Laparoscopy and endometriosis

A laparoscopy (keyhole surgery) can be used in the diagnosis or treatment of a number of conditions of the abdomen and pelvic area. The advantage of laparoscopy is that only a small cut (incision) is required. 

The added advantage of laparoscopy in endometriosis is that your diagnosis can be confirmed and treatment can be carried out at the same time. It can also be used to find out where the endometriosis is and how much of it there is, as well as making sure there is no other medical problem that is causing your symptoms.

If endometriosis can be seen during the laparoscopy, a sample will usually be taken for biopsy. This will confirm the diagnosis.

Your treatment will depend on where the endometriosis is found and how much is found.

Spots of endometriosis throughout the pelvis can be removed surgically or by burning (using diathermy or laser). Endometriosis in the ovaries will usually have formed a cyst called an endometriotic cyst (endometrioma). This will need to be removed.

Studies have shown that five years after surgery, up to 70 per cent of women will have no evidence of endometriosis returning.

Not all endometriosis can be treated with laparoscopy, however. Sometimes endometriosis affects other organs such as the bowel or ureter (the tube from the kidney to the bladder). If this is the case, you may require further surgery at a later date. Further surgery is likely to involve other specialist surgeons.

Laser or diathermy?

Laser and diathermy are tools the doctor can use to heat tissue. Both can be used for either burning the endometriosis (ablation) or cutting it out. Both methods have advantages and disadvantages. A gynaecologist will use the method they are most experienced and comfortable with.

Burning or cutting

The Royal Women's Hospital is researching both to find out which is the most effective treatment for endometriosis. In some areas though, cutting it out does seem to be better.

Risks

There are risks with all surgery. With laparoscopy, problems are rare but can be severe. They include:

  • infection in the bladder, uterus or cuts on the abdomen
  • organ damage or bleeding – (one in five hundred)
  • death – (one in twenty thousand).

The specific risks of treating endometriosis with laparoscopy include:

  • damage to bowel (one in three thousand).
  • damage to the bladder or ureter.

These complications may require immediate treatment. They can be serious and may require more extensive surgery at a later time.

Other risks include:

  • the possibility of the symptoms not improving,
  • scar (adhesion) formation.

In some cases it may not be possible to remove all endometriosis or the endometriosis may come back at a later time.

Before surgery your doctor must discuss the risks with you so when you provide consent for the operation you understand what the risks are. Don't be afraid to ask questions.



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