Faculty Bibliography

After initial videolaseroscopy for the treatment of endometriosis-associated infertility, 157 patients underwent a second-look laparoscopy to evaluate and treat recurrence of disease and/or adhesions. The patients were divided into two groups. Group 1 consisted of 135 patients who underwent second-look laparoscopy for persistent infertility and/or recurrence of pain. Group 2 consisted of 22 patients who achieved pregnancy after initial surgery and underwent second-look laparoscopy for evaluation of ectopic pregnancy or in association with uterine evacuation for first trimester spontaneous abortion. Both groups of patients demonstrated a significant reduction in adhesion scores involving the ovaries, tubes, posterior cul-de-sac, anterior cul-de-sac, and omentum/bowel. Although the initial mean adhesion scores were similar for both groups, at second-look laparoscopy the mean adhesion scores were significantly lower for group 2, particularly for ovarian and tubal adhesions. None of the patients formed de novo adhesions. From these results we may conclude that videolaseroscopy: (1) is effective in reducing peritoneal adhesions; (2) is associated with a low frequency of postoperative adhesion recurrence; and (3) appears to completely avoid de novo adhesion formation.

In using laser laparoscopy for the treatment of endometriosis, protecting patients from inadvertent injury to pelvic structures adjacent to diseased tissue has been a major concern. In many cases, because of this risk, surgeons have stopped short of effecting thorough treatment of endometrial implants on the bowel, bladder, ureters, or great vessels. In a large series of patients, we have used hydrodissection successfully with few complications. We believe that the technique of hydrodissection is a safe and efficient method, permitting more thorough treatment of endometriosis that otherwise might be deemed untreatable by laser laparoscopy.