Skip to main content
SpringerLink
Log in

Laser laparoscopy—indications, techniques and results

  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

The laser has revolutionized the role of gynaecological laparoscopy from a purely diagnostic one to that of first line operative intervention. Since the first report from Professor Bruhat of the use of the carbon dioxide (CO2) laser at laparoscopy in 1979, there have been several advances made both in the type of laser used in gynaecology and the techniques employed.

Initially used for the treatment of endometriosis and adhesions, the laser has been used in such diverse areas as treatment of polycystic ovarian disease, neosalpingostomies and myomectomies.

Another advantage of laser laparoscopy is that it can often lead to a complete withdrawal from, or marked reduction in medication requirements, particularly when used in the treatment for dysmenorrhoea, endometriosis and polycystic ovarian disease.

Today, there are few gynaecological procedures that cannot be performed laparoscopically, there-by avoiding all the sequelae associated with laparotomy.

The laser as a surgical tool has been at the forefront of minimally invasive surgery. Minimal invasive surgical techniques not only reduce the length of stay in hospital, a crucial factor in today's economic climate, but also reduce post-operative morbidity, decrease the length of convalescence and allow the woman to return more quickly to her normal routine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sampson JA. Perforating hemorrhagic cysts of ovary.Arch Surg 1921,3:245–323

    Google Scholar 

  2. Barbieri RL, Kistner RW. Medical management of endometriosis. In: Raynaud J-P, Ojasoo T, Martini L (eds). New York: Raven, 1984:27–40

    Google Scholar 

  3. Barbieri RL, Evans S, Kistner RW. Danazol in the treatment of endometriosis: analysis of 100 cases with a four year follow-up.Fertil Steril 1979,37:737–46

    Google Scholar 

  4. Shaw RW, Matta W. Reversible pituitary ovarian suppression induced by an LHRH analogue in the treatment of endometriosis—comparison of two dose regimens.Clin Reprod Fertil 1986,4:329–36

    PubMed  CAS  Google Scholar 

  5. Shaw RW. LHRH analogues in the treatment of endometriosis—comparative results with other treatments. In: Healy D (ed)Baillière's Clinical Obstetrics and Gynaecology, Vol2(3). London: Baillière Tindall, 1988:659–75

    Google Scholar 

  6. Jelley R, Magill P. The effect of LHRH agonist therapy in the treatment of endometriosis (English experience).Prog Clin Biol Res 1986,225:227–38

    PubMed  CAS  Google Scholar 

  7. Olive DL, Haney AF. Endometriosis-associated infertility: a critical review of therapeutic approaches.Obstet Gynecol Surv 1986,41:538–55

    Article  PubMed  CAS  Google Scholar 

  8. Seibel MM, Berber MJ, Weinstein FG, Taymor ML. The effectiveness of Danazol on subsequent fertility in minimal endometriosis.Fertil Steril 1982,38:534–537

    PubMed  CAS  Google Scholar 

  9. Evers J. The second look laparoscopy for evaluation of endometriosis should not be performed during ovarian suppression.Fertil Steril 1987,47:502–504

    PubMed  CAS  Google Scholar 

  10. Allen JM, Stein DS, Shingleton HM. Regeneration of cervical epithelium after laser vaporisation.Obstet Gynecol 1983,62:700–4

    PubMed  CAS  Google Scholar 

  11. Bruhat MA, Mage C, Manhes M. Use of the carbondioxide laser via laparoscopy. In: Kaplan I (ed)Laser Surgery, Proceedings of the Third Congress of the International Society for Laser Surgery, Vol.III. Tel Aviv: International Society for Laser Surgery, 1979:235–8

    Google Scholar 

  12. Tadir Y, Kaplan I, Zuckerman K. A second puncture probe for laser laparoscopy. In: Atsumi K, Nimsakul N (eds)Laser Surgery, Proceedings of the Fourth Congress of the International Society for Laser Surgery, Vol.IV. Tel Aviv: International Society for Laser Surgery, 1979:25–6

