How is the operation performed?
The diagnostic part is a thorough examination of all parts of the pelvis under magnification with staging according to r-ASRM; then each lesion is coagulated with a bipolar instrument until completely destroyed, lesions on the ligaments and peritoneum of the pouch of Douglas are excised and sent for histology, adhesions are separated, for endometriomas a cystectomy is performed, and the patency of the tubes is checked. The operation reduces pain in most patients and increases the pregnancy rate in stages I–II by 1.5–2 times. Further tactics are hormonal therapy to prevent relapse or active pregnancy planning.
Indications
- chronic pelvic pain, painful menstruation and sexual intercourse that cannot be treated with medication;
- infertility due to endometriosis (stages I–II - removal of lesions increases the pregnancy rate);
- endometrioid cysts, infiltrative foci, adhesions in endometriosis;
- clarification of diagnosis and stage with histological confirmation.
Surgical treatment of endometriosis
The goal of laparoscopy is to remove or destroy all visible foci of endometriosis (from red and black “powder” lesions to white fibrous and infiltrates), to separate adhesions and restore the anatomy, preserving the ovaries and tubes. Superficial lesions of the peritoneum are coagulated bipolarly or with a laser, deep ones are excised, endometriomas are exfoliated. After surgery, if there are no plans for pregnancy, anti-relapse hormonal therapy (dienogest, COCs, IUD with levonorgestrel) is prescribed; in case of infertility, conception is recommended in the next 6–12 months, when the chances are maximum. For deep infiltrative endometriosis involving the intestine and ureters, the operation is performed by a multidisciplinary team.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
