Laparoscopy, also known as keyhole surgery, is used to diagnose and treat several pelvic and abdominal conditions, including endometriosis. Carried out under general anesthesia, this minimally invasive surgery allows surgeons to locate, identify, and remove cysts or implants that are symptomatic with endometriosis.
In this article, we discuss what happens during laparoscopic surgery for endometriosis, as well as what patients can do to aid their recovery and prevent endometrial implants from regrowing.
What Is Laparoscopy?
Laparoscopy is a minimally invasive surgical procedure that allows surgeons to see inside the abdomen and pelvic cavity without having to open the area completely.
Instead of a long incision across or along the length of the abdomen, laparoscopic surgery involves making 2-4 small incisions around the belly button or lower abdomen. A long, thin telescopic camera called a laparoscope is inserted into one incision, and surgical instruments are inserted into the other(s).
When performed for endometriosis, laparoscopies enable surgeons to locate, view, and remove endometrial-like tissue growing outside the uterus. Although some stay for overnight observation, most patients can go home on the same day after a laparoscopy.
When Is Laparoscopy Recommended for Endometriosis?
Pain medication and hormone therapy are often the first forms of medical treatment prescribed for endometriosis. For some women, this can relieve the pain and stop the growth of endometriosis implants. That said, hormone therapy, which typically involves suppressing the production of estrogen, is not suitable or successful for all endometriosis patients.
Healthcare providers recommend laparoscopy for endometriosis in the following cases:
- To diagnose endometriosis by confirming the presence of endometrial implants
- When endometriosis symptoms have not improved with hormone therapy
- To remove an ovarian cyst (endometrioma) that is causing pain or interfering with ovulation
- When endometriosis causes infertility in women trying to get pregnant
- When symptoms of endometriosis are affecting women’s mental health and quality of life
- If endometriosis is adversely affecting the bladder or bowel
What Happens During Laparoscopy for Endometriosis?
Laparoscopies are performed under general anesthesia, meaning patients are asleep during the procedure and do not feel any pain. After the small incisions are made in the abdomen an instrument called a cannula is inserted to inflate the abdomen with a gas like carbon dioxide. This enables the surgeon to see the inside of the abdomen more clearly on a screen once the laparoscope is inserted.
If endometrial implants like cysts, lesions, or adhesions are found, the surgical instruments required to remove them are inserted through the other incision(s).
Surgeons typically use two different types of procedures to remove endometrial tissue growing outside the uterus – excision or ablation. Excision involves surgically removing the misplaced tissue and ablation means freezing or lasering it off. Once all misplaced endometrial tissue is removed, the surgeon will close the incisions with stitches.
Recovering from Laparoscopy for Endometriosis
Undergoing a procedure under general anesthesia leaves some people feeling groggy or nauseous, so it’s a good idea to have a friend or family member collect you from the hospital after a laparoscopy. Patients might also experience some vaginal bleeding, mild abdominal pain, and tenderness around the surgical incisions after endometriosis surgery. However, these will usually subside within 7-10 days.
Surgeons recommend refraining from showering for the first few days to allow the incisions to heal. Eating well, getting plenty of rest, drinking water, and going for small walks will help the body to recover and eliminate excess gas after a laparoscopy. Intense exercise, stretching, bending, sex, and heavy lifting should be avoided for 7-10 days after laparoscopy, or until your post-surgery check-up.
Laparoscopy for Endometriosis: Does It Work?
Statistics reveal that 80% of women who undergo laparoscopic surgery for endometriosis feel relief from their symptoms. However, recurring symptoms are common in as many as 40% of women within five years.
Laparoscopy for endometriosis is also known to improve fertility, with over 70% of women under the age of 25 falling pregnant afterward. That said, if women have not conceived within 12 months of the procedure further surgery rarely helps.
Relief from Symptoms After Laparoscopy for Endometriosis
For best results after laparoscopic surgery for endometriosis, healthcare providers recommend having a treatment plan in place to prevent the regrowth of endometrial tissue outside the uterus. This plan typically includes pelvic physical therapy, the regular use of vaginal dilators and pelvic wands, and either hormone therapy or fertility treatment, depending on whether patients are hoping to get pregnant or not.
Two medical devices in particular are recommended by pelvic health physical therapists for endometriosis patients to use at home to prevent symptoms from recurring, and regain a better quality of life.
Pelvic Wands
Pelvic wands are ergonomic massage tools designed to prevent painful scar tissue from forming after endometrial implants have been removed via laparoscopy. Made from body-safe medical-grade silicone, pelvic wands are also helpful to massage deep pelvic trigger points which are often associated with endometriosis.
Vaginal Dilators
Due to the pain and discomfort women with endometriosis often experience during sex (dyspareunia), many tend to abstain or suffer in silence. After endometrial implants are removed via laparoscopy, many patients, especially those hoping to get pregnant, are keen to resume intercourse.
However, pain is registered psychologically in the body as well as physically. And after a few uncomfortable sexual experiences, the mind begins to signal the vaginal and pelvic floor muscles to tighten in protection mode at the mere thought of penetration. This can lead to continued dyspareunia for women with endometriosis despite having the painful implants removed via laparoscopy.
In these cases, the use of vaginal dilators in the comfort and privacy of their own home can help women to relax the pelvic floor muscles and relieve the vaginal tightness associated with fear of penetration. By slowly progressing through a set of incrementally sized dilators, women can gently and gradually rebuild the confidence to enjoy pleasurable sex again.
Conclusion
Laparoscopy for endometriosis is a surgical procedure that can diagnose and treat the condition at the same time. Although successful in relieving symptoms and improving fertility for many women with endometriosis, symptoms do return for some. If you are considering a laparoscopy for endometriosis, speak with your healthcare provider about putting a treatment plan in place after surgery to prevent the reoccurrence of symptoms afterward.
References
Women’s Health – Endometriosis - https://www.womenshealth.gov/a-z-topics/endometriosis
Medline Plus – Laparoscopy - https://medlineplus.gov/lab-tests/laparoscopy/
Web MD - What is Laparoscopic Surgery for Endometriosis?
https://www.webmd.com/women/endometriosis/laparoscopic-surgery
Reproductive Facts - Endometriosis: Does it cause infertility? https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/endometriosis-and-infertility-can-surgery-help/
National Library of Medicine - Physiotherapy Management in Endometriosis - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740037/
National Library of Medicine - Recurrence patterns after surgery in patients with different endometriosis subtypes: A long-term hospital-based cohort study.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073694/
Journal of Minimally Invasive Gynecology - Long-term fertility after laparoscopy for endometriosis-associated pelvic pain in young adult women - https://www.jmig.org/article/S1553-4650(14)00288-X/fulltext