Learn more about endometriosis diagnosis

As I have been discussing for the past several weeks, endometriosis is a very common condition that can cause infertility. It can also cause many other symptoms, such as chronic pelvic pain, pain with intercourse, and pain with periods. This is why we focus on endometriosis diagnosis

In last week’s blog, I wrote about the tests that are available to diagnosis endometriosis. There is no accurate blood test to use when making the diagnosis. However, many radiologic studies, especially ultrasound, can be useful. This week I want to write about the only reliable way to definitively diagnose endometriosis.

Laparoscopy for endometriosis diagnosis

The most common technique to find endometriosis is laparoscopy. This outpatient surgical procedure involves passing a small surgical telescope through the patient’s belly button and into her abdomen.

The procedure generally takes anywhere from 30 minutes to 2 hours to perform. Once the patient is asleep, the doctor makes a 10 mm (less than ½ inch) incision in the belly button. There are actually several good reasons for this. First of all, this is the easiest place on your abdomen to hide a scar. Most importantly, it is one of the safest surgical sites on your abdominal wall.

The next steps

After making this small incision, the doctor passes a needle into the abdomen. He gently passes carbon dioxide gas through the needle to inflate the abdominal wall. Next, he introduces the telescope into the abdomen with a camera attached to the lens. This camera is hooked up to a large TV monitor so that everyone in the operating room can see exactly what the surgeon is seeing.

The surgeon then carefully examines all visible abdominal organs, including the liver, the gallbladder, the appendix, the diaphragm, and the intestine for any signs of abnormality.

The doctor then makes one or two 5mm incisions just below the top of the pubic line. These incisions are for the insertion of additional instruments that the surgeon needs to move the pelvic organs around, find, and eventually treat endometriosis. Once the surgeon confirms the presence of endometriosis, the next step is to treat it.

Two techniques for treating endometriosis

There are two basic techniques to surgically treat endometriosis: destruction or removal. Most surgeons choose to destroy the lesions, using a variety of different types of energy – such as light (laser), electricity (cautery), or sound (harmonic scalpel). Regardless of the method chosen, the basic purpose of the energy is to super-heat the endometriosis cells to the point that the material inside the cell is destroyed, killing the lesion. The same types of energy can be used to actually cut the lesions out. While it may make more sense to actually remove the lesions, the concern is that this removal may create more scar tissue (adhesions) than actually destroying the lesions. There are many scientific studies that have looked at this issue, but there is not yet any definitive conclusion as to which method is best.

The two main purposes of endometriosis surgery are to make a definitive diagnosis and, most importantly, to get rid of all of the lesions. This is often not the end of the story, however. Next week we will discuss what to do after surgery.