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:
You will be advised not to
eat or drink for at least 8 hours before a laparoscopy. Laparoscopy is usually
general anesthesia, although you can stay awake if
spinal anesthetic. A
gynecologist or surgeon performs the procedure.
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
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
Laparoscopy is used to examine the
pelvic organs and to remove implants and scar tissue. This procedure is typically used for checking and treating:
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.
As with hormone therapy, surgery
relieves endometriosis pain for most women. But it does not guarantee
long-lasting results. Some studies have shown:
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
After laparoscopy, your next steps depend on how severe your
endometriosis is and your age. If you are older than 35,
egg quality declines and miscarriage risk increases with each passing year.
In that case, your doctor may recommend infertility treatment, such as
insemination, or in vitro fertilization. If you are
younger, consider trying to conceive without infertility treatment.
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.1
Complications from the surgery are rare but
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.
In vitro fertilization (IVF), an
assisted reproductive technology, is an alternative to
surgery to correct infertility caused by endometriosis.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
American College of Obstetricians and Gynecologists (2010). Management of endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225–236.
Fritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.
Ferrrero S, et al. (2010). Endometriosis, search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
American Society for Reproductive Medicine (2012). Endometriosis and infertility: A committee opinion. Fertility and Sterility, 98(3): 591–598.
June 7, 2013
Sarah Marshall, MD - Family Medicine
& Kirtly Jones, MD - Obstetrics and Gynecology
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