Though research into the area of non-invasive diagnosis continues, currently at this time an accurate diagnosis of Endometriosis can only be obtained surgically. Most commonly, this surgery is done via a procedure called laparoscopy.
What is a laparoscopy?
Laparoscopy is a Minimally Invasive Surgery (MIS) that currently provides the most accurate diagnosis of endometriosis through the least invasive surgical procedure. Laparoscopic surgery is the most advanced treatment for endometriosis, because it offers permanent removal of the endometriomas and offers the greatest pain relief. This surgery includes the excision of the endometriomas, and the scar tissue and adhesions that develop.
What happens during a laparoscopy?
A laparoscopy allows for a doctor to visualize your abdominal-pelvic region via an instrument known as a laparoscope, a thin, lighted instrument that is fitted with a telescopic lens, light sources and a miniature video camera.
During laparoscopy, organs will be manipulated for viewing, biopsies will be taken, the diagnosis of endometriosis will be confirmed, and removal of the disease will be performed.
The surgery begins with a small (approximately ½ inch long) incision being made through the navel, into which a needle is inserted. For better visualization inside the abdominal cavity, carbon dioxide gas is injected into the abdomen through this needle. This colorless, odorless gas distends the abdominal cavity so that the organs will lift and separate to allow the laparoscope to be safely inserted. Additional similar incisions will likely be made in the pubic hairline and/or over the ovaries, through which surgical instruments can be inserted.
Once all the instruments have been strategically inserted, Dr. Seckin will begin to explore the organs and surrounding tissue, take biopsy samples, and then remove the endometriosis and adhesions. These instruments are an extension of the surgeon’s hands, so the best results are obtained when you use the most experienced surgeon.
The first step of laparoscopic surgery is diagnosing. Dr. Seckin will systematically visually evaluate each section inside the abdominal and pelvic cavity. The peritoneum (the lining inside the body) covers the pelvis, bladder, bowel, abdominal cavity, appendix and diaphragm (bottom of the lung). It must be inspected systematically and meticulously for endometriosis, one layer at a time, so that no area is missed.
He will then take biopsies of areas that look suspicious for the disease. A pathologist than examines the tissue and gives the feedback to Dr. Seckin. Tissue is also taken and sent out for more extensive examination.
There are three basic surgical methods that are used today for treating endometriosis and they include: excision, vaporization and ablation.
Excision, which is Dr. Seckin’s method of treatment, involves cutting out the disease while preserving the healthy portions of the affected organs. Wide excision removes all of the endometriosis including the microscopic endometriosis. Studies show this is the most effective surgical means of treating endometriosis and offers the longest symptomatic relief.
Vaporization, often referred to as the EVE Procedure™ stands for Excision and Vaporization of Endometriosis. The procedure involves the destruction of implants by instant boiling of the cellular water with a high-power laser of electrosurgical tool. This procedure is considered superficial and has a high recurrence rate. It often prevents adequate retrieval of tissue samples, due to the destructive nature of the technique. Laparoscopic helium plasma coagulation of endometriosis is another way of vaporizing endometrial deposits. Using a laparoscope, an ionized beam of helium gas is directed at endometrial deposits to destroy the affected tissue. It involves desecration of implants by heating and drying the affected tissue(s). Studies have shown, and Dr. Seckin agrees, that this method has a high recurrence rate for the disease.
Ablation of endometriosis involves burning away the surface of the lesion by using a high-energy heat source; typically, a laser. This should not be confused with the procedure known as endometrial ablation (e.g., Novasure®). Endometrial ablation is performed for the treatment of abnormally heavy bleeding, wherein the endometrium, the thin layer lining the uterus, is destroyed. This lessens or altogether stops the menstrual flow. Endometrial ablation is not a treatment for endometriosis.
Fulguration involves burning away the implants with a spark of electricity from an electrosurgical tool. Again, studies are showing that there is a high recurrence of the disease with this method. In addition to the laser and other surgical tools, some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as the energy source.
Following the surgery
Once the surgeon is confident that all procedures have been performed and adequate samples have been taken, all instruments will be withdrawn. The abdomen is deflated and incisions closed, usually with a few dissolvable stitches covered by band-aids. Scarring is generally minor.
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