One of the only most widely used techniques for endometriosis diagnosis is laparoscopy. Although other techniques, such as transvaginal ultrasound and MRIs, are gaining favour in the clinical setting, to date, laparoscopic diagnosis remains the ‘gold standard’.

Laparoscopy is a procedure carried out under general anaesthetic; it is also known as ‘keyhole surgery’, as the incisions made are very small. The procedure is relatively straight-forward and considered to be minimally invasive.

Step-by-step

• A catheter is used to empty the bladder during the anaesthetic process.
• A fine needle is inserted through the belly button and the abdomen is filled with carbon dioxide. This separates the stomach from the bowel and enables the surgeon to see the surrounding organs more clearly.
• Small cuts (about 1cm long) are made in the region of the belly button and bikini line.
• A thin tube containing a light source and camera (laparoscope) is inserted through the incisions.
• The surgeon performs a thorough inspection of the uterus, ovaries, fallopian tubes, Pouch of Douglas, bowel, bladder and surrounding area.
• Other instruments may be used, for example, to hold tissue out the way, excise endometrial masses, and/or drain excess fluid.
• Once surgery is complete, the gas and catheter are removed and the incisions are closed using glue or stitches.

Laparoscopies for the diagnosis of endometriosis

If endometrial tissue is identified during a laparoscopy, surgeons will usually attempt to remove it immediately, via resection or ablation. In mild cases of endometriosis this may be the only treatment that is required, avoiding the need for further, more invasive procedures.

Laparoscopies are, therefore, not solely a diagnostic tool, but also a potential treatment option, with a number of studies showing pain reduction and improved fertility after excision of tissue. In fact, it is the treatment of choice for most infertile women. The major downside to this technique is that, with time, the endometrial deposits often reform and pain and infertility may return, necessitating further treatment.

As well as removing endometrial tissue, a laparoscopy can enable surgeons to remove ovarian cysts and divide pelvic adhesions, with a view to improving fertility.

Why have a laparoscopy?

Laparoscopy is a preferred option for patients with endometriosis because, compared to more invasive techniques such as hysterectomy or complex surgery, recovery times are shorter, there is less bleeding and scarring is reduced due to the small incisions.

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Sources:

• Bulletti, C, et al. “Endometriosis and Infertility.” Journal of Assisted Reproduction and Genetics, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1.
• Marcoux, S, et al. “Laparoscopic Surgery in Infertile Women with Minimal or Mild Endometriosis. Canadian Collaborative Group on Endometriosis.” The New England Journal of Medicine, vol. 337, no. 4, 24 July 1997, pp. 217–222., doi: 10.1056/NEJM199707243370401.
• Overview: Laparoscopy (Keyhole Surgery). NHS, www.nhs.uk/conditions/laparoscopy/. Page last reviewed: 01/08/2018.
• Laparoscopic Surgery for Endometriosis. Endometriosis UK, www.endometriosis-uk.org/sites/default/files/files/Information/laparoscopic_surgery.pdf. Last updated: April 2012.