Surgery for Endometriosis of the Bowel, Bladder, Ureter, and Diaphragm

Operative videolaparoscopy in general and videolaseroscopy using COz laser via operative channel of the laparoscope have revolutionized management of endometriosis in our practice. Adhesion formation is reduced and subsequent fertility rates exceed those obtained with laparotomy. The most complicated cases of endometriosis, including involvement of the rectovaginal septum, gastrointestinal and urinary tracts, and the diaphragm, can now be treated endoscopically by an experienced operative laparoscopist. Operative videolaparoscopy has gained rapid acceptance because it eliminates the need for laparotomy in treating endometriosis, and thereby allows rapid recovery, avoids hospital admission, creates fewer adhesions,I and provides better results.' Diagnostic laparoscopy has provided the gold standard for diagnosing endometriosis. Simultaneous diagnosis and treatment reduce the number of exposures to anesthesia, the risks of morbidity from repeat surgical procedures, preoperative patient apprehension, and costs. Videolaparoscopy and videolaseroscopy simulate microsurgical techniques and are ideally suited to the surgical treatment of endometriosis. A miniature video camera is attached to the eyepiece of the laparoscope, and the procedure is observed on a monitor, producing magnification of the surgical field comparable to surgical loupes and permitting the surgical assistants to participate actively. A C02 laser directly coupled to the operating channel of the laparoscope (Coherent, Palo Alto, CA) is used, in ultrapulse mode, to excise and vaporize, minimizing thermal damage and eliminating the need for suture material.3,4