Endoscopy in the management of endometriosis

Endoscopy has replaced laparotomy in nearly all patients requiring surgical treatment of endometriosis. Controlled trials have shown electrosurgery is more effective than expectant treatment in the resolution of infertility due to peritoneal endometriosis and equally effective as laparotomy. Laparoscopy surgery reduces patient morbidity and costs when compared with laparotomy. No significant difference has been demonstrated between laser or electrosurgery in resolving infertility related to peritoneal endometriosis. Peritoneal endometriosis is difficult to diagnose and its extent is obscured by occult endometriosis in microscopic foci. Biopsy is required to establish the diagnosis as all of the described lesions of endometriosis may also be due to other diseases. Excision of the lesions may be by electrosurgery, laser or scissor diathermy. Scissor diathermy has advantages over laser or electrosurgery. Endometriomas may be removed by one- or two-stage excisional surgery. Follow-up laparoscopy is often indicated because of the association with secondary adhesive formation. Pouch of Douglas endometriosis requires special attention to the identification of the extent of disease and the technique of removal. Rectal involvement may require rectal surgery, most of which can be achieved by laparoscopy. Hysterectomy and oophorectomy may be performed laparoscopically and are indicated for recurrent extensive disease not controlled by medical or conservative surgical procedures, for adenomyosis or for extensive pelvic adhesions.