    Google Scholar 

  13. Daniell JF, Brown DH. Carbon dioxide laser laparoscopy in experimental animals and humans.Obstet Gynecol 1982,59:761–4

    PubMed  CAS  Google Scholar 

  14. Feste JR. Laser laparoscopy, a new modality.J Reprod Med 1985,30:413–17

    PubMed  CAS  Google Scholar 

  15. Martin DC. Carbon dioxide laser laparoscopy for the treatment of endometriosis associated with infertility.J Reprod Med 1985,30:409–12

    PubMed  CAS  Google Scholar 

  16. Sutton CJG. Initial experience with the carbon dioxide laser laparoscopy.Lasers Med Sci 1985,1:25–31

    Article  Google Scholar 

  17. Donnez J. Carbon dioxide laser laparoscopy in infertile women with endometriosis and adnexal adhesions.Fertil Steril 1987,48:390–4

    PubMed  CAS  Google Scholar 

  18. Nezhat C, Crowgey SR, Garrison CP. Surgical treatment of endometriosis via laser laparoscopy.Fertil Steril 1986,45:778–83

    PubMed  CAS  Google Scholar 

  19. Sutton CJG: CO2 laser laparoscopy in endometriosis. In: Sutton CJG (ed)Baillière's Clinical Obstetrics and Gynaecology, Vol3. London: Baillière Tindall, 1989:499–523

    Google Scholar 

  20. Rock JA, Dubin NH, Ghodgaonkar RB et al. Cul-desac fluid in women with endometriosis: fluid volume and prostanoid concentrations during the proliferative phase of the cycle—days 8–12.Fertil Steril 1982,35:747–50

    Google Scholar 

  21. Halme J, Becker S, Hammond MG, Ray S. Pelvic macrophages in normal and infertile women: the role of patent tubes.Am J Obstet Gynecol 1983,142:890–5

    Google Scholar 

  22. Fakih H, Baggett B, Holtz G et al. Interleukin-1: a possible role in the infertility associated with endometriosis.Fertil Steril 1987,47:213–7

    PubMed  CAS  Google Scholar 

  23. Weed JC, Arquembourg PC. Endometriosis: can it produce an autoimmune response resulting in infertility?Clin Obstet Gynecol 1980,23:885–93

    PubMed  CAS  Google Scholar 

  24. Badawy SZA, Cuenca V, Stitzel A et al. Autoimmune phenomenon in infertile patients with endometriosis.Obstet Gynecol 1984,63:271–5

    PubMed  CAS  Google Scholar 

  25. Jansen R, Russell P. Nonpigmented endometriosis: Clinical, laparoscopic and pathologic definition.Am J Obstet Gynecol 1986,155:1154–9

    PubMed  CAS  Google Scholar 

  26. Chatman DL. Pelvic peritoneal defects and endometriosis: Allen-Masters syndrome revisited.Fertil Steril 1981,36:751–6

    PubMed  CAS  Google Scholar 

  27. Nisolle-Pochet M, Paindevine B, Bourdon A et al. Histologic study of peritoneal endometriosis in infertile women.Fertil Steril 1990,53:984–8

    Google Scholar 

  28. Redwine DB. Age-related evolution in colour appearance of endometriosis.Fertil Steril 1987,48:1062–3

    PubMed  CAS  Google Scholar 

  29. Vernon MW, Beard JS, Graves K, Wilson EA. Classification of endometriotic implants by morphologic appearance and capacity to synthesise prostaglandin F.Fertil Steril 1986,46:801–6

    PubMed  CAS  Google Scholar 

  30. Cornillie FJ, Oosterlynck D, Lauweryns JM, Konickx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance.Fertil Steril 1990,54:978–83

