An investigation of the surgical treatment of endometriosis

Background The surgical treatment of endometriosis has developed in recent decades alongside the development of laparoscopic surgery and has been directed towards understanding and improving the outcomes related to fertility and pain. Little is known about the techniques and instruments actually used by gynaecological laparoscopic surgeons in relation to the evidence available. Furthermore, it is still not clear whether vaporisation or ablation of lesions is as efficacious as excision. Objectives Firstly, to internationally survey the views of gynaecologists to find out how they surgically treat endometriosis. Secondly, to determine whether excision or vaporisation is the optimal surgical technique for minimal to moderate endometriosis. Methods A 34 question web-based survey was constructed, piloted and sent out by email to the members of the BSGE, ESGE and AAGL to get a snapshot of current practice. A randomised blinded trial of harmonic scalpel excision versus carbon dioxide laser vaporisation for the treatment of minimal to moderate endometriosis in women with pelvic pain was carried out, using as a primary outcome measure EHP-30 Core pain domain, and secondary outcomes for VAS scores for dysmenorrhoea, ... (continues)