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Types of laparoscopic procedure //

Endometriosis

This is a condition in which cells similar to those lining the uterus (or womb) (endometrium) are found in areas outside the womb. Adenomyosis is a condition where endometriosis occurs in the actual muscle of the uterus. Common sites for endometriosis are the ovary, fallopian tubes, pelvic support structures, surface of the bowel and lining of the abdominal cavity (peritoneum). This tissue will undergo cyclical menstrual changes at the time of your periods, causing inflammation, scarring and eventually damage of adjacent structures. In the ovary this can lead to formation of blood-filled cysts ("chocolate cysts" or "endometrioma").

Endometriosis can present with a variety of symptoms. In many women, there are no obvious symptoms and the diagnosis is made during the course of investigations for other conditions. However many women who have the condition have some or a combination of the following symptoms, to varying degrees of severity: 

  • chronic pelvic pain

  • heavy periods (menorrhagia)

  • painful periods (dysmenorrhoea)

  • painful sexual intercourse (dyspareunia)

  • pain while opening your bowels (dyschaezia)

  • chronic tiredness/fatigue

  • subfertility

Diagnosis may be made by clinical examination or detection of ovarian chocolate cysts by ultrasound scan. However, the "gold-standard" is by laparoscopy due to characteristic visual findings (sometimes with biopsy of tissues). Occasionally the ovarian marker, serum CA125 may be elevated.

Treatment is directed towards relief of symptoms such as pain or heavy periods. It may also be needed in some cases of associated subfertility (discuss with subfertility expert). Hence it may be a combination of pain-killing drugs, hormonal treatment (including Mirena IUS) ("pseudo-pregnancy") or drugs to induce a temporary and reversible menopause.

If these are not successful, then surgery may be suggested. This can include destruction or excision of endometriosis deposits by keyhole-surgery; drainage of chocolate cysts or removal of an ovary and fallopian tube; division of adhesions in an attempt to restore pelvic anatomy distorted by the disease. Laparoscopic hysterectomy may be indicated if fertility is not an issue. In some cases, open surgery may be the only option. Not all gynaecologists are experienced in dealing with the condition.

Management of the disease is complex and may require multi-professional input (e.g. pain specialists, bowel surgeons). With particularly severe cases, referral to a regional endometriosis specialist/centre may be suggested.

Further information regarding endometriosis can be found through the following links (and in the "Useful Links" section of this website, including European Guidelines, the BSGE and the major charities/support groups).



 

 

 

 

 

 

 

 

 

 

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gynaecology, laparoscopy, hysterectomy, gynaecologists, keyhole surgery,northeast England, cyst, pain

Types of laparoscopic procedure (continued) //

Management of uterine fibroids

A fibroid (leiomyoma) is a benign "tumour" (i.e. swelling) arising from the smooth muscle layer (myometrium) of the uterus. They can be single or multiple and vary in size (e.g. pea-sized to filling the abdominal cavity). The malignant version of a fibroid (leiomyosarcoma) is extremely uncommon. Many fibroids do not cause any symptoms; some do grow; they may be associated with heavy menstruation, painful sexual intercourse, urinary symptoms and sometimes subfertility. Large fibroids can cause abdominal swelling. Often they are found incidentally during the course of investigations. Information is available from several sites.

 

 

 

 

 

 

 

 

 

 

Treatment depends on the size of the fibroid and symptoms caused and has varying success.

  1. Observation only

  2. Medication to improve symptoms such as heavy periods (including the Mirena IUS)

  3. Medication to shrink the fibroids (Gonadotrophin Releasing Hormone analogues; the new Progesterone-blocker Ulipristal Acetate, licensed for pre-surgical treatment)

  4. Uterine Artery Embolisation of Fibroids (UAEF) performed by an "interventional" radiologist to block the blood supply to the fibroid long-term and shrink it (further information below)

  5. Surgery - MYOMECTOMY - a method of removing or "shelling-out" the fibroid, leaving the uterus intact. This is not advisable in post-menopausal women, due to the risk of occult malignancy,

  6. Surgery - HYSTERECTOMY - various methods can be performed to remove the uterus and fibroid(s). However, laparoscopic surgery may not be feasible for very large fibroids.

 

 

 

 

Fibroids sutable for laparoscopic treatment

gynaecology

1) Uterus distorted by multiple fibroids. These may be found incidentally during ultrasound scan for symptoms such as pain or heavy periods. Surgical options include laparoscopic subtototal or total hysterectomy or myomectomy.

gynaecology, laparoscopy, hysterectomy, gynaecologists, keyhole surgery,northeast England, cyst, pain

2) Multiple large fibroids treated by open surgery. However, laparoscopic surgery is feasible for selected cases such as these. Pre-operative imaging (e.g. MRI Scan) and careful surgical planning will be required first.

gynaecology, laparoscopy, hysterectomy, gynaecologists, keyhole surgery,northeast England, cyst, pain

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