Surgery

What is a laparoscopy?

The word laparoscopic comes from two Greek words. The first is lapara, which means "the soft parts of the body between the rib margins and hips," or, more simply, the "flank or loin." The other Greek root is skopein, which means "to see or view or examine." The word skopein has become 'scope' in English over time.

The term laparoscopy refers to a type of surgery in which small cuts are made in the tummy, through which a laparoscope (the small camera with a light ) and other instruments can be placed to allow structures within the abdomen and pelvis to be seen. A variety of probes or other instruments can also be pushed through these small incisions in the skin. In this way, a number of surgical procedures can be performed without the need for a large surgical incision. This is also why laparoscopic surgery is described as "minimally invasive" - the ports (incisions) are only 0.5cm to 1cm wide.

Endo patients often talk about having a "lap", which is short for laparoscopy. But looking around with the laparoscope is just one part of surgery - during a surgery, endometriosis disease should be removed at the same time.

Each time a woman with endometriosis has a lap, it can affect her ovarian reserves. This means how many eggs you have. "Look and see laps" with no disease being removed are discouraged for this reason.

Although with a quality surgery, a woman's ovarian reserves should recover in the months following excision surgery; repeat ablative surgeries are strongly discouraged as they can cause fertility problems within themselves due to causing further adhesions, scar tissue and not actually removing the endometriosis disease.

Excision surgery testimonials

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What kind of surgeries are there for endometriosis?

Although many endometriosis surgeons around the world can perform minimally invasive surgery, not all surgeons are expertly trained and experienced in removing all endometriosis disease (both visible and invisible/microscopic disease) - which should not be in the pelvis in the first place.

The current gold standard treatment for endometriosis is complete removal of the lesions, diseased areas and any endometriomas by excision. This means the disease is cut out by the roots. You can think about endometriosis like an iceberg. Often there is hidden disease underneath, and this is why ablation - the burning off of the tops of the lesions - does not work.

A hysterectomy cannot treat or cure endometriosis, as by definition it occurs outside of the uterus. However, women with adenomyosis may find relief from their uterine pain after a hysterectomy. If a woman does choose to have a hysterectomy, all endometriosis should be excised at the same time.

To learn more about adenomyosis follow the links in the resource page.

What is the difference between excision and ablation?

Put simply, excision cuts out the disease completely, and ablation burns it off. Excision can bring long term relief because it actually removes all the disease from the pelvis (and beyond), so it's considered currently the closest thing we have to a "cure".

Should I travel for surgery? Who should I see?

If an experienced endometriosis excision expert is not available in your country, you may wish to travel for surgery. This is not a decision to be taken lightly but women who do, consider it worthwhile due to the pain relief they now experience and it may be better financial value in the long run if no further surgeries are needed.

You can find names of surgeons in your country (or close to your country) by joining the Nancy's Nook closed Facebook group, where you will also find lots of other useful resources.

Also have a look in the Resources section on this website, which lists 3 surgeons in England and two in Europe.

You should see a surgeon who is not only skilled but also someone who truly listens to you and puts you at ease. Every case of endometriosis is individual and it's important to find a doctor who is fully understanding of this fact.

Some women find that when they return to Northern Ireland, very little help is available to them if there are any post-op complications. It's really important to have a consultant you can phone if this happens, and an understanding GP at home.

Should I have a laparoscopy? Can MRIs or ultrasounds diagnose endo?

A laparoscopy combined with tissue samples extracted via excision and sent to the pathology lab to be tested for endometriosis, is the only way to be formally diagnosed.

If ablation is used, then there will be no tissue to send to the lab as the area will be burnt away (superficially).

MRIs and transvaginal ultrasounds (using the transducer wand) have important roles in helping a surgeon and their team to "map for surgery". This means they'll know better the areas to look in for endometriosis when they put the little camera in. However, for many women their MRIs and Ultrasounds are "negative" yet they still had endometriosis found at surgery. Be very wary of any doctor who says that no endometriosis was seen during your MRI and/or ultrasound(s), and therefore you "don't have endo". Seek a second opinion. MRIs and ultrasounds done to specific protocols and interpreted by a sonographer who is experienced in identifying endometriosis can actually reveal a lot about where endometriosis is in a patient's body as well as any other conditions they might have e.g. adenomyosis, Crohn's - but they are not 100% accurate.

How soon after surgery should I feel better?

Those having ablation surgery often feel better for a few months, then symptoms and pain quickly return, sometimes worse than before.

After excision surgery it could take around 12 weeks to feel fully better, as the tissues inside the body heal. Each person is different and depending on health status going into surgery, some may feel better quicker than others.

If you are having extreme pain in the weeks after excision surgery it's important to check in with your consultant or GP immediately incase you have an infection or post-op complication. Do not delay in seeking medical attention.

With thanks to FTWW for permission to use this image.

I don't feel better after excision

There are many reasons why a patient may not feel 100% better after quality excision. Here are just a few:

- the patient also has adenomyosis, so they continue to have a "bowling ball in the pelvis" feeling and very heavy bleeding/long periods/flooding during periods

- the patient also has Crohn's or ulcerative colitis

- the patient also has an auto immune disorder such as lupus which is causing them to be exceptionally tired

- the patient has ovarian remnant syndrome (read more about this here)

Keep your consultant updated about your pain and symptoms and don't feel bad or guilty that you're not better yet. Endometriosis is a complex, long term disease so it's realistic to know that it takes time to feel better.

To be sure you had excision surgery you need to check your post-operative notes. They should state the word excision and from what areas endometriosis was excised from. You should also receive the pathology report showing that the endometriosis which was cut out was sent to the lab to confirm it was definitely endometriosis. If you have not received any hospital records, notes or a follow up from your surgeon this is a serious red flag and you should request them immediately under the GDPR protocol.

What should I pack in my hospital bag?

Dressing gown
Slide on slippers (will be difficult to bend down)
Comfy pyjamas with a smooth waistband that will not dig in
Comfy knickers
A bra that is easy to put on and take off yourself
Big loose t-shirt, zip-up hoodie, jogging bottoms and a squishy cushion to place between your lower abdomen and the seatbelt on your way home
Your own period pads if you prefer them
Headphones, preferably noise cancelling incase the ward is noisy at night
Notebook & pen
Toiletries; especially moisturiser, hand cream and lipbalm
Face cloths so you can wash your face
Face/baby wipes incase you want to freshen up but can't get out of bed e.g. Water Wipes
Phone charger, preferably one with a very long cord
Some snacks and some herbal tea bags
Boiled sweets, if you like them

Things the hospital will give you:

Compression socks
Period pads for any vaginal bleeding after surgery