Laparoscopy for Endometriosis

What is laparoscopy?

Laparoscopy is a common procedure used for diagnosing and removing mild to moderate endometriosis. The surgeon puts a small viewing instrument known as laparoscope through a small abdominal cut. If more access is needed, the surgeon makes a small cut or two on the abdomen to insert more surgical tools.

Laparoscopy helps the surgeon to:

• Assess the internal body organs to find out if the patient has signs of endometriosis, among other problems. This procedure is the only method for diagnosing endometriosis accurately. However, diagnosis showing "no endometriosis" is never accurate. The growth may be too small or hidden to be seen by the surgeon.
• Get rid of any noticeable endometriosis implants, as well as scar tissue, which can possibly trigger sterility or pain.

What does the procedure entail?

Your doctor may ask you to avoid drinking or eating anything for 6 hours or more prior to laparoscopy. Most likely you’ll be given general anesthetic medication to make you fully unconscious. However, in some few cases, the procedure is done under spinal or local anesthesia to keep the patient partially awake.

During a laparoscopy, a surgeon or a gynecologist inflates your abdomen with gas. The gas pushes the walls of your abdomen from the internal organs for a better view. The surgeon puts a laparoscope into your abdomen via a tiny cut to help him or her have a better view of your abdomen. More cuts may be needed for inserting equipment to move some abdominal internal structures and organs to make them more visible. Laparoscopy normally takes around 30- 45 minutes.  

If the surgeon needs to remove either the scar tissue or endometriosis, he/she will utilize one among a variety of methods such as excision or destruction of tissue using electric current or laser beam. Once the procedure is complete, the surgeon uses a few stitches to close the cuts on your abdomen. Laparoscopy usually leaves very minimal or even no scars at all.

Advanced laparoscopic surgical operation

An advanced laparoscopic surgical operation is performed to treat severe pelvic pains and suspected endometriosis. This must be carried out by an expert surgeon who have had extensive experience and skills in removing these types of lesions. Scar tissues must be resected fully to ensure they won't recur. Cysts related to endometriosis, as well as the capsules that contain them, must be removed using a method that does not injure the ovarian tissue. The surgeon should also be ready to incise the lesions related to endometriosis, which, by the way, may affect other organs like the bladder and the intestines. Appendectomy may also be done in cases where adhesions are present or the appendix is affected.

Expectations after the surgery

Laparoscopy is mostly carried out as an outpatient procedure. However, a patient may be required to spend a night in the hospital if the surgical operation becomes more complicated or takes a much longer time. An example of such complications is when your bowel gets partially or fully resected.

How to handle worries

Nearly all people, to some extent, fear most forms of surgical operation. Patients who are about to undergo surgery fear the pain, anesthesia, and outcome of the procedure. Your doctor can help you with this. Have an open discussion with your doctor about your fears and concerns. Doctors are trained to help patients manage their expectations, making patients ready and relaxed before surgery.

What to bring along?

Pack extremely loose clothes, especially an over sized pullover, which you will wear after the operation. Other things that you should consider packing include small pads, socks, and slippers. If you think that you may be asked to stay overnight in the hospital, also pack lotion, toothbrush, bathrobe, and a hair comb.

When is laparoscopy required?

Laparoscopy is an important procedure used in examining the organs located within the pelvis. It is also used to remove abnormal growths and scar tissues in the pelvic area. Again, this procedure is used for the check-up and treatment of the following:

• Severe endometriosis or scar tissue suspected to be affecting internal organs like the bowel and bladder.
• Recurring, severe, or persistent endometrial pain even after hormone treatment.
• Endometrioma
• Endometriosis which is capable of making the patient infertile.

When is laparoscopy not required?

Viewing pelvic organs directly isn’t the sole method of establishing the presence of endometriosis. Hormone therapy is usually recommended in cases where endometriosis is suspected.

How effective is it?

Undergoing laparoscopic surgery mainly addresses the pain suffered due to endometriosis. Just like hormone therapy, laparoscopy reduces endometriosis pain in majority of patients. However, the surgery doesn’t assure longstanding results. About 60 to 80% of women report reduced pain in the first month following the operation, while around 50% of them had recurred symptoms two years after the surgery. In some cases, the use of hormone therapy after the surgical operation prevents the re-growth of endometriosis, thus extends the period of reduced pain.

Endometriosis and infertility

If endometriosis is affecting your fertility, your physician may use laparoscopy to check and get rid of the symptoms. However, the removal of mild endometriosis may not guarantee improved fertility.

Your doctor will assess the severity of your endometriosis and inquire about your age to establish what to do next. If you’re aged over 35 years, your physician may prescribe a treatment course for infertility like medication, in vitro fertilization, and insemination since miscarriage risks are usually higher at that age. If you’re below that age, try conceiving without using such treatments.

How is it diagnosed?

Your doctor may suspect endometriosis as a result of characteristic symptoms, physical assessment, reports, pelvic ultrasound, X-ray, and CT scan variations. Nevertheless, the findings may be similar with those found in other diseases. Thus, laparoscopy or laparotomy becomes the only way to diagnose endometriosis. Microscopic assessment of tissue is carried out for the confirmation of the diagnosis. All lesions that look like endometriosis aren’t really endometriotic, while, at times, normal lesions may turn out to be naturally endometriotic.

Your surgeon will carry out a biopsy for visual diagnosis confirmation. Besides, he should be able to classify the stage of the endometriosis. Endometriosis progresses with time and, in the process, it makes one infertile. The disease usually recurs after treatments and persists until menopause. Therefore, it is vital to diagnose the illness as soon as possible to prevent recurrence, as well as aid in long term treatment and family planning purposes. 

How is endometrioma treated?

Endometrioma is a benign, estrogen-dependent cyst that can be treated using various surgical methods, such as draining and partial or full resection. All these treatments provide pain relief to majority of patients. Full cutting and removal of endometrioma relieves pain for good, prevents re-growth, and, in some cases, a requirement for another surgical operation.

What are the possible risks?

Although they’re rare, some of the risks associated with the operation include:

• Infection of the pelvis
• Uncontrollable bleeding
• Adhesion on the surgery site
• The bowel, ureters, and the bladder may become damaged

Point of view

Unlike open abdominal surgeries, laparoscopic surgery causes fewer traumas to body tissues, involves smaller cuts, and results in less scarring. The recovery time for laparoscopic surgery is also short. The patient may even be allowed to go home on the same day of the operation.

A surgeon must have absolute expertise in laparoscopic procedure and full knowledge of how to use the equipment in order to successfully perform the surgery and provide post-surgical follow-ups.