    Google Scholar 

  31. Absten GT. The physics of light and lasers. In: Sutton CJG (ed)Lasers in Gynaecology. London: Chapman & Hall Medical, 1992:1–23

    Google Scholar 

  32. Bellina JH, Hemmings R, Voros IJ, Ross LF. Carbon dioxide laser and electrosurgical wound study with an animal model. A comparison of tissue damage and healing patterns in peritoneal tissue.Am J Obstet Gynecol 1984,148:327–34

    PubMed  CAS  Google Scholar 

  33. Sutton CJG, Hill D. Laser laparoscopy in the treatment of endometriosis. A 5-year study.Br J Obstet Gynaecol 1990,97:181–5

    PubMed  CAS  Google Scholar 

  34. Daniell JF, Feste JR. Laser laparoscopy. In: Keye WR (ed)Laser Surgery in Gynecology and Obstetrics. Boston: Hall, 1985:147–65

    Google Scholar 

  35. Keye WR, Dixon J. Photocoagulation of endometriosis by the argon laser through the laparoscope.Obstet Gynecol 1983,62:383–6

    Article  PubMed  Google Scholar 

  36. Kelly RW, Roberts DK. CO2 laser laparoscopy: A potential alternative to Danazol in the treatment of Stage I and Stage II endometriosis.J Reprod Med 1983,28:638

    PubMed  CAS  Google Scholar 

  37. Daniell JF. Operative laparoscopy for endometriosis.Semin Reprod Endocrinol 1985,3:353–9

    Google Scholar 

  38. Davis GD. Management of endometriosis and its associated adhesions with the CO2 laser laparoscope.Obstet Gynecol 1986,68:422

    PubMed  CAS  Google Scholar 

  39. Olive DL, Haney AF. Endometriosis-associated infertility: A critical review of therapeutic approaches.Obstet Gynecol Surv 1986,41:538–55

    Article  PubMed  CAS  Google Scholar 

  40. Sutton CJG. Advances in surgical management. In: Shaw RW (ed)Endometriosis, Advances in Reproductive Endocrinology, Carnforth: Parthenon, 1990, Chap 1:209–24

    Google Scholar 

  41. Nezhat C, Winer W, Crowgey S, Nezhat F. Video laseroscopy for endometriosis.Fertil Steril 1989,51:237–40

    PubMed  CAS  Google Scholar 

  42. Lilford RJ, Dalton ME. Effectiveness of treatment of infertility.BMJ 1987,295:155–6

    PubMed  CAS  Google Scholar 

  43. Olive DL, Haney AF. Endometriosis-associated infertility: a critical review of therapeutic approaches.Obstet Gynecol Surv 1986,41:538–55

    Article  PubMed  CAS  Google Scholar 

  44. Alexander-Williams J. Do adhesions cause pain?BMJ 1987,294:659–60

    PubMed  CAS  Google Scholar 

  45. Rapkin A. Adhesions and pelvic pain. A retrospective study.Obstet Gynecol 1986,68:13–15

    PubMed  CAS  Google Scholar 

  46. Chan C, Wood C. Pelvic adhesiolysis—the assessment of symptom relief by 100 patients.Aust NZ J Obstet Gynaecol 1983,25:295

    Google Scholar 

  47. Macdonald R, Sutton CJG. Adhesions and laser laparoscopic adhesiolysis. In: Sutton CJG (ed)Lasers in Gynaecology. London: Chapman & Hall Medical, 1992:95–117

    Google Scholar 

  48. Daniell JF. Laparoscopic enterolysis for chronic abdominal pain.J Gynecol Surg 1989,5:61–6

    Google Scholar 

  49. Devroey P, Zimmerman M, Naatgeboren N, Van Steirteghem. Ovarian adhesions impair ovulation.Acta Euro Fert 1985,16:183–6

    CAS  Google Scholar 

  50. Winston RML. Tubal microsurgery In: Studd JWW (ed)Progress in Obstetrics and Gynaecology. Edinburg: Churchill-Livingstone, 1981, Chap 1:291–303

