Surgical Treatment of Endometriosis
Surgical treatment is the treatment of choice to perform in all the different locations of endometriosis and whatever the manifestation of the disease, since it is the only method capable of producing the elimination of endometriotic lesions.
Specific indications for laparoscopic surgery include:
- Chronic pelvic pain
- Presence of endometriosis
- Presence of endometrioma
- Pelvic adhesions
- Obstruction of the uterine tube
- Infertility
The different procedures during laparoscopy are:
Endometriosis Ablation and Excision
Endometriotic lesions (implants of endometrial tissue that lie outside the endometrium) can be excised (tissue removed) using bipolar or monopolar energy.
Vaporization and fulguration of endometriosis
Endometriotic implants can be burned through a shock wave with bipolar or monopolar energy.
Drainage and Exceresis of the endometrioma capsule
Endometrioma is a special type of ovarian cyst, which occurs due to the growth of ectopic endometrial tissue deposited on its surface that progressively invaginates the ovarian cortex.
The ideal is to remove the endometrioma capsule (capsule excision), but there are cases, where some factors, for example the size of the endometrioma, the presence of multiple adhesions and excessive bleeding, where only the cyst drainage is used.
Presacral Neurectomy (PNS)
This pelvic denervation technique tends to improve up to 70% of patients operated on for dysmenorrhea (pain with menstruation).
This procedure consists of sectioning the fibers of the superior hypogastric plexus, near the fourth and fifth lumbar vertebrae.
Its indications are in women with centrally perceived chronic pelvic pain, especially intractable dysmenorrhea, in whom a relief rate of 65% to 89% is obtained.
Laparoscopic Ablation and Lysis of the Uterosacral Nerve (LUNA)
To confirm or rule out the study of a patient with chronic pelvic pain, the ideal approach is by laparoscopy.
The LUNA is a therapeutic measure for patients with chronic pelvic pain (CPP).
Pain impulses from the uterus, cervix, and proximal fallopian tubes pass through nerve fibers arising in the paracervical plexus of Frankenhauser, at the base of the uterosacral ligaments, and traverse the upper and lower portions of the hypogastric plexus.
Its objective is to section the uterosacral ligaments in their proximal portion approximately 0.5-1 cm from their insertion site in the uterus, laparoscopically using bipolar coagulation.
It is indicated in women with centrally perceived CPD where a relief rate between 63% and 81% is achieved, however this rate decreases markedly after 6 to 12 months to 51%.
Treatment of deep endometriosis
The treatment of deep endometriosis depends on each case, depending on the degree of depth and its extension, the patient must be evaluated by a multidisciplinary team depending on the affected organ. Treatment is based on radical surgery, this means that the affected portion of the organ where the injury is located must be removed or, failing that, the entire organ must be removed.