Surgical Treatment

Surgical treatment of endometriosis is indicated when medical treatment fails, when large endometriomas (ovarian chocolate cysts) are present, or in the treatment of infertility. The role of surgery, via laparoscopy or laparotomy, is to resect or destroy endometriotic implants, remove an endometrioma, remove pelvic adhesions and repair obstructed fallopian tubes (tuboplasty.) Removal of the uterus, alone or with the ovaries and fallopian tubes, should be considered only when it has been established that the ovaries or uterus are the source of the symptoms and that all other treatment modalities have failed. The last requirement is critical. "Failed treatment" is a relative term and depends to a large extent on the dedication, expertise, surgical skills and motivation of the treating physician to spare the involved organs. Meticulous surgery including microsurgical technique in resecting endometriotic implants, lysis of adhesions and pelvic reconstruction may achieve better and more lasting results than less sophisticated surgical techniques. Combining medical and surgical treatment may also be helpful.

A special procedure to relieve pain caused by endometriosis is LUNA (laparoscopic uterosacral nerve ablation.) It involves the destruction of many nerve fibers that provide sensation to the cervix and lower uterine segment. The effectiveness of this procedure in relieving menstrual pain is variable (50-75%). Another procedure known as presacral neurectomy involves severing the nerve fibers which convey pain sensation from the uterus and pelvic floor and is more effective in relieving pain. If presacral neurectomy is performed meticulously it may give long term relief from pelvic pain even if the endometriosis progresses

What happens during laparoscopy?
Laparoscopy is usually performed under general anesthesia; however it can be performed with other types of anesthesia that permit the patient to remain awake. The typical pelvic laparoscopy involves a small (1/2" to 3/4") incision in the belly button or lower abdomen. The abdominal cavity is filled with carbon dioxide. Carbon dioxide causes the abdomen to swell which lifts the abdominal wall away from the internal organs, so the doctor has more room to work.
Next, a laparoscope (a 1/2" fiber-optic rod with a light source and video camera) is inserted through the belly button. The video camera permits the surgeon to see inside the abdominal area on video monitors located in the operating room.
Depending on the reason for the laparoscopy, the physician may perform surgery through the laparoscope by inserting various instruments into the laparoscope while using the video monitor as a guide. The video camera also allows the surgeon to take pictures of any problem areas he discovers.
In some cases, the physician may discover that he is unable to accomplish the goal of surgery through the laparoscope and a full abdominal incision will be made. However, if this is a possibility in your case you physician will discuss this with you prior to surgery, and the surgical consent form will include this possibility.

Is there any risk associated with laparoscopy?
Certain women face an increased risk with any surgical procedure including who smoke, overweight, cardiovascular diseases, as well as women in the late stages of pregnancyor who use certain drugs. If you think you may fall into any of these categories be sure to discuss your surgical risks with your physician. Although rare, perforation of the bowel or liver are possible complications that may occur during laparoscopy