Womens Health, Fitness, Weight Loss, Beauty and More

Laparoscopic surgery for endometriosis

Surgery Overview

Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. Instead of using a large abdominal incision, the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision. If the surgeon needs better access, he or she makes one or two more small incisions for inserting other surgical instruments.

If your doctor recommends a laparoscopy, it will be to:

View the internal organs to look for signs of endometriosis and other possible problems. This is the only way that endometriosis can be diagnosed with certainty. But a “no endometriosis” diagnosis is never certain—growths (implants) can be tiny or hidden from the surgeon’s view.
Remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. If an endometriosis cyst is found growing on an ovary (endometrioma), it is likely to be removed.
Laparoscopy procedure
You will be advised not to eat or drink for at least 8 hours before a laparoscopy. Laparoscopy is usually done under general anesthesia, although you can remain awake if you have local or spinal anesthetic. A gynecologist or surgeon performs the procedure.

For a laparoscopy, the abdomen is inflated with gas (carbon dioxide or nitrous oxide). The gas, which is injected with a needle, pushes the abdominal wall away from the organs so that the surgeon can see them clearly. The surgeon then inserts a laparoscope through a small incision and examines the internal organs. Additional incisions may be used to insert instruments to move internal organs and structures for better viewing. The procedure usually takes 30 to 45 minutes.

If endometriosis or scar tissue needs to be removed, your surgeon will use one of various techniques, including cutting and removing tissue (excision) or destroying it with a laser beam or electric current (electrocautery).

After the procedure, the surgeon closes the abdominal incisions with a few stitches. Usually there is little or no scarring.

What To Expect After Surgery

Laparoscopy is usually done at an outpatient facility. Sometimes a surgery requires a hospital stay of 1 day. You will likely be able to return to your normal activities in 1 week, maybe longer.

Why It Is Done

Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue. This procedure is usually reserved for checking and treating:

Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder.
Endometriosis pain that has continued or returned after hormone therapy.
Severe endometriosis pain (some women and their doctors choose to skip medicine treatment).
An endometriosis cyst on an ovary (endometrioma).
Endometriosis as a possible cause of infertility. The surgeon usually removes any visible implants and scar tissue. This may improve fertility.
When laparoscopy may not be needed
Directly viewing the pelvic organs is the only way to confirm whether you have endometriosis. But this is not always needed. For suspected endometriosis, hormone therapy is often prescribed.

How Well It Works

Pain relief
As with hormone therapy, surgery relieves endometriosis pain for most women, but it does not guarantee long-lasting results.

Between 70% and 100% of women report pain relief in the first months after surgery.1
About 45% of women have symptoms return within the first year after surgery.2 This number increases over time.1
Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.3

Infertility
If infertility is your primary concern, your doctor will probably use laparoscopy to look for and remove signs of endometriosis.

Research has not firmly proven that removing mild endometriosis improves fertility.4
For moderate to severe endometriosis, surgery will improve your chances of pregnancy.5
In some severe cases, a fertility specialist will recommend skipping surgical removal and using in vitro fertilization.
Overall, pregnancy rates are highest in the 6 to 18 months after surgery.6

After laparoscopy, your next steps depend on how severe your endometriosis is and your age. If you are older than 35, egg quality declines and miscarriage risk increases with each passing year. In that case, your doctor may recommend infertility treatment, such as fertility drugs, insemination, or in vitro fertilization. If you are younger, consider trying to conceive without infertility treatment.

Endometrioma
There are various ways of surgically treating an endometrioma, including draining it, cutting out part of it, or removing it completely (cystectomy). Any of these treatments brings pain relief for most women, but not all. But cystectomy is most likely to relieve pain for a longer time, prevent an endometrioma from growing back, and prevent the need for another surgery.1

Risks

Complications from the surgery are rare but include:

Pelvic infection.
Uncontrolled bleeding that results in the need for a larger abdominal incision (laparotomy) to stop the bleeding.
Scar tissue (adhesion) formation after surgery.
Damage to the bowel, bladder, or ureters (the small tubes that carry urine from the kidneys to the bladder).
What To Think About

The benefits of laparoscopic surgery compared with open abdominal surgery include less tissue trauma and scarring and smaller incisions along with being able to have an outpatient procedure or a shorter hospital stay and a shorter recovery time.

The skill of the surgeon is critical when surgery is used to treat endometriosis that is causing infertility. The use of a laparoscope, lasers, and some of the operative procedures require additional training for a surgeon. Doctors report varying pregnancy rates after endometriosis surgery.

