Macro- and microsurgical treatment of endometriosis

Abstract

The surgical treatment of endometriosis is in rapid evolution, some would say revolution, owing to advances in microsurgical instrumentation, endoscopic methods, and operative adjuncts including adhesion inhibitors. Standards of treatment are difficult to define, perhaps better referred to as accepted treatment options. This chapter, summarizing one surgeon’s approach to endometriosis surgery, can at best be a snapshot in time of accepted operative methods; in fact, the degree of being accepted varies, as there continues ample controversy regarding optimum treatment of this confusing disease. Hopefully, in 5 to 10 years, some of the principles described in this chapter will seem overly simplistic, much as we now view the previous standard of hysterectomy and castration for all endometriosis patients. The history of endometriosis treatment may provide useful perspective, however, in the ’modern approach’ to surgical treatment. In the following section, a brief overview of historical trends will suggest where surgical treatment is heading, as well as give proper credit to the work of surgeons who pioneered new options in endometriosis therapy.