What is Laparoscopy
Laparoscopy is the primary surgical choice for diagnosing and treatment for endometriosis. Laparoscopy involves inserting a tiny telescope connected to a camera called a laparoscope through a small incision in the umbilicus in order to view the reproductive organs. Laparoscopy makes examination of the abdominal cavity possible without a large abdominal incision.
Endometriosis can be suspected based on characteristic symptoms, physical examination findings, and/or changes on pelvic ultrasound, CT scans, or x-rays. However, other diseases may give similar findings and the only way to diagnose endometriosis is through a surgical procedure called a laparoscopy or laparotomy. The diagnosis needs to be confirmed by microscopic examination of the tissue. Not every lesion having a visual appearance of endometriosis is actually endometriotic and sometimes atypical lesions may be endometriotic in nature. Your laparoscopic surgeon should take a biopsy to confirm his visual diagnosis. He should also be able to assign a score for the size, depth, and location of endometriotic lesions which is the basis for classifying endometriosis as Stage I, II, III, or IV — with Stage I being the minimal and Stage IV the most advanced. Endometriosis is a progressive disease which impairs fertility, tends to come back after treatments, and lasts as long as there is ovarian function, that is, until menopause. Therefore, prompt definitive diagnosis and staging are extremely important for lifelong treatment, recurrence prevention, and family planning.
Diagnostic laparoscopy is a minor surgical procedure performed under anesthesia on an outpatient basis. An experienced laparoscopic surgeon should be able to resect or destroy endometriotic lesions with electrical current or laser at the time of diagnostic laparoscopy.
Advanced Laparoscopy Surgery
Advanced laparoscopic surgery for chronic pelvic pains and suspected endometriosis should be performed by a surgeon with the necessary skills and expertise in the resection of such lesions and in an operating room equipped for such a surgery. Endometriotic implants should be resected, vaporized, or fulgurated and care should be taken to perform as complete as possible resection of deep infiltrating endometriotic nodules which are usually the cause of pelvic pains. To reduce pain transmission, nerve interruption procedures such as uterosacral (US) nerve ablation or presacral neurectomy should also be considered. Adhesions (scar tissues) should be completely resected and measures preventing their reformation should be applied. Endometriotic cysts should be resected with their capsule – using ovarian tissue-sparing technique – rather than be drained. The surgeon should also be prepared to resect endometriotic lesions that may involve other organs such as the bowel or bladder. Appendectomy should also be performed if there are adhesions or if endometriosis involves the appendix.