    Google Scholar 

  51. Donnez J. CO2 laser laparoscopy in infertile women with adnexal adhesions and women with tubal acclusion.J Gynecol Surg 1989,5:47–53

    Google Scholar 

  52. Bruhat M, Mage G. Pregnancy following salpingostomy: comparison between CO2 laser and electrosurgery procedures.Fertil Steril 1983,40:472–5

    PubMed  Google Scholar 

  53. Gomel V. Salpingostomy by laparoscopy.J Reprod Med 1977,18:265–7

    PubMed  CAS  Google Scholar 

  54. Daniell JF, Diamond MP, McLaughlin DS et al. Clinical results of terminal neosalpingostomy with the use of CO2 laser: report of intra-abdominal laser study group.Fertil Steril 1986,45:175–8

    PubMed  CAS  Google Scholar 

  55. Feste JR. Gynaecological surgery using the CO2 laser. In: Sutton CJG (ed)Lasers in Gynaecology. London: Chapman & Hall Medical, 1992:25–54

    Google Scholar 

  56. Donnez J. CO2 laser laparoscopy in infertile women with adnexal adhesions and women with tubal occlusion.J Gynecol Surg 1989,5:47–53

    Google Scholar 

  57. Tulandi T, Farag R, McInnes R et al. Reconstructive surgery of hydrosalpinx with and without the carbon dioxide laser.Fertil Steril 1984,42:839–42

    PubMed  CAS  Google Scholar 

  58. Singhal V, Li TC, Cooke ID. An analysis of factors influencing the outcome of 232 consecutive tubal microsurgery cases.Br J Obstet Gynaecol 1991,98:628–36

    PubMed  CAS  Google Scholar 

  59. Winston RML, Magara RA. Microsurgical salpingostomy is not an obsolete procedure.Br J Obstet Gynaecol 1991,98:637–42

    PubMed  CAS  Google Scholar 

  60. Toaff R, Toaff ME, Peyser MR. Infertility following wedge resection of the ovaries.Am J Obstet Gynecol 1976,124:92–6

    PubMed  CAS  Google Scholar 

  61. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope.Fertil Steril 1984,41:20–4

    PubMed  CAS  Google Scholar 

  62. Kelly RW. Polycystic ovaries disease; the surgical approach. In: Donnez J (ed)Laser Operative Laparoscopy and Hysteroscopy. Leuven: Nauwelaerts, 1989:79–84

    Google Scholar 

  63. Daniell J, Miller W. Polycystic ovaries treated by laparoscopic vaporisation.Fertil Steril 1989,51:232–6

    PubMed  CAS  Google Scholar 

  64. Keckstein J. Laparoscopic treatment of polycystic ovarian syndrome. In: Sutton SJG (ed)Baillière's Clinical Obstetrics and Gynaecology Vol3(3). London: Baillière Tindall, 1989:563–81

    Google Scholar 

  65. Keckstein J, Borchers K, Wolf A et al. Is laparoscopic laser surgery an alternative for polycystic ovarian disease? In: Donnez J (ed)Laser Operative Laparoscopy and Hysteroscopy. Leuven: Nauwelaerts, 1989:95–107

    Google Scholar 

  66. Sundell G, Milson I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women.Br J Obstet Gynaecol 1990,97:588–94

    PubMed  CAS  Google Scholar 

  67. Dawood MY. Dysmenorrhoea. In: Reiter RC (ed)Clinical Obstetrics and Gynecology, Vol33(1). Philadelphia: JB Lippincott Co., 1990:168–78

    Google Scholar 

  68. Lumsden MA. Dysmenorrhoea. In: Studd JWW (ed)Progress in Obstetrics and Gynaecology. Edinburgh: Churchill Livingstone, 1985, Chap 5:276–92

