How many times can u have laser laparoscopy?

[Kirstyferg]

[stevieflp]

Hi - according to the opinion of those consultants who have gone on to specialise in endo, rather than being general gynae consultants, as YellowRose says above, excision is far better.

My consultant, who is one of the worldwide top endo consultants explained the various levels of surgery thus:

Laser Surgery:

Burns endo off the surface which is fine if that is all you have (still better to be excised though). Like a gardner only cutting weeds down from the surface and not necessarily getting the roots. Forms scar tissue being a burn. Therefore, if the roots remain active, endo cannot establish where there is scar tissue but can continue to develop and emerge elsewhere. It can bring short term relief, but is generally just that. He said it takes far less skill than excision surgery to perform and is generally offered by those not trained in excision surgery. I have seen on Endo UK forum ladies who have had their symptoms return and their consultant has arrogantly said, 'oh it can't be the endo returned as I removed it' (yes by laser and probably not all of it) which speaks for itself!

Excision surgery:

This is where endo is cut away. It is far more effective as it takes it away from the surface and any deeper layers it may be residing in. However, many who say they do excision surgery do only remove patches of endo. It will have a good outcome for the endo that was removed. However, if endo is extensive or unseen, there is a good likelihood that, over time, further patches will become problematic and lead to multiple surgeries. Hence the general belief that endo cannot be cured. Dr David Redwine has also said that where ladies complain of further pain following excision, it is not the endo that was removed that has returned, but simply that which was not removed that is now causing symptoms.

Total Radical Peritoneal Excision:

This is an extension of patch excision surgery. It is the removal of the whole membrane and deeper endo throughout the peritoneal cavity. This heals cleanly and leaves you with a new peritoneum. If all endo is removed in this way, it prevents it from progressing and causing further problems and far less likely to require the multiple surgeries we all hear about on the forum.

You might wonder why 'total radical peritoneal excision' has not become the gold standard for endo treatment - it should be, particularly for advanced endo - but it is the most demanding gynaecological surgery in terms of skill and in terms of length of surgery / demanding on the surgeon lasting anthing between 5 and 10 hours. Not many surgeons world-wide have yet reached the stage where they devote the time to develop such skills to perform this and so stick with less demanding\less effective surgery, although some of the more endo focussed gynaes are starting to take notice of the benefits of removing all endo (seen and as yet unseen) as opposed to removing just patches of seen endo. Total Radical Peritoneal Excision technique has a higher chance of removing it all.

Sadly I think there are only a few consultants surgeons worldwide who currently perform surgery to remove all endo. Most excise patches/as much as their skill level will allow them to - but this does help relieve symptoms but with a higher possibility of future surgeries.

GPs tend to refer you to whoever has the title 'Gynae' at the local hospital - but they all have such a wide range of specialisms and some really are 'general' with a broad spectrum of knowledge but not specialising in particular. Best to see someone who has chosen to become an endo expert with up-to-date knowledge and enhanced skills relating to endo. Excision surgery is the most satisfactory way of treating endo at the current time, with radical excision being the best.

I can recommend the following books:

Stop Endometriosis and Pelvic Pain by Dr Andrew S Cook (top USA Endo Surgeon Consultant)

100 Questions and Answers about Endometriosis by by Dr David Redwine (retired top US Endo Surgeon Consultant (acknowledged as world leader in the field)

All best wishes x x

[Hidden]

I had it three times, then when I went to have IVF they told me I couldn't have it as my womb was now to thin and weak to hold a baby :(. If you are wanting to have children my advice would be to NOT have laser treatment xx

[Impatient]

You may not need lasers on the uterus at all - it depends on the location of the shallow endo. Lasers working on any other organs or tissues aside fro the uterus will not have any impact on the uterus.

The biggest threat from multiple surgeries is not the laser but the adhesions or scarring that each surgery will encourage to grow. The adhesions themselves can be a real long term nuisance.