many gynecologists is that laparoscopic surgery relieves the symptoms in many cases and it restores fertility in some cases.
Risks and complications of laparoscopic surgery
The risks and complications of laparoscopic surgery are the same as those associated with a diagnostic laparoscopy except that there is the additional risk of damaging organs during cauterization.
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