the most common procedure used to diagnose and remove mild to moderate
endometriosis. Instead of using a large abdominal
incision, the surgeon inserts a lighted viewing instrument called a laparoscope
through a small incision. If the surgeon needs better access, he or she makes
one or two more small incisions for inserting other surgical instruments.
If your doctor recommends a laparoscopy, it will be to:
There is no way to prevent endometriosis. But there are several things that raise your risk of developing it:
Having a close relative with endometriosis, especially a mother or a sister.
Having a short menstrual cycle -- less than 25 days.
Having menstrual flow lasting more than a week.
Having heavy flow.
Having medical condition that blocks or constricts your cervix or vagina.
Having a birth defect of the uterus, such as a double uterus or a double cervix.
View the internal
organs to look for signs of endometriosis and other possible problems. This is
the only way that endometriosis can be diagnosed with certainty. But a "no
endometriosis" diagnosis is never certain. Growths (implants) can be tiny or
hidden from the surgeon's view.
visible endometriosis implants and scar tissue that may be causing pain or
infertility. If an endometriosis cyst is found growing on an ovary
(endometrioma), it is likely to be removed.
For a laparoscopy, the abdomen is inflated with gas (carbon dioxide or
nitrous oxide). The gas, which is injected with a needle, pushes the abdominal
wall away from the organs so that the surgeon can see them clearly. The surgeon
then inserts a laparoscope through a small incision and examines the internal
organs. Additional incisions may be used to insert instruments to move internal
organs and structures for better viewing. The procedure usually takes 30 to 45
If endometriosis or scar tissue needs to be removed, your
surgeon will use one of various techniques, including cutting and removing
tissue (excision) or destroying it with a laser beam or electric current
After the procedure, the surgeon closes the
abdominal incisions with a few stitches. Usually there is little or no
What To Expect After Surgery
Laparoscopy is usually done at an
outpatient facility. Sometimes a surgery requires a hospital stay of 1 day. You
will likely be able to return to your normal activities in 1 week, maybe
Why It Is Done
Laparoscopy is used to examine the
pelvic organs and to remove implants and scar tissue. This procedure is typically used for checking and treating:
Severe endometriosis and scar tissue that is
thought to be interfering with internal organs, such as the bowel or bladder.
Endometriosis pain that has continued or returned after hormone
Severe endometriosis pain (some women and their doctors
choose to skip medicine treatment).
An endometriosis cyst on an
Endometriosis as a possible cause of
infertility. The surgeon usually removes any visible implants and scar tissue.
This may improve fertility.
When laparoscopy may not be needed
viewing the pelvic organs is the only way to confirm whether you have
endometriosis. But this is not always needed. For suspected endometriosis,
hormone therapy is often prescribed.
How Well It Works
As with hormone therapy, surgery
relieves endometriosis pain for most women. But it does not guarantee
long-lasting results. Some studies have shown:
Most women-about 60% to 95%-report pain
relief in the first months after surgery.1
45% of women have symptoms return within the first year after surgery. This number increases over time.2
Some studies suggest that using hormone therapy after
surgery can make the pain-free period longer by preventing the growth of new or
If infertility is your primary
concern, your doctor will probably use laparoscopy to look for and remove signs
Research has not firmly proved that removing
mild endometriosis improves fertility.3
For moderate to severe endometriosis, surgery will improve your
chances of pregnancy.4
In some severe cases, a fertility
specialist will recommend skipping surgical removal and using
in vitro fertilization.
There are various ways of surgically
treating an endometrioma, including draining it, cutting out part of it, or
removing it completely (cystectomy). Any of these treatments brings pain relief
for most women but not all. Cystectomy is most likely to relieve pain for
a longer time, prevent an endometrioma from growing back, and prevent the need
for another surgery.3
Complications from the surgery are rare but
bleeding that results in the need for a larger abdominal incision (laparotomy)
to stop the bleeding.
Scar tissue (adhesion) formation after
Damage to the bowel, bladder, or ureters (the small tubes that
carry urine from the kidneys to the bladder).
What To Think About
The benefits of laparoscopic
surgery compared with open abdominal surgery include less tissue trauma and
scarring and smaller incisions along with being able to have an outpatient
procedure or a shorter hospital stay and a shorter recovery time.
The skill of the surgeon is critical when surgery is used to treat
endometriosis that is causing infertility. The use of a laparoscope, lasers,
and some of the operative procedures require additional training for a surgeon.
Doctors report varying pregnancy rates after endometriosis surgery.