Laparoscopic surgical treatment of endometriosis

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Endometriosis is a common gynecological problem defined as the presence of functional endometrial glands and stroma outside the uterus, causing pain and infertility. It is reported that the prevalence varies between 30-70% in the population undergoing laparoscopy for infertility, and between 4.5-82% in laparoscopy performed for pelvic pain.

There are no signs or findings that provide a definitive diagnosis of endometriosis; The most ideal approach for definitive diagnosis is laproscopic imaging and biopsy. The aim of surgical treatment in patients with chronic pelvic pain due to endometriosis is the removal of all visible endometriotic foci and restoration of normal anatomy.

Another surgical treatment method that can be applied in these patients is pelvic denervation surgeries. These are mainly uterine nerve ablation and pre-sacral neurectomy.

Laparoscopic uterosacral nerve ablation (LUNA) is the destruction of efferent nerve fibers within the uterosacral ligaments to relieve pelvic pain originating from the uterus. Pre-sacral neurectomy is the destruction of nerve fibers coming from the uterus at the level of the superior hypogastric plexus.

It is an accepted fact that endometriosis has an important relationship with infertility. Today, surgical treatment and especially laparoscopic surgical approach in infertility associated with endometriosis have gained great importance. The ovaries and fallopian tubes are frequently affected by endometriosis, and as a result, the tubo-ovarian relationship is disrupted and the retention and transport of the ovum are adversely affected.

In addition, large endometriomas can disrupt the normal pelvic anatomy to such an extent that the ovum is not released and retained by the tubules.

There is a consensus that medical treatment has no place in the treatment of ovarian endometriomas, also called chocolate cysts, and surgical treatment is the gold standard. Laparoscopic cystectomy and laser or bipolar coagulation of the cyst wall, oophorectomy and adnexectomy are surgical approaches.

Laparoscopic surgery is also the most effective approach in the treatment of severe endometriosis. The development of endoscopic techniques allows complete removal of even deep infiltrative endometriotic lesions. Various energy modalities such as electricity and laser or sharp dissection can be used in the surgical treatment of endometriosis.

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