    Google Scholar 

  69. Doyle JB: Paracervical uterine denervation by transection of the cervical plexus for the relief of dysmenorrhoea.Am J Obstet Gynecol 1955,70:1–16

    PubMed  CAS  Google Scholar 

  70. Doyle JB, Rosiers JJ. Paracervical uterine denervation for relief of pelvic pain.Clin Obstet Gynecol 1963,6:742–53

    Article  Google Scholar 

  71. Royal College of General Practitioners.Oral Contraceptives and Health. London: Pitman Medical, 1974

    Google Scholar 

  72. Henzl MR. Dysmenorrhoea.Sex Med Today 1985,9:7–11

    Google Scholar 

  73. Dawood MY. Dysmenorrhoea: Achievements and challenges.Pain Analg 1985,1:20

    Google Scholar 

  74. Donnez J, Nisolle M. Carbon dioxide laser laparoscopy in pelvic pain and infertility. In: Sutton CJG (ed)Baillière's Clinical Obstetrics and Gynaecology, Vol3(3). London: Baillière Tindall, 1989:525–43

    Google Scholar 

  75. Sutton CJG. Laser laparoscopic uterine nerve ablation. In: Donnez J (ed)Laser Operative Laparoscopy and Hysteroscopy. Leuven: Nauwelaerts, 1989:43–52

    Google Scholar 

  76. Mitchell DE, McSwain HF, McCarthy JA, Peterson HB. Hysterosalpingographic evaluation of tubal patency after ectopic pregnancy.Am J Obstet Gynecol 1987,157:618–22

    PubMed  CAS  Google Scholar 

  77. Tuomivaara L, Kauppila A. Radical or conservative surgery for ectopic pregnancy? A follow-up study of fertility in 323 patients.Fertil Steril 1988,50:580–3

    PubMed  CAS  Google Scholar 

  78. Semm K, Mattler L. Local infiltration of Ornithin 8-Vasopression (POR 8) as a vasoconstrictive agent in surgical pelviscopy applied to myoma enucleation, salpingotomy in cases of tubal pregnancy and peripheral salpingostomy.Endoscopy 1988,20:298–304

    Article  PubMed  CAS  Google Scholar 

  79. DiMarchi JM, Losasa TS, Kobara TY, Hale RW. Persistent ectopic pregnancy.Obstet Gynecol 1987,70:555–8

    PubMed  CAS  Google Scholar 

  80. Bell OR, Awadalla SG, Mattox JH. Persistent ectopic syndrome: A case report and literature review.Obstet Gynecol 1987,69:521–3

    PubMed  CAS  Google Scholar 

  81. Higgins KA, Schwartz MB. Treatment of persistent trophoblastic tissue after salpingostomy with methotrexate.Fertil Steril 1986,45:427–8

    PubMed  CAS  Google Scholar 

  82. Pouly JL, Manhes H, Mage G et al. Conservative laparoscopic treatment of 321 ectopic pregnancies.Fertil Steril 1986,46:1093–7

    PubMed  CAS  Google Scholar 

  83. Konickx PR, Witters K Brosens J et al. Conservative laparoscopic treatment of ectopic pregnancies using the CO2 laser.Br J Obstet Gynaecol 1991,98:1254–9

    Google Scholar 

  84. Meyer WR, DeCherney AH. Laparoscopic treatment of ectopic pregnancy. In: Sutton CJG (ed)Baillière's Clinical Obstetrics and Gynaecology, Vol.3(3). London: Baillière Tindall, 1989:583–94

    Google Scholar 

  85. Llundorff P, Thorburn J, Lindblom B. Fertility out-come after conservative surgical treatment of ectopic pregnancy evaluated in a randomised trial.Fertil Steril 1992,57, 998–1002

    Google Scholar 

  86. Vermesh M, Silva PD, Rosen GF et al. Management of unruptured ectopic gestation by linear salpingostomy: a prospective randomised clinical trial of laparoscopy versus laparotomy.Obstet Gynecol 1989,73:400–4

