Endometriosis diagnosis: Ultrasound versus Laparoscopy
|It's a surgical endoscopic procedure to visualize the pelvic structures and
perform limited surgery.
||It is a procedure that records ultrasound waves as they are reflected from
The echoes are digitalized and converted into 2-d images (3-d on
experimentation) of the examined area.
- no solid food for eight hours before surgery
- no liquids for six hours before surgery
- physical examination and a history before surgery
- blood tests
- preoperative medication
- enema before surgery
- laxatives before surgery
- vaginal irrigations before surgery
- general anesthesia ultrasound before surgery
- partial bladder filling
Technique (very brief description)
- bladder catheterization
- 10 mm stab within the umbilicus
- needle insertion into the peritoneal cavity
- 2 liters of gas are introduced into the abdomen
- trocar and cannula insertion
- the trocar is replaced by the laparoscope
- a small suture is applied after finishing
- We apply a transducer to the skin over the area to examine.
monitor displays images from the body's structures.
surface is covered with a special gel
- postoperative pain (frequent)
- postoperative abdominal distension (frequent)
- small permanent scars (always)
- vaginal bleeding
- uterine perforation due to the uterine cannula insertion
- tubo-ovarian abscess and other pelvic infections
- wall abscesses
- internal bleeding
- urinary infections
- subcutaneous emphysema
- pre- and retroperitoneal emphysema
- epiploon and mediastinum emphysema
- respiratory problems
- heart attack
- bowel perforation
- cysts perforation
- vessel perforation
- stomach perforation
- previous abdominal surgery
- pelvic infections
- many cardiac and pulmonary diseases
- diaphragmatic hernia
Ultrasound reveals inner structural characteristics while laparoscopy just
shows structures' surface. So, ultrasound can detect adenomyosis, cervical
endometriosis, renal implants, etc., where lesions cannot be reached with the
Neither laparoscopy nor ultrasound let us do any histopathological diagnosis.
We need a biopsy to do it. Biopsy is not advisable because we could spread new
When we need to remove any cyst, we would advise to perform a sonogram before
the laparotomy rather than a laparoscopy. Risk and cost are different but
results are equivalent.
We could extend ultrasound examinations to other organs and structures like
pleura, bladder, kidney, liver, cervix, etc., and do it as often as needed.
Ultrasound let us detect extraperitoneal endometriosis implants and we can
safely do it as much as we want.
One of the main goals to practice laparoscopy has been to correct anatomy
distortions due to endometriosis. But endometriosis has systemic effects where
laparoscopy has nothing to do.
Let us think about this: laparoscopy lets us diagnose endometriosis;
bronchoscopy, bronchitis; cystoscopy, cystitis; endoscopy, gastritis, etc.,
however we do not use those procedures whenever we suspect those problems.
From Investigaciones Médicas # 48, by Gonzalo E. Díaz MD