Diagnostic Laparoscopy
Diagnostic laparoscopy is a surgical procedure in which a small tube (laparoscope) with a camera attached to the end is inserted into a small cut (incision) made around the patient’s navel, to look inside the abdomen and pelvis for endometriosis.
Once the first incision around the navel is made, carbon dioxide is pumped into the abdomen through the incision to create space between the pelvis and the abdomen, allowing the laparoscope to move around with ease. The surgeon will then make another incision (around 2 inches left or right of the navel) to insert an instrument to gently move organs in the pelvic cavity as needed, to look for lesions that are ‘hiding behind’ organs.
The laparoscope also contains a light source, to better visualise the abdomen, and is attached to a second tube to increase its length. Currently, laparoscopy is the only way to diagnose endometriosis. If any endometrial lesions are found, they will be removed by excision or ablation. A sample of endometrial tissue will also be sent to a lab to confirm that endometriosis has been found.
Operative Laparoscopy
The ultimate aim of an operative laparoscopy is to remove any endometrial lesions, ovarian cysts, or adhesions.
If superficial endometriosis is found during surgery, the patient can undergo both the diagnostic and operative laparoscopy in one sitting, provided that consent was given prior to surgery for any lesions to be removed. Another cut can be made on either side of the navel, to remove the lesions. If severe, deep infiltrating endometriosis is found, particularly involving the bladder and bowels, the patient may have their operative laparoscopy at a later date so they can be prepared for the procedure.
Excision
Excision is a surgical technique that uses scissors to cut away endometrial lesions without damaging the surrounding tissue. Removal of endometrial lesions by excision is akin to removing a garden weed from the root, rather than just cutting it from the surface. Excision requires a highly skilled surgeon, so it is best for an endometriosis excision specialist to carry out the procedure, to delay the recurrence of the growth of endometrial lesions.
Ablation
Ablation is a surgical technique that uses a fine laser beam or a heat gun to ‘burn’ away endometrial lesions from the surface. It is typically used for the removal of superficial endometriosis, as to not cause damage to underlying organs. This technique cannot be used for deep infiltrating endometriosis. More gynaecologists are likely to use this technique over ablation, as excision requires further specialist training.
What risks come with surgery?
Although laparoscopy is a relatively straightforward surgery, all surgery comes with risks. The risks associated with laparoscopy are typically minor and are resolved during the healing time after surgery (4-6 weeks). Other rare risks can also occur during surgery, including:
- Uncontrolled bleeding
- Uterine perforation
- Damage to bowels/bladder
- Damage to a major blood vessel
- Deep vein thrombosis in the leg (blood clot)
Some risks can also come about after surgery. Contact your GP/doctor if you experience the following within 48 hours of surgery:
- Difficulty urinating
- Foul smelling vaginal discharge
- Discharge from insicions
- Burning senstion while unrinating
- Nausea and/or vomiting
- High Fever
- Increased bleeding from cuts
How effective is surgery?
Currently, it is not possible to predict how much a patient will benefit from operative laparoscopy, or any other surgical treatment for endometriosis (see below). The effectiveness of surgery depends on a variety of factors, however, a key factor is the level of expertise of the surgeon(s) completing the surgery. Where possible, patients should advocate for surgery by excision specialists or for treatment at an endometriosis specialist centre, as they will be more knowledgeable about the disease than general gynaecologists.
What other surgical procedures are used to treat endometriosis?
If symptoms persist after excision or ablation and quality of life worsens, some patients may consider further surgery, such as:
- Hysterectomy: This procedure involves the removal of the uterus through the abdomen, or through the vagina. A Sub-Total Hysterectomy refers to the surgical removal of the uterus while leaving the cervix intact, whereas a Total Hysterectomy refers to the removal of the uterus and the cervix. The decision to have a hysterectomy is a very personal choice, and should only be done after a weighing up the risks and benefits identified from books, articles and personal accounts from women with endometriosis, in combination with your own personal wishes.
- Oophorectomy: This refers to the removal of an ovary. The surgical removal of both ovaries is referred to as a ‘bilateral oophorectomy’, and results in instant menopause that cannot be reversed.
- Salpingo-oophorectomy: This refers to the removal of an ovary and a fallopian tube.
- Laparoscopic Uterine Nerve Ablation (LUNA)/Presacral Neurectomy (PSN): These procedures aim to relieve pain from enodmetroisis and/or painful periods (dysmenorrhea) by cutting the nerves around the uterus to prevent pain signals from the uterus reaching the brain. LUNA targets nerves in or around the uterosacral ligament defin, where as PSN targets presacral nerves of the uterus, cervix and fallopian tubes. These procuedures are normally carried as the final stage of laparoscopic surgery. Unfortunately, a research study from 2007 found that LUNA did not provide better pain relief than laparoscopy alone. A more recent study is needed provide a more recent update.
Your body, your choice.
Remember, it’s your body: you are the only one who can live in it, so you should be able to have the final say on the choices that affect you and your body. A major part of self-advocacy is standing up for yourself when your needs and concerns are not being met. If you ever feel as though a clinician you interact with does not respect and listen to your concerns, please find another one who will.