Laparoscopy

September 15, 2011

Laparoscopy is a medical procedure which can be utilized to treat a variety of gynecological disorders. A small tube (endoscope) is introduced into the affected organ. The medical practitioner can visualize the organ, and if indicated, perform surgery/treatments via the endoscope. Laparoscopy is often done to diagnose (by direct visualization) and treat the common condition of endometriosis (abnormal uterine tissue). Laparoscopic treatment of endometriosis can be either conservative or radical. Conservative surgery aims to retain the patient’s fertility. However, such surgery may involve dissection of the urinary tract, the bowel, and the tissue around the vagina and rectum (rectovaginal septum). A wide range of laparoscopic procedures can be performed on patients with endometriosis. These include treatment of peritoneal lesions (endometrial tissue in the abdomen), the ovaries, the intestines, and the urinary tract.

The ovary is one of the most common pelvic organs to be affected with endometriosis. Ovarian involvement may be as simple as superficial implants to deeply infiltrating endometriosis. Two approaches have been proposed for the treatment of ovarian endometriosis: fenestration versus excision. Fenestration consists of simply opening the capsule of the cyst ovary and irrigating (“washing out”). No excision of endometriosis occurs. Excision requires removal of the ovarian cyst itself or at least its destruction by coagulation or laser techniques. The recurrence rate and the long-term outcome on ovarian function are unknown.

in the past, intestinal endometriosis diagnosed at laparoscopy has generally required conventional surgery. However, in our experience, laparoscopic treatment of colorectal endometriosis, even in advanced stages, is safe, feasible, and effective in nearly all patients.

Severe endometriosis of the bladder and the ureter (tubes leading from the kidney to the bladder) may be asymptomatic and can cause gradual kidney (renal) impairment. The efficacy of the laparoscopic approach for the diagnosis and treatment of severe urinary tract endometriosis has been thoroughly evaluated in the literature. Laparoscopic repair is the primary treatment of advanced endometriosis. However, superficial implants can be treated by simple excision (cutting away of abnormal tissue). Laparoscopic approach is safe and effective in the diagnosis and treatment of early as well as advanced urinary tract endometriosis.

Laparoscopic cutting of specific affected pelvic nerves (presacral neurectomy) is infrequently used as a last resort in the treatment of intractable endometriosisassociated pelvic pain. The pattern of pelvic pain improves dramatically after the procedure in the majority of cases. The procedure seems to be associated with an acceptable rate of long-term side effects.

Many studies compared laparoscopy and laparotomy (conventional surgery of the pelvis) in the management of endometriosis. It has been found that laparoscopy causes less postoperative growths (adhesions) and reduces impairment of reproductive function compared to laparotomy. Pregnancy rates with laparoscopic treatment and laparotomy are probably similar, although no randomized trial has been performed. Postoperative recovery has clearly been shown to be better with laparoscopy compared to laparotomy.

SEE .ALSO: Endometriosis, Infertility

Suggested Reading

  • Al-Azemi, M., Bernal, A. L., Steele, J., Gramsbergen, I., Barlow, D., & Kennedy, S. (2000). Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Human Reproduction, 15, 72—75.
  • Bedaiwy, M. A., Falcone, T., Sharma, R. K., Goldberg, J. M., Attaran, M., Nelson, D. R., et al. (2002). Prediction of endometriosis with serum and peritoneal fluid markers: A prospective controlled trial. Human Reproduction, 17, 426-431.
  • Jerby, B. L., Kessler, H., Falcone, T., & Milsom, J. W. (1999). Laparoscopic management of colorectal endometriosis. Surgical Endoscopy, 13, 1125-1128.
  • Jones, K., & Sutton, C. (2000). Endometriomas: Fenestration or excision? Fertility and Sterility, 74, 846-848.
  • Ling, F. W. (1999). Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstetrics and Gynecology, 93, 51-58.
  • Lundorff, P., Hahlin, M., Kallfelt, B., Thorburn, J., & Lindblom, B. (1991). Adhesion formation after laparoscopic surgery in tubal pregnancy: A randomized trial versus laparotomy. Fertility and Sterility, 55, 911-915.
  • Marcoux, S., Maheux, R., & Berube, S. (1997). Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. New England Journal of Medicine, 337, 217-222.
  • Mol, B. W., Bayram, N., Lijmer, J. G., Wiegerinck, M. A., Bongers, M. Y., van der Veen, F., et al. (1998). The performance of CA-125 measurement in the detection of endometriosis: A meta-analysis. Fertility and Sterility, 70, 1101-1108.
  • Nezhat, C., Nezhat, F., Nezhat C. H., Nasserbakht, F., Rosati, M., & Seidman, D. S. (1996). Urinary tract endometriosis treated by laparoscopy. Fertility and Sterility, 66, 920-924.
  • Nezhat, C. H., Seidman, D. S., Nezhat, F. R., & Nezhat, C. R. (1998). Long-term outcome of laparoscopic presacral neurectomy for the treatment of central pelvic pain attributed to endometriosis. Obstetrics and Gynecology, 91, 701-704.
  • Redwine, D. B. (1999). Ovarian endometriosis: A marker for more extensive pelvic and intestinal disease. Fertility and Sterility 72, 310-315.
  • Singh, M., Goldberg, J., Falcone, T., Nelson, D., Pasqualotto, E., Attaran, M., et al. (2001). Superovulation and intrauterine insemination in cases of treated mild pelvic disease. Journal of Assisted Reproduction and Genetics, 18, 26-29.
  • Sutton, C. J., Ewen, S. P., Whitelaw, N., & Haines, P. (1994). Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertility and Sterility, 62, 696-700.
  • Tulandi, T., & al-Took, S. (1998). Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation. Fertility and Sterility, 69, 229-231.

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