Surgeons disagree about reconstruction of fallopian tubes that have been affected by endometriosis.1

In vitro fertilization (IVF), an assisted reproductive technology, is an alternative to surgery to correct infertility caused by endometriosis.

Alternative Medicine Saved Our Lives

 

These courageous pioneers faced extreme disability or death. But when they exhausted the best traditional treatments for their diseases, their hope endured. Instead of giving up, they sought—and found—new life on the frontiers of alternative medicine. Along the way, each of the women grappled with fear and uncertainty while coping with the rigorous physical demands of their unproven treatments. But they’ve all defied their grim prognoses, and live each day filled with energy, optimism, and joy. Learn by their examples what it takes to forge a personal path to your best health.

Raphaela Savino, 68, Brooklyn, Nurse

Then: A diagnosis of stage 2 ovarian cancer

Now: “I’ve been healthy for 15 years”

As a nurse, Raphaela Savino was always admired for her strength and independence. So it came as no surprise to her friends and family that after she was diagnosed with aggressive ovarian cancer in 1992, she chose an unconventional path toward recovery.

Savino did have surgery to remove her ovaries, uterus, and fallopian tubes but refused the recommended follow-up chemotherapy, which promised her a 70% chance of surviving for 5 years. “Having cared for cancer patients, I knew chemo would make me sick and destroy my immune system, which I needed to get strong,” she says. If the time she had left was limited, she wanted to pack it with as much joy and energy as possible.

Still, she felt she should do something and became interested in alternative strategies for staving off a recurrence of the disease. Her research led to Nicholas Gonzalez, MD, a Manhattan immunologist who’s had success treating cancer with pancreatic enzymes, which come from pigs. Gonzalez’s approach is based on century-old research by Scottish embryologist John Beard, who first theorized that enzymes in the pancreas could have strong cancer-fighting properties.

Gonzalez prescribed the enzymes and a custom diet consisting of raw foods, vitamins, minerals, and trace elements designed to fight cancer and bolster her immunity, which appealed to her because it was the opposite of what she feared from chemo. The supplements totaled nearly 200 pills a day.

“This is really aggressive medicine,” Gonzalez says. “We’re as tough as any oncologist is with chemo. The idea that you just drink some green juice is not true. It’s a tough road.”

How tough? Savino rose every morning before dawn to prepare her meals, apportion her pills, and plan her detoxification routine, all the while coping with side effects typical of the early stages of the treatment, such as aches and extreme fatigue. “I was exhausted. But I could feel the effects right away, and that made me stick with it. I began to look better, more alive. I felt like my immune system was being challenged in a positive way, not destroyed, like with chemo.”

As each month passed, she felt better and stronger. Blood tests revealed an increasingly vigorous immune system and declining cancer markers. Within 18 months, she began reducing the number of supplements she took and today, 15 years later, is down to about 70 pills a day. She hasn’t seen an oncologist in that time but is confident she is healthy.

“I’m stronger than ever,” says Savino, who now also works as a health care consultant. “I take adventure trips—white-water rafting, horseback riding—to Utah and Canada. The younger women are always amazed. They can’t believe I had such a serious illness.”

Second opinion
Although Savino credits her special diet for warding off a recurrence, the American Cancer Society has a different explanation: “The surgery is what saved her life,” says Barrie Cassileth, PhD, chief of the integrative medicine service at Memorial Sloan-Kettering Hospital in New York City and an ACS spokesperson. “It’s important to eat well and stay strong, but no diet has ever been shown to cure cancer.” She points out that the greatest risk in pursuing alternative care for a serious illness is that it may prevent you from receiving lifesaving conventional treatment.

Bottom line: Ovarian cancer is deadly, surgery offers the only proven chance of a cure, and chemotherapy provides insurance. Most doctors would consider Gonzalez’s regimen only as an adjunct to conventional therapy.

Kathy Simonik, 52, Barrington IL, Graphic Designer

Then: Needed a metal rod to support her spine

Now: “I do 10-minute headstands”

After several back operations and years of therapy, Kathy Simonik was advised 5 years ago to have two final surgeries to implant a metal rod running through much of her spine. Although it would drastically impede her range of motion—she wouldn’t be able to turn her head without turning her entire body—the procedure, her doctors said, would relieve her incessant pain.

Simonik had good reason to be skeptical about the operation’s success. Her last surgery, to implant two metal rods and six screws, left her with 18 months of sciatic nerve pain. So she ignored their advice and turned instead toward an obscure alternative treatment called naprapathy. “I left the doctor thinking, I gave this my all. I said no and never went back.”

She mentioned her decision to a friend, who recommended that she see Patrick Nuzzo, a local naprapath. (Naprapaths are licensed only in Illinois and New Mexico.)