Lasers in the surgical management of endometriosis

Endometriosis affects millions worldwide. Its symptoms include non-cyclical pelvic pain, dysmenorrhoea, dyspareunia and subfertility. The diagnosis is made by laparoscopy, and operative laparoscopic surgery for endometriosis is also possible. As well as conventional laparoscopic techniques, lasers have been used in laparoscopic surgery for the past two decades. The main advantages of lasers are that they allow surgeons to perform operative surgery via the minimally invasive approach of laparoscopy, the operation is largely bloodless, the injury to the surrounding tissue is highly controllable and postoperative adhesion formation has been shown to be no greater than with conventional methods. The CO₂ laser is the most precise laser for the division of adhesions and the accurate and safe vapourization of deposits of endometriosis. Several types of operative procedure to treat endometriosis have been carried out with the CO₂ laser laparoscope. This article provides an overview of laser physics, the effects on the tissues, the clinical use of lasers, the appearance of endometriotic lesions and the management of endometriosis of the peritoneum, ovary, rectovagina, ureter and bladder by laser laparoscopic techniques.