Endo surgery - Laser vs cutting treatment

[MumaM]

Hi guys, I have my laparoscopy next week.

The surgeon hasn't provided any details on how he will treat the endometrioses or adhesions if he finds them and I have recently read how much it can vary. I.e remove the endo with a laser (risks damaging ovaries), bursting the sacks (good chance it comes back) or cutting it out.

I talked to the pre-op team and they said my only chance is to ask him when I see him - literally just before the surgery. No chance to do further research or consider the pro's and con's of what he is proposing before he actually does it. Bit frustrated by this. Does anyone have any further experience or knowledge of either?

[Lindle]

Have you had a scan or is this a diagnostic lap as the first investigation? Do you know who is doing it (don't name them but do you know the name) and have you checked he has a special interest in endo?

[MumaM in reply to Lindle]

Thanks for your reply. He is a gynaecologist and surgeon and does various key hole surgeries for all kinds of gynae issues. It’s on the nhs but it’s a private hospital that they’ve referred me to. His profile on Circle doesnt say anything about a particular interest in endo, just generally lists the various things he deals with. The surgery is a laparoscopy +\- proceed so he will treat what he finds.

[Lindle in reply to MumaM]

Just be aware that it is a requirement of NICE and NHS England that only those with a special interest deal with endo and also that a lap is no longer the gold standard for diagnosis. A scan should be done first which aims to pick up any deep disease which then avoids a diagnostic lap - referral to an endo centre then follows. A diagnostic lap is for those with negative scans.

Having said that there is a lack of sonographers who have the training to pick up deep disease and until this is in place I suspect that diagnostic laps will still be done. So be aware that only superficial endo and uncomplicated endometriomas can be treated at the lap. If there is any indication of deep disease and/or rectovaginal this must be left alone and you should then be referred to an endo centre.

Laser is a tool not a method - it is used for both excision and ablation. Laser ablation can be used for superficial disease as well as excision and the most important factor is the skill and training of the surgeon and not tool or method. Anyone having a lap really should have a consultation before the procedure to go through all the details. A diagnostic lap is or should be a detailed, systematic inspection of the pelvis/abdomen which requires expertise in endo.