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Abstract
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In the United Kingdom
the majority of diagnostic laparoscopies for pelvic pain will be
undertaken by physicians in training and are usually poor. If
endometriosis is diagnosed at all it will be so on the basis of dark
powder burn lesions, more subtle lesions such as white scarring or sago
grains being missed. Biopsy confirmation is rare. In patients who have
had previous laparoscopic fulgaration or laser ablation carbon
deposition makes the diagnosis more difficult. Such patients will often
have had infiltrating or nodular lesions inadequately treated and thus
be symptomatic but with no clear surface lesions, obscuring the correct
diagnosis even further.
A policy of excision biopsy with lesion mapping,
the data being entered onto a palm top computer immediately after the
operation, together with the reports of the subsequent histological
examination, allows for accurate assessment of the presence, extent and
histological grading of endometriotic lesions. Allowing for heat
artefact following laser or diathermy excision it is possible to assess
the false positive rate for individual surgeons. At follow up relief in
terms of areas of pelvic tenderness associated with possible areas of
inadequate excision can be assessed and further surgical intervention
planned on the basis of clearly mapped and identified areas of disease.
Areas of tenderness in the pelvis tend to be site
and disease specific.(1) Rapid data entry and analysis is possible so
that up to date data is easily available for presentation.
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