Introduction to laparoscopy

Initial laparoscopy is sometimes required to make a definite diagnosis of endometriosis (see Indications for referral in endometriosis); in other cases, management is based on a presumed clinical diagnosis. Ideally, laparoscopy should be performed by a gynaecologist who is an expert in endometriosis surgery. Some deposits may be excised or ablated during an initial diagnostic laparoscopy. Subsequent treatment should favour medical management rather than laparoscopic surgery, to avoid scarring from repeated procedures, especially if the individual wants to conceive.

Further excisions or ablations are indicated to treat:

• infertility
• recurrent endometriosis (despite ongoing medical and/or previous surgical treatment)
• complications of endometriosis (eg bowel adhesions)
• deep endometriosis involving the bowel, bladder or ureter.