    PubMed  CAS  Google Scholar 

  87. Reich H, Friefeld M, McGlynn F. Laparoscopic treatment of ectopic pregnancy.Obstet Gynecol 1987,68:275–9

    Google Scholar 

  88. Brumsted J, Kessler C, Gibson C et al. A comparison of laparoscopy and laparotomy for the treatment of ectopic pregnancy.Obstet Gynecol 1988,71:889–92

    PubMed  CAS  Google Scholar 

  89. Fisher JC. Basic laser physics and interaction of laser light with soft tissue. In: Shapshay SM (ed)Endoscopic Laser Surgery Handbook. New York: Marcel Decker Inc., 1987:118

    Google Scholar 

  90. Corson SL, Unger M, Kwa D et al. Laparoscopic laser treatment of endometriosis with the Nd:YAG sapphire probe.Am J Obstet Gynecol 1989,160:718–21

    PubMed  CAS  Google Scholar 

  91. Kojima E, Morita M, Otaka K, Yano Y. Nd:YAG laser laparoscopy for ovarian endometriomas.J Reprod Med 1990,35:592–6

    PubMed  CAS  Google Scholar 

  92. Keye WR, Hansen LW, Astin M, Poulson AM. Argon laser therapy of endometriosis: a review of 92 consecutive patients.Fertil Steril 1987,47:208

    PubMed  Google Scholar 

  93. Daniell JF. Laparoscopic evaluation of the KTP/532 laser for treating endometriosis—initial report.Fertil Steril 1986,46:373–7

    PubMed  CAS  Google Scholar 

  94. Keye WR The future of laser surgery. In: Sutton CJG (ed)Lasers in Gynaecology London: Chapman & Hall Medical, 1992:257–68

    Google Scholar 

  95. Schenken RS. Gonadotrophin-releasing hormone analogs in the treatment of endometriomas.Am J Obstet Gynecol 1990,162:579–81

    PubMed  CAS  Google Scholar 

  96. Reich H, McGlynn F. Treatment of ovarian endometriomas using laparoscopic surgical techniques.J. Reprod Med 1986,31: 577–84

    PubMed  CAS  Google Scholar 

  97. Martin DC. Laparoscopic treatment of ovarian endometriomas.Clin Obstet Gynecol 1991,34: 452–9

    Article  PubMed  CAS  Google Scholar 

  98. Daniell JF, Kurtz BR, Gurley LD. Laser laparoscopic management of large endometriomas.Fertil Steril 1991,55:692–5

    PubMed  CAS  Google Scholar 

  99. Brumsted JR, Deaton J, Lavigne E, Riddick DH. Postoperative adhesion formation after ovarian wedge resection with and without ovarian reconstruction in the rabbit.Fertil Steril 1990,53:723

    PubMed  CAS  Google Scholar 

  100. DeCherney AH, Semm K. Gynaecological surgery and endoscopy.Curr Opin Obstet Gynecol 1991,3: 359–61

    Google Scholar 

  101. Gordon AG, Magos AL. The development of laparoscopic surgery. In: Sutton CJG (ed)Baillière's Clinical Obstetrics and Gynaecology, Vol3(3). London: Baillière Tindall, 1989:429–50

    Google Scholar 

  102. Sutton CJG. Operative laparoscopy.Curr Opin Obstet Gynaecol 1992,4:430–8

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynaecology, The Royal Surrey County Hospital, Guildford, Surrey, UK

    N. L. Whitelaw & C. J. G. Sutton

Authors
  1. N. L. Whitelaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. J. G. Sutton
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Whitelaw, N.L., Sutton, C.J.G. Laser laparoscopy—indications, techniques and results. Laser Med Sci 8, 83–92 (1993). https://doi.org/10.1007/BF02547803

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02547803

Key words

Search

Navigation