Endometriosis is a condition where cells similar to those of the endometrium (the uterus lining) grow outside the uterus. Some of the most common places this tissue may be found include:
There are a number of different symptoms of endometriosis and these can differ in each woman. Some of the most common endometriosis symptoms include:
Laparoscopic surgery is the most reliable way to diagnose endometriosis, and is one treatment option available to women with the condition. During this surgery, patches of endometriosis are removed. This offers more long-term relief from symptoms than other treatments can currently offer.
Laparoscopic surgery (also known as keyhole surgery) is a method of surgery that uses very small incisions. A thin tube (laparoscope) with a telescope is inserted into the incisions to provide a clear view of the abdomen. This is usually preferred to an open operation, because:
The extent of the surgery depends on the reasons for the surgery, along with other factors, including:
Laparoscopy is usually performed under general anaesthesia, but in some circumstances may be done with spinal or epidural anaesthesia. Depending on the extent of the laparoscopy, it may be a simple day procedure, or it may require a longer hospital stay.
A laparoscopy may be performed to diagnose endometriosis, and/or to remove patches of endometriosis from the organs of the pelvis. Laparoscopy is usually recommended in order to:
About 80% of women with pelvic pain from endometriosis report a reduction in pain following laparoscopy. Improvement is greater in women whose endometriosis is moderate to severe. 10-20% of women report a return of their pain within a year of surgery.
Improved fertility following laparoscopy has only been proven in women experiencing minimal or mild endometriosis, however many doctors believe that fertility can be improved in the case of moderate or severe endometriosis as well.
A diagnostic laparoscopy is performed exclusively for diagnosis, rather than treatment. Sometimes a small piece of tissue is taken from a suspected endometriosis patch to be tested by a pathologist. This is called a biopsy.
Operative laparoscopy involves treating endometriosis patches, not just diagnosing them. It is often done at the same time as a diagnostic laparoscopy, but the two may be performed separately.
Sometimes laparoscopy needs to be transitioned into a laparotomy, where the surgeon has to make a larger incision. The surgeon may make this decision for the safety of the patient or in order to remove the endometriosis more thoroughly. A laparotomy is sometimes planned from the beginning for women who have had many previous surgeries.
Some women are disappointed if their laparoscopy is converted to a laparotomy, but this decision is always made with the patient’s health as the priority. It is not considered a failure or complication of the procedure.
Before surgery, your doctor will take your medical history. Inform your doctor of any health issues you have had, particularly any:
Tell your doctor any medications you have recently taken, including prescription drugs, over the counter medicine, illicit substances, and natural therapies like herbs.
Your doctor may recommend that you stop taking the contraceptive pill for a month before the surgery. They will be able to recommend another method of contraception to use during this time. If you smoke, you should stop in the weeks before and after surgery. Ask your doctor if you require further information or help with this.
A small incision is made near the navel, and a laparoscope (a thin tube with a light and camera attached) is inserted. Carbon dioxide gas is used to gently inflate the abdomen. This gives the surgeon better access and a clear view by lifting the abdominal wall off the organs.
The pelvic organs may be gently moved for inspection using two instruments: one placed through another incision in the lower abdomen, and another placed inside the uterus (with entry via the vagina). More incisions may be made during the surgery depending on the amount of endometriosis being removed, and its location.
There are a number of techniques that can be used to remove endometriosis, including:
Your surgeon will choose the best technique(s) based on the location of the endometriosis, the reason for the surgery, and their own preference. Sometimes endometriosis extends deeply into the pelvic organs, so complete removal can be difficult.
After the treatment is finished, the laparoscope is removed and the carbon dioxide gas is allowed to escape. Incisions may be closed with small stitches or with sticking plaster. A catheter may be inserted to drain urine during recovery. The entire laparoscopic procedure can take anywhere from 30 minutes to a few hours. A second surgeon is often present to assist with the surgery.
You may be able to go home the same day as your laparoscopic surgery, however some treatment requires an overnight stay in hospital, or longer. Ask your doctor if you are unsure.
If your laparoscopy was performed under general anaesthetic, you should not drive for at least 24 hours. It is advised that you avoid making important decisions in the days following surgery, and while you may return to work if you wish, most women take a few days off. You should shower and bathe as normal after surgery. You may use tampons, but should ensure they are changed regularly.
Some symptoms you may experience in the days after surgery include:
Your doctor will prescribe a painkiller to take during recovery. If pain persists, let your doctor know. Laparoscopy recovery time varies from a few days to a couple of weeks. You may resume normal physical activity, including sexual activity, when these symptoms pass and you are feeling up to it.
It is common to experience constipation following abdominal surgery, and is especially common if endometriosis was removed from the bowel. The use of codeine or pethidine for pain relief can make constipation worse. You can relieve constipation by eating a light diet with a lot of fruit, drinking lots of water, and engaging in gentle exercise like walking. Psyllium husks may be added to cereal, or a mild laxative may be used. Sometimes during laparoscopy, the function of the fallopian tubes is tested using dye. If this is the case, you may experience blue vaginal discharge.
Some symptoms are not normal, and may indicate a problem. Contact your doctor if you experience:
If your doctor cannot be contacted, these are good reasons to visit the emergency room.
There are always risks associated with surgery, but doctors recommend it when they believe the benefits will outweigh these risks. Doctors don’t usually outline every possible side effect or complication of a treatment, but it can be empowering to be fully informed when making decisions about your health.
Some of the risks of laparoscopy apply to all forms of surgery. These include:
Other risks apply specifically to laparoscopy. These include:
There are other possible complications that are not included here, which may arise due to interacting health issues or risk factors such as smoking or obesity. You may wish to ask your doctor about the risks associated with your particular medical history and lifestyle.
This article is not a substitute for advice from a doctor who knows your particular circumstances, and does not contain all known information about laparoscopy or endometriosis. Please discuss any questions or concerns with your doctor.