CO2 laser laparoscopy. A potential alternative to danazol in the treatment of stage I and II endometriosis.

Abstract

Most clinicians currently agree that stage I and II pelvic endometriosis, as determined by the American Fertility Society classification, is best treated with danazol when there are no significant peritubal or periovarian adhesions. This therapy offers excellent pregnancy rates and avoids the risk of pelvic adhesions, which can occur after conservative laparotomy. However, the significant disadvantages of danazol include androgenic side effects, breakthrough bleeding, prolonged treatment time and high cost. It is not unheard of for a patient to choose laparotomy over danazol because of these disadvantages. An ideal form of therapy would avoid these disadvantages and be accessible at diagnostic laparoscopy, when the disease is detected. We have worked with such a treatment, the CO2 laser, for one year. With the CO2 laser adapted to the operating laparoscope we have treated stage I and II pelvic endometriosis at the time of the original diagnostic laparoscopy. Due to the precise control the operator has over the laser, implants on the peritoneum over the bladder and bowel or near the ureters can be treated safely. There is little danger of damaging adjacent structures, as one might experience with electrocautery. Ovarian endometriomas of less than 1 cm and mild adhesions can also be removed safely by tissue vaporization.