Endometriosis affects about 10% of women of reproductive age worldwide, causing chronic pelvic pain and infertility in up to 90% of those affected1 2. Diagnosis is often delayed by an average of seven years due to the invasive nature of laparoscopy and limited access to specialized care1 2. While imaging tests like transvaginal ultrasound and MRI are helpful, laparoscopy remains the gold standard for definitive diagnosis and treatment of endometriosis3 4. This minimally invasive procedure allows surgeons to visualize and remove endometriotic lesions, offering symptom relief and improved fertility outcomes5 6.
Purpose of Endometriosis Laparoscopy
Laparoscopy plays a crucial role in both diagnosing and managing endometriosis1 . It is considered the gold standard for diagnosing deep infiltrating endometriosis through direct visual inspection of the pelvic organs3 . In cases of unexplained infertility, diagnostic laparoscopy has revealed abnormal pathologies such as endometriosis, adhesions, and tubal problems in 60% of women7 . Beyond diagnosis, laparoscopic excision techniques are the preferred therapeutic approach, allowing surgical removal of endometriotic implants and nodules, which is the only cytoreductive treatment available5 8.
Before resorting to surgery, empiric medical therapy is often tried to manage symptoms1 . However, when symptoms persist or fertility is affected, laparoscopy offers a definitive method to confirm diagnosis and provide treatment simultaneously. Surgical removal of lesions can alleviate pain and improve chances of pregnancy9 .
Laparoscopy Types for Endometriosis
Diagnostic laparoscopy is performed when symptoms suggest endometriosis but imaging tests are inconclusive3 6. Small incisions are made near the belly button to insert a laparoscope, a tiny camera that allows surgeons to inspect the abdominal and pelvic organs directly4 10. During the procedure, targeted biopsies of suspected lesions are taken for histological confirmation4 . This approach helps to identify endometriosis, adhesions, or other pelvic abnormalities that may explain symptoms or infertility7 .
Imaging tools such as transvaginal ultrasound (TVUS) and MRI have high but not perfect sensitivity and specificity—76% and 94% for TVUS, and 82% and approximately 90% for MRI, respectively—making laparoscopy necessary in some cases for accurate diagnosis3 . Diagnostic laparoscopy also assesses the extent of disease, which is essential for planning treatment6 .
Therapeutic laparoscopy involves the excision or ablation of endometriotic lesions under camera guidance5 11. Excision refers to the surgical removal of endometriotic tissue, while ablation destroys lesions using energy sources such as diathermy11 . Laparoscopic surgery is minimally invasive, involving multiple small incisions through which trocars are inserted to introduce surgical instruments4 .
This surgical approach is considered the standard treatment for endometriosis due to its effectiveness in removing lesions and reducing symptoms5 . It offers advantages over laparotomy, including fewer complications, less pain, and faster recovery9 . In advanced cases, specialized techniques such as nerve-sparing or robotic-assisted laparoscopy may be used to improve outcomes and reduce adhesions8 12.
Preparing for Laparoscopy
Preparation for laparoscopy depends on whether the procedure is diagnostic or therapeutic6 . Patients typically receive preoperative counseling that includes instructions on fasting, medication adjustments, and postoperative expectations6 . General anesthesia is administered during the procedure, so patients are advised to fast for a specified period beforehand to reduce anesthesia risks6 .
Additional preparation steps may include:
- Arranging transportation home due to anesthesia effects6
- Packing essentials for a possible overnight hospital stay6
- Carrying identification and insurance information for hospital admission6
- Avoiding smoking and certain medications on the day of surgery13
- Undergoing bowel preparation if lesions involve the gastrointestinal tract13
These steps help ensure patient safety and optimize surgical outcomes.
How Laparoscopy Works
Laparoscopy is typically performed in a hospital or ambulatory surgical setting6 . After the patient is dressed in a surgical gown and positioned on the operating table, general anesthesia is administered intravenously or via inhalation to induce unconsciousness6 . The surgical site is disinfected before the procedure begins6 .
Laparoscopy is a minimally invasive surgery that uses small incisions and a camera to both diagnose and treat endometriosis. This approach offers faster recovery and fewer complications compared to traditional open surgery6 9.
A small incision is made near the umbilicus (belly button) to insert the laparoscope4 . Carbon dioxide gas is insufflated into the abdomen to create a pneumoperitoneum, inflating the abdominal cavity for better visualization of pelvic organs4 . The laparoscope is maneuvered to inspect the uterus, ovaries, fallopian tubes, and other pelvic structures4 .
Additional small incisions allow insertion of trocars, which facilitate the introduction of surgical instruments for biopsy, excision, or ablation of endometriotic lesions4 . At the end of the procedure, instruments are withdrawn, and the carbon dioxide gas is released4 . Incisions are closed with sutures or adhesive strips and covered with sterile dressings6 .
Postoperative monitoring occurs in a recovery area until the patient fully awakens from anesthesia6 . Patients may experience abdominal bloating and discomfort due to the gas used during surgery, and loose clothing is recommended for comfort6 .
