Laparoscopy for Endometriosis: What You Need to Know

Introduction

Laparoscopy for endometriosis is a minimally invasive surgical procedure aimed at identifying and removing endometriosis lesions. This technique is increasingly preferred over laparotomy, a more invasive alternative with larger scars. Thanks to the minimally invasive approach, postoperative recovery is quicker and less painful. To monitor symptoms and menstrual cycles related to endometriosis, our app EndoVoice can be a helpful support tool.

Treatment Options

The treatment of endometriosis can include both pharmacological therapies and surgical interventions. Laparoscopy is one of the most common surgical options for addressing endometriosis. This minimally invasive technique involves identifying and removing endometriosis lesions through small incisions (5 to 10 mm) in the abdomen, through which the surgeon inserts a camera and the necessary surgical instruments. The laparoscopic approach reduces recovery time and postoperative pain compared to laparotomy, which is used only in rare cases of extensive lesions and adhesions.

Laparoscopic surgery aims to remove endometriotic cysts from the ovaries, eliminate superficial endometriosis lesions, and excise deep endometriosis nodules from abdominal organs while preserving their integrity. Additionally, laparoscopic treatment can help restore the pelvic anatomy, including the tubes and ovaries, in infertile women.

The Laparoscopy Process for Endometriosis

The goals of laparoscopic surgery for endometriosis are to remove endometriotic cysts from the ovaries, eliminate superficial endometriosis lesions, and excise deep endometriosis nodules from abdominal organs while preserving their integrity. Additionally, laparoscopic treatment can help restore the pelvic anatomy, including the tubes and ovaries, in infertile women.

Patients are usually discharged 24 hours after laparoscopic surgery, unless there are complications or special needs that require a longer observation period to ensure optimal recovery. In the first 24-48 hours, patients may experience pain in the small surgical wounds, at the base of the neck, and in the shoulder, especially on the right side. This pain is due to the gas used during the laparoscopic procedure, which is slightly irritating to the phrenic nerve and disappears within 48 hours after surgery.

Exercise, such as walking, is very useful in resuming metabolism and a sense of well-being. It is recommended to take at least two walks a day, gradually increasing the duration day by day. Even walking back and forth in a large house can contribute to movement and improved overall well-being.

The Importance of the Surgical Team's Experience

Surgery for endometriosis requires an experienced surgical team to ensure the best possible outcome. The experience of the team is crucial for three main objectives:

1. Symptom Resolution: The treatment should aim to eliminate or significantly reduce endometriosis symptoms, improving the patient's quality of life.
2. Fertility Preservation: The surgical team should be able to preserve the reproductive function of women with endometriosis, especially those who wish to have children in the future.
3. Reducing Recurrence Risk: The surgery should be performed with the goal of reducing the risk of endometriosis recurrence over time, avoiding further interventions and complications.

Specialized centers invest heavily in researching new techniques, such as the use of 3D laparoscopy, an innovative support for the surgeon's performance and for the integration of technology with professional skills.

Postoperative Care after Laparoscopy

After laparoscopic surgery for endometriosis, it is essential to understand the recovery process and recommendations for optimal healing. This section will discuss the observation period and discharge, postoperative pain management, and the importance of physical exercise in resuming metabolism and a sense of well-being.

Observation Period and Discharge

Under normal conditions, patients are discharged 24 hours after surgery. However, if there are complications or special needs, the observation period may be extended to ensure optimal recovery. In severe cases of deep endometriosis involving organs such as the intestines, ureters, and bladder, a dedicated multidisciplinary team is necessary, combining detailed preoperative assessment for this pathology.

Postoperative Pain and Pain Management

In the first 24-48 hours after surgery, patients may experience pain, not so much at the site of the small surgical wounds but at the base of the neck and shoulder, mainly on the right side. This pain is due to the gas used during the laparoscopic procedure, which is slightly irritating, especially to the phrenic nerve located under the diaphragm and radiates pain to the base of the neck. This symptom resolves on its own within 48 hours after surgery.

The Importance of Physical Exercise in Resuming Metabolism and Well-Being

Physical exercise is very useful in resuming metabolism and a sense of well-being. It is usually recommended to take at least two walks a day, gradually increasing the duration day by day. Some people report doing a lot of movement by walking back and forth in a large house. Maintaining an adequate level of physical activity helps improve blood circulation, reduce inflammation, and promote the healing process. Additionally, physical activity contributes to improving mood and sleep quality, important aspects for optimal recovery after surgery.

Innovative Techniques in Laparoscopy for Endometriosis

Specialized centers for laparoscopic surgery for endometriosis invest heavily in researching new techniques that can further improve the surgeon's performance and the integration of technology with professional skills. Among these innovations, two stand out for their importance:

1. The Use of 3D Laparoscopy: 3D laparoscopy provides an innovative support for the surgeon, offering a three-dimensional view of the anatomical structures during the procedure. This technology allows for greater precision and safety in identifying and removing endometriosis lesions, resulting in improved treatment quality and outcomes.
2. The Importance of Technological Integration with Professional Skills: The success of laparoscopic surgery for endometriosis depends not only on the technology used but also on the skills and experience of the surgical team. It is essential that the team consists of professionals specialized in treating endometriosis, capable of making the best use of the available technologies and adapting to new innovations in the field.

Choosing a specialized center and a surgical team with specific experience in endometriosis is crucial to ensure symptom resolution, future fertility preservation, and reduced risk of recurrence. Additionally, specialized centers constantly work to improve and refine the techniques used, aiming to offer patients increasingly effective and safe treatment.

1. New technologies in the surgical management of endometriosis
   Massimello, F., Di Spiezio Sardo, A., Bifulco, G., Angioni, S., & Cela, V. (2023). New technologies in the surgical management of endometriosis. AboutOpen, 10(1), 50–54. https://doi.org/10.33393/ao.2023.2547
2. Surgical Therapy of Endometriosis: Challenges and Controversies
   Rimbach, S., Ulrich, U., & Schweppe, K. W. (2013). Surgical Therapy of Endometriosis: Challenges and Controversies. PMC. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858988/
3. Robotic assisted versus laparoscopic surgery for deep endometriosis
   Castañeda, J., et al. (2024). Robotic assisted versus laparoscopic surgery for deep endometriosis. International Journal of Gynecological Cancer. https://doi.org/10.1007/s11701-024-01954-2
4. Laparoendoscopic single-site surgery for deep infiltrating endometriosis
   Zhang, S., Yu, H., Dong, Z., et al. (2023). Laparoendoscopic single-site surgery for deep infiltrating endometriosis based on retroperitoneal pelvic spaces anatomy: a retrospective study. Scientific Reports, 13, 10785. https://doi.org/10.1038/s41598-023-38034-8
5. Review on endometriosis surgery
   Horne, A.W., et al. (2021). Review on endometriosis surgery - Gynecology and Pelvic Medicine. Gynecology and Pelvic Medicine. Retrieved from https://gpm.amegroups.org/article/view/7261/html