Laparoscopy For Endometriosis


Laparoscopy for endometriosis refers to the direct visual inspection of the abdominal cavity and pelvis and all the organs inside these cavities, for any evidence of endometriosis by means of an instrument called a laparoscope. As its name implies, it is done to help exclude or confirm a suspicion of endometriosis as the possible cause of a chronic pelvic or abdominal pain.

Endometriosis is a difficult to diagnose disease.

Laparoscopy for endometriosis is also a type of keyhole surgery

It is a common cause of abdominal pain in many women of child bearing age who go to visit their doctor over and over again without any clear diagnosis.

It commonly causes lower abdominal pain, heavy menstrual bleed, pain during bowel opening that tends to come on around the time of menstruation, deep seated pain during intercourse and lower back pain in some ladies.

It is one of the most common cause of infertility.

The "gold standard" test or investigation used in the diagnosis of endometriosis is through the use of video assisted laparoscopy (VAL). This is often referred to as laparoscopy for short.

Laparoscopy for endometriosis refers to the direct visual inspection of the abdominal cavity and pelvis and all the organs inside these cavities, for any evidence of endometriosis by means of an instrument called a laparoscope. As its name implies, it is done to help exclude or confirm a suspicion of endometriosis as the possible cause of a chronic pelvic or abdominal pain.

A laparoscope is a small type of telescope - tiny tube about the width of a pen, fitted with a light source, magnifying lens, and camera at its end. 

The laparoscope is inserted into the abdomen via a small 1-2cm cut on the skin just below or on the umbilicus or navel. This helps prevent you needing to be cut open with a wound anything between 10 cm to 30 cm or more through an open surgical operation just to inspect and see what your side is like.

This "diagnostic laparoscopy" is done under general anaesthesia, meaning that you will need to be put to sleep while the procedure lasts. It is not painful and recovery from it is usually very fast. Most women who have  laparoscopy for endometriosis are able to recover and go back to work within a week.

How Does Laparoscopy Help Endometriosis

Because during laparoscopy the whole of the internal cavities and organs where endometriosis often occur can be looked at directly by means of a laparoscope, it is the very best way to make a certain diagnosis of endometriosis.

The type, size location and extent of any endometriosis tissue seen can be documented with a video evidence and thus treatment can be better planned and targeted.

A positive laparoscopy has a detection rate of more than 32 percent. This means that if a surgeon thinks that a tissue seen is endometriosis, it means that there is more than a third of the chances that it is. Even though this may seem low, it is the highest detection rate possible in the diagnosis of this potentially crippling disease.

Tissues can be taken during laparoscopy for endometriosis and sent to the lab to confirm the diagnosis, a thing that is not possible my testing for endometriosis with ultrasound or CT or indeed any other form of  scan. Getting back a negative histology or lab result does not exclude the presence of endometriosis.

If during a laparoscopy for endometriosis a lesion is found deep seated in the pelvis, removing it is the best cure for pain associated with endometriosis.

Research shows that fertility improves after laparoscopy surgery for endometriosis and tubal flushing if done during the laparoscopy will significantly improve the chance of getting pregnant

Another way that laparoscopy helps endometriosis complications is that it reduces the risk of adhesion formation that is associated with open surgery or laparotomy.

How is Laparoscopy Done ?

As explained above, if you and your doctor have reached a conclusion that the best option to investigate the cause of your recurrent or chronic pelvic and abdominal pain is laparoscopy, you will be booked and given a date for it.

