SURGICAL TREATMENT OF ENDOMETRIOSIS: LASER LAPAROSCOPY

Laser laparoscopy for endometriosis is surgery which attempts to remove and destroy endometrial implants, cysts and adhesions using a laser beam.

Lasers are fine, highly concentrated beams of light that can be precisely aimed and controlled. They have been used in some branches of medicine for many years. Opthamologists use lasers to treat a variety of eye diseases and dermatologists use them to remove skin cancers and other skin growths.

There are several different types of lasers used in laser laparoscopy and each one has its own particular characteristics and uses. The three types of lasers that are most commonly used in the treatment of endometriosis are the carbon dioxide laser, the argon laser and the Nd:YAG laser. The type of laser used by your gynaecologist will usually depend on which type is available.

Who is suitable for laser laparoscopy

Laser laparoscopy is most suitable for women with minimal to moderate endometriosis. It is not usually suitable for women with severe endometriosis.

Things to discuss before laser laparoscopy

At some stage before the operation you and your gynaecologist should discuss what procedures are proposed and what should be done if a laparotomy is needed.

What happens with laser laparoscopy

A laser laparoscopy involves the same basic routine as that which is used for a diagnostic laparoscopy except that a laser instrument is inserted through a channel in the laparoscope. The laser beam then travels through special fibres known as fibre-optics before being directed onto the relevant tissue in the pelvic cavity.

The laser beam can be used to remove or destroy superficial endometrial implants and endometriomas, and to remove adhesions. The implants, endometriomas and adhesions are removed or destroyed by directing and focussing the laser on to them and using the intense energy of the laser beam to ‘vaporise’ or break up their cells.

Effectiveness of laser laparoscopy

Laser laparoscopy has several advantages over other surgery. It involves less risk of accidentally damaging underlying organs because the gynaecologist is able to precisely control the depth and amount of tissue being destroyed. Similarly, because the laser destroys only the target tissue and leaves the surrounding tissue undamaged, there is likely to be less pain and discomfort and faster healing of the affected area. It is thought that the main advantage of laser laparoscopy is that it may produce less scarring and fewer adhesions than other types of surgery. In addition, because laser surgery usually involves a laparoscopy it has all the advantages associated with having laparoscopic surgery rather than a laparotomy.

The main disadvantage of laser laparoscopy as opposed to conventional laparoscopic surgery is that some women have taken significantly longer to recover from the operation because they were under the general anaesthetic for a greater period of time as laser laparoscopy takes longer to perform.

So far, there are few statistics on the effectiveness of laser laparoscopy. At present there is no evidence to suggest that laser laparoscopy is any more effective than other surgeries in terms of eradicating the disease or relieving the symptoms. Rather, in the hands of an experienced operator, the results of laser laparoscopy appear to be similar to those of other surgical treatments.

Risks and complications of laser laparoscopy

The risks and complications of laser laparoscopy are the same as those associated with a diagnostic laparoscopy.

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