What is a laparoscopy?
This procedure entails visualization of the abdominopelvic region via an instrument known as the laparoscope, a thin, lighted instrument that is fitted with a telescopic lens and miniature video camera.
What happens during a laparoscopy?
During laparoscopy, organs will be manipulated for viewing, biopsies will be taken, removal of disease will be performed and diagnosis confirmed.
A small (approximately ½ inch long) incision is made through the navel, into which a needle is inserted. Carbon dioxide gas is injected into the abdomen through this needle. This colorless, odorless gas distends the abdominal cavity so that the organs will lift and separate and allow the Laparoscope to be inserted. Additional similar incisions will likely be made in the pubic hairline and/or over the ovaries, through which surgical instruments can be introduced.
Once all the instruments have been placed into the pelvis and all organs have been satisfactorily investigated, biopsy samples will be taken and destruction of Endometriosis and adhesions will be performed.
Destruction of the lesions can be done in various ways. These include:
Excision: cutting out of all disease by any means (including laser), while preserving the healthy portions of affected organs. Studies show this is the most effective surgical means of treating the disease and offers the longest symptomatic relief.
Vaporization: destruction of implants by instant boiling of the cellular water with a high power laser or electrosurgical tool. This procedure is considered superficial and has a high recurrence rate; it often prevents adequate tissue samples from being obtained, due to the destructive nature of the technique.
Ablation: ablation of Endometriosis involves burning away the surface of the lesion by using a high-energy heat source; typically, the laser. This should not be confused with the procedure known as endometrial ablation (e.g., Novasure®). Endometrial ablation is performed for the treatment of abnormally heavy bleeding, wherein the endometrium (thin layer lining the uterus) is destroyed, thereby lessening or altogether stopping the menstrual flow. Endometrial ablation is not a treatment for Endometriosis.
Coagulation: desiccation of implants by heating and drying the affected tissue(s). This is generally an incomplete method with a high recurrence of disease.
Fulguration: burning of implants with a spark of electricity from any electrosurgical tool. As with other superficial means, fulguration is associated with a rapid recurrence rate.
In addition to the laser and other surgical tools, some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as the energy source.
Following the surgery
Once the surgeon is confident that all procedures have been performed and adequate samples have been taken, all instruments will be withdrawn. The abdomen is deflated and incisions closed, usually with a few dissolvable stitches covered by band-aids. Scarring is generally minor.