Management of Severe Endometriosis (Laparoscopic Scarless)

Laparoscopic procedure has two advantages, laparoscopy acts as a diagnostic and treatment tool for endometriosis. Severe Endometriosis, a condition involving abnormal thickening and growth of endometrial tissue, outside the uterus(womb) , is well treated with this procedure.

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spilled endometrial cells in endometriosis

The innermost layer of the womb is called the endometrium. When the endometrial tissue abnormally grows anywhere outside the womb, its called endometriosis. This can be caused by backward flow of menstrual blood, genetic factors or any previous uterine surgery.

Endometriosis Management – Background

Laparoscopy is the primary procedure of choice for diagnosis and treatment of Endometriosis. It aims to relieve the patient by destroying the endometrial tissue that is occupying various parts of the abdominal cavity

How is Endometriosis treated Laparoscopically?

The surgeon makes a small incision at, or around, the belly button and lower portion of the belly (single incision if the patient opts for scarless procedure).

A laparoscope is placed into one incision, with a small camera attached to the tip.

At first the womb and surrounding organs are examined for presence of any abnormal tissue.

Once identified, specialized radiotherapy or laser instruments are inserted and the abnormal tissues are destroyed by burning with electrical or ultrasound energy.The endometrial tissue giving severe pain to the patient suffering from endometriosis are often stuck to the surrounding tissue ,they need to be separated from the normal tissue like the intestine and then to be burnt off.

Treatment window

Surgical treatment is usually advised so as to improve the woman’s fertility and also to provide relief from the symptoms. Moreover, heavy menstrual bleeding in these patients makes them susceptible to develop anemia. Early intervention can prevent this. However, very rarely does endometriosis leads to cancer.


Risk of infection is minimal. But one much watch out for persistant bleeding after surgery.

One must have regular follow up with the surgeon to make sure that the wound is healing well and to watch out for any recurrence

Laparoscopic management of Endometriosis FAQ

At some point of time during your menstrual cycle, a small number of cells lining your uterus (endometrium) found their way backwards through your tubes and got spilled into your belly (peritoneum). These cells ought to have gone downwards and out through the vegina. Unfortunately because they went in a reverse direction, they got embedded in your abdomen.

Yes, every month when your uterus wall responds to the hormonal changes, the similar cells that are embedded in your belly also respond to the hormones, swell up and get more blood drawn to them. This cause you to have pain and discomfort.

Yes, it is possible to switch off the hormones by using newer drugs like GnRH agonists (Gonadotropin Releasing Hormone agonists), which cut off the hormonal input to the cells that are making the mischief. However these hormonal manipulations are not always successful.

Well, in that case, a keyhole surgery option is there. You could have a laparoscopic ablation of the endometriosis spots, during which a keyhole incision allows us to look into your belly and see all these tiny clumps of endometriotic cells. Then we burn out these clumps and destroy these cells so that they do not cause pain or trouble to you again.

Yes, it is a delicate procedure as these endometreotic clumps often get adherent to the neighbouring tissues, causing lots of problems. So one gently does it the areas away from the other organs, lest from the damaged.

Certainly the endometrial clumps that gave you pain will safely be ablated. However if you have a tendency to go on forming the endometriosis, that could be recurrent disease over a period of time. Only after menopause, when all your hormone gets switched off, will this diseases cease to bother you. If your close to your menopause you could simply wait it out, allowing nature to do its job.

Laparoscopic management of Endometriosis Specialists

Dr. J. S. Rajkumar


M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)

Dr. Deepa Ganesh

Advance Laparoscopic Gynecologist, Robotic Surgeon & Cosmetic Gynecologist Surgeon

Dr. Jayalakshmi

Obstetrician and gynaecologist, Infertility specialist and Laparoscopic surgeon