Page 17 - Journal of WALS

WJOLS

10.5005/jp-journals-10007-1123
A Comparative Study of the use of Different Energy Sources in Laparoscopic Management of Endometriosis-Associated Infertility
REVIEW ARTICLE
A Comparative Study of the use of Different

Energy Sources in Laparoscopic Management

of Endometriosis-Associated Infertility

1 Puneet K Kochhar, Pranay Ghosh
2
1 Assistant Professor, Department of Obstetrics and Gynecology, Lady Hardinge Medical College and Smt SK Hospital, New Delhi, India
2 Senior Resident, Department of Obstetrics and Gynecology, Lok Nayak Hospital, New Delhi, India

ABSTRACT
Background: Although there is controversy about the mechanism by which endometriosis causes infertility, laparoscopic treatment for
endometriosis-associated infertility is becoming popular. However, the optimal modality of energy sources used for dissection and
ablation in infertile women remains unexplored.
Objective: To study the best available evidence exploring the use of laparoscopic surgery in infertile women with endometriosis,
compare various available energy sources, and their effect on surgical outcome and probability of pregnancy.
Methods: A retrospective review of literature was done to explore the role of laparoscopic surgery and various energy sources in
managing endometriosis-associated infertility, using keywords—endometriosis, laparoscopy, infertility, electrosurgery and ultrasonic
energy.
Results: Laparoscopic treatment of endometriosis using mechanical or electrical technologies was proposed in the 1980s. Later, use
of lasers to vaporize endometriosis and to excise adhesions became popular. The invention of ultrasonic generator and tissue response
electrosurgical generator has revolutionized laparoscopic surgery for endometriosis.
Conclusion: No prospective randomized double-blind controlled trial has been conducted to date in this area. Current evidence suggests
that laparoscopic excision or ablation, either by electrocautery or laser, improves pregnancy rates. However, the impact of newer
energy sources and tissue dissection techniques in this field is yet to be explored.
Keywords: Endometriosis, Infertility, Laparoscopy, Electrosurgery, Ultrasonic energy.

INTRODUCTION and by de novo adhesion formation. However, endoscopic
surgery fulfils the important microsurgical principles of gentle
Endometriosis is a severely debilitating condition among women
of reproductive age group causing pain and infertility. It was handling of tissue, constant irrigation, meticulous hemostasis,
first described in 1860 by von Rokitansky. In 1925, Dr Sampson and precise tissue dissection. Operative techniques in
described endometriosis as, “presence of ectopic tissue which endometriosis are dependent upon the type and extent of the
possesses the histological structure and function of uterine lesions. Various technologies can be used, of which
2
mucosa”. 1 hydrodissection and the CO laser appear to be the most
6,7
In the recent years, there has been a significant increase in efficient tool.
the number of infertile patients with endometriosis. It is not This review explores the available evidence addressing the
clear whether this represents an increase, or simply reflects the use of laparoscopic surgery in infertile women with
more frequent use of laparoscopy. The incidence is 40 to 60% endometriosis, and compares various available energy sources
in women with dysmenorrhea and 20 to 30% in women with and their effect on surgical outcome and probability of
subfertility. 2-4 pregnancy.
Endometriosis is believed to cause infertility based on a
higher prevalence of the disease in subfertile women (up to METHODOLOGY
5
50%) compared with women of proven fertility (5-10%). In the This study entailed a retrospective review of literature using all
current era, endometriosis is known to account for 10 to 15% of available English databases, Cochrane register and Medline
the cases of infertility. articles, which explored the role of laparoscopic surgery and
The goal of treating pelvic and peritoneal endometriosis is various energy sources in managing endometriosis-associated
to destroy the implants in the most effective and least traumatic infertility, using keywords—endometriosis, laparoscopy,
way to minimize the formation of postoperative adhesions. infertility, electrosurgery and ultrasonic energy. A hand
Reproductive pelvic surgery procedures performed by searching of relevant journals and conference proceedings was
laparotomy are frequently complicated by adhesion reformation also done.

World Journal of Laparoscopic Surgery, May-August 2011;4(2):89-95 89