The LASER used pelviscopically provides a precise and bloodless technique for the management of endometriosis. Adequate management of endometriosis by pelviscopy include 3 steps; a pelviscopic diagnosis with peritoneal fluid sampling for
cytologic
examination and biopsies of implants and of peritoneum to assure a correct diagnosis, a pelviscopic evaluation of extending with AFS scoring in order to classify the severity of the disease, and a pelviscopic treatment with the removal of ovarian
endometrioma and ovarian cyst, adhesiolysis of adnexal adhesion, treatment of endometrial implants, peritoneal washing, hemostasia, peritoneal lavage and PAVH (pelviscopically assisted vaginal hysterectomy). These surgical procedures are very
easily
performed by Nd: YAG LASER under the pelviscopy. The hospital stay was relatively short and complications were a few with usually minor complication. And there was no injury on morbidity caused by LASER energy.
There are four main advantages in pelviscopic treatment with LASER; Firstly, as endometriosis is often asymptomatic and discovered only during pelviscopic inspection of the pelvis, diagnosis and treatment can be achieved during the same
procedures.
Second, treatment of endometriomas and of adhesions is not possible with medical treatment but is now effective using pelviscopy or surgical procedures. Third, endometriosis often induces severe peritoneal inflammation, so a procedure such as
pelviscopic surgery which causes minimal peritoneal injury when compared with surgical procedures performed by laparotomy, And lastly, pelviscopic procedures are easily achieved second look operation.
We studied 116 endometriosis patients who visited to OB-GY department of Yongsan hospital, Chung-Ang university medical college from Augus 1989 to July 1992 retrospectively. We achieved the results of that the pain was improved in 81% (74/79) of
patients and adhesion, endometrial implants and ovarian endometrioma were improved at second look operation in 80.1%(21/26), 69.2%(18/26) and 84.6%(22/26)respectively. Of the 36 infertile patients, we had attempted pregnancy at 18 patients after
operation and we detected 7(38.9%) pregnancies.
As a conclusion that the nearly all endometriosis can be treated pelviscopically LASER and postoperative hormonal treatment.
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