Chapter 68: Laparoscopic Laser Vaporization of Endometrial Implants

Thomas W Hilgers

Endometriosis · Surgical Treatment

Chapter 68: Laparoscopic Laser Vaporization of Endometrial Implants

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 933-944, 2004

RRM Academy Synopsis

KTP laser fiber outlines endometriosis for removal or vaporization

In a 2004 textbook chapter on NaProTECHNOLOGY surgery, a KTP laser fiber outlines endometriosis implants at laparoscopy for removal or vaporization. The author prefers KTP or Nd:YAG lasers for this work, and the chapter reviews laser safety.

Key Findings

Laser light has a single wave length and a single parallel direction, which makes the tissue effect more predictable and gives the surgeon better accuracy.
Surgical dosage combines power, time and area. Low dosages coagulate tissue, and high dosages vaporize or cut it, depending on the area.
Surgical NaProTECHNOLOGY uses the CO2 laser at laparotomy, and the KTP and Nd:YAG lasers at laparoscopy. The Nd:YAG laser is generally considered the better coagulator; the CO2 laser produces the least necrosis.
In the illustrated technique, a KTP laser fiber outlines the lesion with a circumferential peritoneal incision, and the tissue is removed for pathology; in other cases the lesion may be vaporized.
Only fairly superficial ovarian endometriosis is vaporized laparoscopically, because exposed ovarian tissue is very adhesiogenic; the chapter describes a small adhesion barrier patch over the defect as prudent.

RRM Context

Surgical NaProTECHNOLOGY, developed by Dr. Thomas W. Hilgers, aims to treat the underlying disease and to avoid damaging adhesions. That aim guides the chapter's choice of laparoscopy or laparotomy for each patient and lesion type, and its adhesion prevention after laser work on the ovary and peritoneum. Restorative surgery for endometriosis seeks to remove disease while preserving surrounding anatomy and ovarian tissue. Excision sends the removed tissue to pathology, which can confirm the diagnosis, as the chapter's circumferential-incision examples show.

Our editorial summary of this paper, not the article's abstract.

Abstract

CO2 laser vaporization technique for peritoneal and superficial ovarian endometriotic implants is described in detail, covering power density settings, spot size, vaporization depth control, and recognition of adequate treatment endpoints. Complete destruction of all visible implants, facilitated by the near-contact survey, is necessary to achieve durable symptom relief and improvement in fertility outcomes.

Topics

Endometriosis › Surgical Treatment › Fertility Sparing Technique · Reproductive Surgery › Laparoscopy › Technique · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 68: Laparoscopic Laser Vaporization of Endometrial Implants

KTP laser fiber outlines endometriosis for removal or vaporization

Key Findings

RRM Context

Abstract

Topics

By this author

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