Laparoscopy is the most common specific surgical diagnostic procedure which is used very often for women suffering from endometriosis. During this procedure doctor inserts the tiny telescope connected to a camera through pretty small incision in the umbilicus in order to examine abdominal cavity and view the reproductive organs and surrounded areas.
Laparoscopy is a very important diagnostic test for endometriosis. Actually the laparoscopy is the only way to see endometrial abnormal implants and diagnose the endometriosis in women. Without this procedure doctors can only suggest or suspect endometriosis based on specific symptoms, pelvic examination and ultrasound tests.
Endometriosis is a complicated progressive disease which usually triggers a lot of pain and infertility. It is long lasting disease depending on female hormones produced by ovaries. During whole life ovaries are active (especially during reproductive ages) and only during perimenopause and menopause the concentration of hormones is going down. It means if you have endometriosis, it could last up to menopause. This is why prompt diagnosis, effective treatment and recurrence prevention are crucial.
Diagnostic laparoscopy is a minor surgical procedure performed under anesthesia – it could be performed in hospital or in outpatient clinic.
Endometrial lesions can be seen at almost any site in the pelvic cavity. Endometriosis is most commonly found on the peritoneum of the pelvis behind the vagina and uterus, underneath the ovaries and sometimes on the ovaries. It can also occur on the peritoneum in front of the uterus, between the uterus and the bladder, on bladder or on the Fallopian tubes.
Severe forms of endometriosis can grow inside the ovary, rather than just on the ovarian surface, forming specific cysts. These cysts fulfilled every month (during menstrual periods) with thick, dark (menstrual-like) blood, which starts to look like melted chocolate – this is why ovarian endometriosis (so called “endometrioma”) commonly called “chocolate cyst”.
Endometriosis lesions can be found sometimes on caesarean-section scars, on post-operation scars, on the bowel, on the intestines, colon, appendix and rectum.
In more rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, in the lung, spine and brain.
The diagnostic procedure usually takes 30-45 minutes (if made by qualified doctors).
Laparoscopic diagnosis should be confirmed by microscopic examination of biopsy tissues taken during the procedure.
Advanced laparoscopy for treatment
Advanced laparoscopy needs special training. Experienced doctor should be able to resect and destroy endometriosis lesions with electrical current or laser.
Endometriosis implants should be resected, vaporized or fulgurated – up to deep infiltrated endometriosis nodules which are usually the cause of severe monthly pelvic pains. To reduce pain transmission, nerve interruption procedures such as uterosacral (US) nerve ablation or presacral neurectomy should also be considered.
All adhesions also should be completely destroyed and removed. During advanced laparoscopy doctor can also remove existing chocolate cysts.
Endometriosis implants can be removed surgically or by burning (using diathermy or laser).
According to scientific studies, during 5 years after laparoscopic surgery up to 70-75% women will have no evidence of endometriosis recurrence.
Laparoscopy – risks
As all surgical procedures, laparoscopy also has some risks:
- Post-operation infections (in bladder, uterus or on abdominal cuts);
- Post-operation scar (adhesion) formation;
- Damage of internal organs (rare);
- Unexpected sudden death (extremely rare).
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