Endometriosis

The surgical approach to treatment of endometriosis is shifting away from laparotomy toward endoscopy as technology and experience improve. All patients with minimal or mild disease and a significant portion of those with advanced disease can be treated endoscopically with little difference in clinical outcome but a significant difference in cost. The various lasers as well as sharp dissection and bipolar cautery are adequate tools for this approach. With complete surgical destruction, medical suppressive therapy adds little therapeutic benefit. There is little evidence to suggest that laparoscopic presacral neurectomy or uterine nerve ablation should be routinely added. Long-term recurrence of disease is probably less than 25%. It is likely that the American Fertility Society classification will be revised to adapt to our changing knowledge and treatment strategy.