LAPAROSCOPY: ONE WAY TO DIAGNOSE ENDOMETRIOSIS
Laparoscopy is a fairly simple procedure that yields excellent results when done correctly.
When the modern and very versatile laparoscope was invented in Sweden about twenty years ago, it was the culmination of a long medical quest to look into and observe the living human body. It is fiber optics, or cold light, that made the laparoscope possible and practical to make. The laparoscope is a long rigid tube equipped with thin glass fibers (along which light travels to “spotlight” organs) and a periscopelike attachment that allows doctors to see into the pelvis and
abdomen. Lightweight and flexible (it can be maneuvered into various positions), the laparoscope not only makes it possible to see into the abdominal cavity but can also be used along with surgical instruments, if necessary, for further medical procedures. Therefore, laparoscopy—the technique that employs the tool—can be performed for either a diagnostic or a therapeutic procedure.
Laparoscopy, it has been found, benefits women with either problem (or both) in this way: since the technique allows a visual inspection of pelvic organs and subsequent diagnosis, it can avert major surgery. For patients with persistently misdiagnosed and undiagnosed pelvic pain, it may finally provide an answer. Doctors can look for signs of endometriosis in its varying stages—from a reddened inflamed appearance of organs to the existence of pepper spots to greater gluelike adhesions to more massive chocolate cysts and tumors. Laparoscopy allows the sighting of such conditions, but remember, it is surgery, though on a lesser scale.
Currently, laparoscopy, familiarly called the Band-Aid procedure, is considered by most doctors to be the only absolute method of detection for endometriosis. Would that it were absolute! As it turns out, laparoscopy is only as good as the practitioner doing the viewing and diagnosing. Endometriosis is sometimes difficult to identify. Endometriosis that is growing on the ligaments behind the uterus or hidden inside tissue can be difficult to spot. To locate such growths, a doctor needs skill and dexterity. The scope must be positioned well below the uterus to catch sight of hard-to-see implants.
Unfortunately, some physicians either are inexperienced or may not fully understand the procedure or the female anatomy, or both. Because of these shortcomings, a number of complications can occur during laparoscopy. If it is not conducted under proper sterile techniques, the procedure can lead to abdominal and pelvic infections. Internal bleeding is a possibility from an incorrectly placed laparoscope; the device can lacerate, perforate, or traumatize the organs. Laparoscopy can cause serious problems like these in the hands of an unskilled physician. Then again, he may be knowledgeable enough about the procedure itself, but lacking as a diagnostician.
Cases of women undergoing this procedure and being told they are free of the disease when, in fact, they are not are not uncommon. One reason, as mentioned, is the surgeon’s skill in detecting it. Another is that the endometriosis may be microscopic and not visible to the eye. This means that evidence of the disease may not be revealed with laparoscopy, although it exists. Otherwise, the disease is officially described at four different stages of severity (I, II, III, and IV), as recently classified by the American Fertility Society.
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