FAQs About Laparoscopic Excision Surgery for Endometriosis

Laparoscopic deep excision surgery is the gold standard for endometriosis treatment. Here are answers to some of the Frequently Asked Questions (FAQs).

What is laparoscopy?

Laparoscopy is a minimally-invasive procedure that allows the surgeon to visualize and operate on internal organs. The incisions from laparoscopy tend to be small, roughly 5-10 mm.

In laparoscopy, the surgeon insufflates the abdomen with carbon dioxide gas that pushes organs apart and provides room for surgery. The surgeon then uses an instrument called a laparoscope (a lighted camera) that relays video information to a monitor.

Laparoscopy can help diagnose and treat endometriosis.

What are the advantages of laparoscopy versus conventional surgery?

Since the incisions are small, laparoscopy leads to a better postoperative recovery and overall decreased risk of complications. Patients tend to have a shorter hospital stay, less pain, less risk of infection or scarring, and a quicker return to normal activities.

What is deep excision surgery?

Endometriosis affects not only pelvic structures but also other organs such as the small and large bowel, ureter/ kidneys, diaphragm, and thorax. When lesions are bigger than 5mm in depth, we say we are dealing with deep-infiltrating endometriosis (DIE).

Excision surgery allows for the complete removal of all lesions, both superficial and deep, with overall preservation of fertility and organ function. All lesions are sent for histological examination in order to definitively diagnose endometriosis.

Can laparoscopic deep excision surgery reduce the risk of symptom recurrence?

Endometriosis is a progressive disease. It is like an iceberg with only a small “peak” visible on the surface and the majority of the lesion deep inside the organ. Therefore, superficial removal of lesions may result in symptom recurrence since the actual lesion is still present underneath. Deep excision allows for the complete removal of the lesion resulting in longer-term symptom relief.

There are several ways to enhance the laparoscopic procedure for better visualization and isolation of endometriosis lesions. At Seckin Endometriosis Center, we can use the Da Vinci system that allows for improved 3D visualization. We also use our patented Aqua Blue Contrast^(TM) technique that changes the color of the peritoneum to expose lesions otherwise not visible by conventional laparoscopic inspection. We perform excision on a per-lesion basis for best results.

Does laparoscopic deep excision surgery allow fertility preservation?

Doctors at the Seckin Endometriosis Center are careful to preserve a patient’s fertility during surgery. Some of these conservative surgical methods include:

• Cold excision techniques without the use of laser ablation, electricity, or heat to maintain egg reserve
• Meticulous hemostasis to reduce scar tissue formation and organ damage

We do not advocate surgical techniques that result in surgical infertility such as oophorectomy or hysterectomy unless the patient desires this route of management and has all the necessary information on the risks and alternatives.

How long does the procedure take?

The exact duration of the procedure will depend on the number and extent of the lesions. Generally, laparoscopic surgery is an outpatient procedure and lasts anywhere from 1-3 hours. Patients will go home the same day or the next day.

Certain cases with multi-organ involvement and advanced disease will require more time and a longer stay in the hospital. If that is the case, the surgeons at the Seckin Endometriosis Center will involve an expert multidisciplinary team for a comprehensive approach to the patient’s needs and to improve the chances of a successful outcome.

What are the typical recovery times following laparoscopic deep excision surgery?

The effects of the general anesthesia may linger for the first 24 hours following surgery. You should have someone take you home and you might want to have someone help you around the house for the first few days. In most cases, you should back to your normal routine after 1-2 weeks.

Depending on your procedure, full recovery can take up to 2-6 weeks. Your doctor will guide you. Overall, you should be able to notice a gradual improvement in postoperative symptoms with each passing day.

What are some of the possible complications?

Laparoscopic deep excision surgery performed by a skilled surgeon is associated with very few postoperative complications.

You can expect fatigue, nausea, light vaginal bleeding, tenderness in the abdomen, and shoulder pain in the initial days following surgery. Usually, these symptoms disappear on their own.

There are small risks of wound infection, serious bleeding, blood clots, and injury to surrounding abdominal organs. You will receive instructions as to when to consult your doctor if necessary.

Can symptoms recur after the procedure?

In most cases when endometriosis is removed, pain improves. However, we cannot guarantee elimination of pain after surgery. Moreover, endometriosis is an estrogen-dominant disease and symptoms can recur over time. We believe excision surgery will lead to the most significant and longest lasting symptom reduction.

How effective is robotic-assisted laparoscopic deep excision surgery?

Though robotic-assisted laparoscopic excision is an exciting development, the platform comes with certain limitations. It does not offer haptic feedback or positional awareness to the surgeon. This means that the surgeon will not have the same ability to “feel” things such as fibrotic scar tissue. In robotic-assisted surgery, the surgeon has to sit away from the patient on a console, which can be limiting if their assistants are not experienced.

On the other hand, just like a handheld instrument, the robot is simply a tool. In the right hands, the robot can offer excellent results. It can combat the physical fatigue of conventional surgery and provide enhanced visualization.

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