Laparoscopic laser treatment for endometriosis

Laparoscopic treatment of pelvic pain associated with minimal and mild endometriosis with use of the Helica Thermal Coagulator

OBJECTIVE

To investigate the clinical efficacy and safety of Helica Thermal Coagulator (TC) in the treatment of pelvic pain associated with minimal (stage I) and mild (stage II) endometriosis.

DESIGN

A clinical observational study.

SETTING

A referral center for laparoscopic treatment of endometriosis.

PATIENT(S)

Eighty-one women with pelvic pain symptoms associated with minimal and mild endometriosis diagnosed at laparoscopy.

INTERVENTION(S)

Helica TC to treat endometriotic lesions. The revised American Fertility Society (rAFS) classification was used to stage endometriosis. Pain symptoms and patient satisfaction were assessed subjectively at 3 and 6 months follow-up.

MAIN OUTCOME MEASURE(S)

Improvement or relief of pelvic pain symptoms, and intra- or postoperative complications.

RESULT(S)

A total of 79 women completed the study to 6 months follow-up. At 3 months, 59 (74.7%) women reported resolution and satisfactory improvement of symptoms, whereas 20 (25.3%) women continued to experience painful symptoms. At 6 months, 69 (87.4%) women reported resolution and satisfactory improvement of symptoms, whereas 9 (11.4%) women reported no changes and 1 (1.2%) woman experienced worsening symptoms. No significant differences were found between minimal and mild disease. No side effects or surgical complications occurred.

CONCLUSION(S)

Meaningful improvements and relief in clinical symptoms can be obtained with conservative laparoscopic surgery. Helica TC is a simple, effective, and safe device for the treatment of pelvic pain in women with stages I and II endometriosis. This approach requires further evaluation as part of randomized controlled trials.

Laser use and research in gastroenterology, gynecology, and general surgery: a status report

OBJECTIVE AND BACKGROUND DATA

Despite the burgeoning growth of laser applications in dermatology and plastic surgery, applications in other specialties have declined. Laser use in gastroenterology, general surgery, and gynecology was examined over the past 3 years. Future trends and opportunities are discussed.

METHODS

The MEDLINE database was scanned for scholarly publications between January 1, 1997, and January 1, 2000, and the number of publications in these specialties was determined. A questionnaire was distributed to 362 general surgeons from the American Society for Laser Medicine and Surgery (ASLMS) to assess current use and future needs. These results were compared to the actual cases performed at a laser center over the same period.

RESULTS

Of 3,331 publications, 21 (0.6%) covered gastroenterology (GE), general surgery (GS), gynecology (GYN), or laparoscopy (LAP). Keyword citations were 2 GS, 3 GYN, 7 GE, and 12 LAP. Questionnaire results and actual utilization were well correlated.

CONCLUSIONS

Lasers are being used in these specialties despite slow development of novel uses. Opportunities exist for future applications.