LAPAROSCOPY FOR ENDOMETRIOSIS
Dr Cook has trained for several years at a Tertiary Referral Unit for Endometriosis (The Queen Elizabeth Hospital, Adelaide). This is a multidisciplinary unit involving Surgical Gynaecologists, Colo-Rectal Surgeons and Urologists. She was later appointed as a Visiting Medical Officer to this Unit.
During this time she performed numerous complex pelvic surgeries for endometriosis. Endometriosis can affect many sites which include the Reproductive Organs (Ovaries, Fallopian Tubes), the bowel (rectum, sigmoid colon, small bowel and appendix) and the bladder and ureter. The approach to endometriosis surgery can be complex and can require planning and liaison with other specialties. These longer procedures can be performed laparoscopically to minimise recovery time, minimise adhesions and minimise pain.
The main focus is on maximising fertility and addressing pain issues. This will be discussed with you at length prior to the planned procedure. Depending on the length of the procedure and the extent of surgery required, you may need to stay in hospital overnight or for a few days.
Endometriosis can also involve well demarcated deposits which are more superficial. These can be situated on the pelvic side walls, superficial rectum, superficial bladder, or the base of the pelvis (Pouch of Douglas). The ovaries can be adherent to other structures including the uterus or pelvic side wall. Adequate treatment of disease involves mobilising ovaries and excising all visible disease. Many surgeons may simply just burn the endometriosis. This is considered inadequate treatment of endometriosis.
The endometriotic deposits can extend deeper into underlying tissues. Full treatment of the disease involves excising (removing) all visible disease. This is the technique which Dr Cook uses.
Endometriosis can also have a very subtle appearance. Dr Cook has the experience to recognise and treat subtle or milder endometriosis.
The approach to endometriosis is individual for each woman. The surgical plan depends on the extent of disease (severe, moderate or mild). The surgical plan also depends on a woman’s symptoms and history
- Is fertility an issue?
- Are there bowel related symptoms?
- Is pain the main feature?
Recovery after Laparoscopy for Endometriosis
Most endometriosis surgery is a day stay procedure – you are discharged on the day of the procedure.
You will be given spare dressings from the hospital. The dressings which are on the four small cuts are water proof. They can be left intact for one week. It is fine to have a shower and get the dressings wet.
Most women will experience a sharp pain in the right shoulder tip or the base of the neck. This is referred pain from the gas being caught under the diaphragm. This will settle over the first 24 hours.
Most women will continue to experience a bloated sensation and sharp shooting sensations for the next 3-5 days. Feeling tired is common. You are advised to avoid swimming and intercourse for one week post procedure.
You can expect to take 3-5 days off work.
Dr Cook will call the day after the surgery to confirm that you are progressing well. She will review you 7-10 days post-operatively to monitor your progress, discuss the procedure and the pathology.