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.
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
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
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
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
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.
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
- 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 following laparoscopy for endometriosis is usually
- 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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