Laparoscopy is a minimally invasive (keyhole) surgical procedure performed through small 0.5-1cm incisions (cuts), that allows the surgeon to examine the inside of the abdomen and pelvis
Minor surgery will involve inspection and cauterising or the removal of the endometriosis tissue or spots. Adhesions (scar tissue) would be divided.
An endometrioma or chocolate cyst (cyst filled with endometriotic fluid) will be opened and removed. Care will be taken to preserve as much normal ovarian tissue as possible and to reconstruct the ovary.
Extensive surgery for endometriosis is also achieved through the laparoscope and usually involves:
- cutting away the endometriosis affected tissue ('endometriotic nodules')
- releasing ovaries
- releasing adhesions and removing the tissue affected by endometriosis around the back and the side of the uterus, around the bladder and the ureters and the space between the rectum and the vagina
- dissecting the ureters (tubes that carry urine from the kidneys to the bladder) to be able to remove endometriosis tissue
If severe endometriosis affects the bladder or is found close to the bladder then a cystoscopy (inspecting the bladder with a scope) may be performed. The bladder may need to be opened to remove the endometriosis. A catheter may be retained inside the bladder and the bladder will be rested for 10 to 14 days.
Endometriosis in the bowels
The bowel may sometimes be involved with endometriosis. The surgical treatment involves dissecting the bowel, so that it is free of endometriosis, and assessing the degree of involvement. At times nothing more needs to be done, however, at other times the endometriosis may need to be cut away.
The surgical approach is determined by the degree of bowel involvement. This may require taking off the surface layer of the bowel or taking out a small disc of bowel and sewing up the resulting hole. Sometimes, if the involvement is extensive, a small section of the bowel needs to be removed and the bowel rejoined. These procedures are sometimes done together with the laparoscopic bowel surgeons depending on the extent of bowel surgery required.
The risk of a major complication from a laparoscopy only is about 1 -2 per 1000. The risk from the most major type of laparoscopic surgery for endometriosis is up to 1 in 10. The members of the surgical team will discuss all the risks in detail when you sign the consent form for the operation.