How is laparoscopy for endometriosis done? The follow is what to expect during this procedure:

  • Laparoscopy for endometriosis is often done as a day case surgery, meaning you should be able to go home within 6 to 8 hours after.
  • You will be given a date for the procedure and asked not to have anything to eat or drink for about 12 hours before the operation (some anaesthetist are very liberal and are happy for you to starve for only 6 hours). You may be able to have small slips of water until a few hours before the surgery if you are very thirsty - but always cross check with your anaesthetist. No bowel prep or preparation is usually required prior to laparoscopy  for endometriosis.
  • On the day of the operation, you will admitted into hospital or the clinic and may have your pulse, blood pressure and temperature checked as a routine to ensure you are in good health for anaesthesia
  • Some surgeons may request for routine blood and urine tests too to have a baseline record
  • You will then be seen by the surgeon and anaesthetist who will introduce themselves, explain exactly what they are going to do and what to expect during and after the operation
  • A cannula may be placed inside a vein in your arm or forearm, a drip set up and then you may be given some medicine to help you go to sleep
  • Once you are asleep, a tube will be passed down your breathing pipe to maintain control of your breathing
  • The surgeon will then clean your abdomen with disinfectant mixed with a detergent and allow the skin to dry.
  • A small cut about 1 - 2 cm (half an inch) would be made just below or on your navel or umbilicus. This is not painful as you will be asleep at this time
  • A graspers is then inserted through a second small cut to help hold and move internal organs if needed
  • A third or fourth small cut may also be required if need for pumping gas into the abdomen to expand the cavity and create space for manoeuvring during the operation or to bring out an endometriosis cyst or tissue, if one is found.
  • The surgeon will then carefully look through the surface of each and every cavity, organ or space in the abdomen and pelvis for any sign of endometriosis. They usually appear like chocolate coloured material - it has nothing to do with chocolate eaten. It is just congealed or altered blood that has stayed for a long time in the cyst or cavity
  • Any evidence of endometriosis is burnt off by means of a special instrument called a diathermy or if possible, they would actually cut and remove big deposits or cysts containing endometriosis tissue
  • All what is done is usually recorded on video and stored on a DVD
  • The abdominal cavity is then washed with warm water with a special agent to help reduce the risk of adhesion after laparoscopy for endometriosis.
  • The instruments are removed, the holes or cuts are stitched with one or two stitches and many surgeons will then inject a local anaesthetic into the cuts on the abdominal wall to help reduce pain after the operation for a longer length of time.
  • The whole procedure usually takes about 45 minutes.

Recovery

Recovery following laparoscopy for endometriosis is usually straightforward.

  • You will be woken up by the anaesthetist and transferred to the recovery room where you will gradually wake up fully.
  • You may feel sore in your through and slightly bloated with mild abdominal discomfort once you are fully awake.
  • You should be able to eat within 2 to 6 hours after this procedure and you can get anti-sickness medication, should you need it.
  • You will then be discharged home with a report of what was found and done
  • By the next day after laparoscopy, you may experience pain all over your body and feel exhausted because of the whole ordeal of the previous day.
  • You may also experience shoulder pain due to the gas used in expanding the abdominal cavity during the operation. This is normal in up to 63% of patients and gets better within 5 days.
  • You may feel pain at the sites of the cuts on your abdomen. This should not be too much, and the use of pain killers like acetaminophen  or paracetamol should help. If you develop severe abdominal pain after laparoscopy, you must call for urgent medical attention. Call your surgeon immediately. It is unusual to have severe pain. Mild to moderate abdominal pain and cramping is normal.
  • There may be mild bloating and feeling of nausea. If you experience significant abdominal distension or swelling after laparoscopy you must call your doctor immediately as well.
  • The pain, bloating and nausea should all settle by day 3 to 5 after laparoscopy.
  • You should be getting ready to resume normal activities by day 7 and go back to work at the end of the first or second week.

If you have had laparoscopy for endometriosis and are experiencing any symptoms that you are not sure of, it is always better to err on the side of caution and call for help. Contact your doctor immediately.

On the whole, laparoscopy is a straight forward and relatively lesser risk surgery compared with open laparotomy. If you are booked to have one done, we hope it goes well with you.

Endometriosis Laparoscopy Experiences: Do You Have One?

Do you have an experience with laparoscopy for endometriosis? What was it like? What went well and what would you have wished was done better? Did it help address the original problem you had? Did you suffer any complication?
Share your experience with laparoscopy for endometriosis!

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