1501 Vaporization and Coagulation Techniques for Excision and Ablation of Endometriosis

Abstract

Study Objective To demonstrate technical problems from the 1980s that resurfaced in 2018. Design Review of published reports. Setting Literature and web review. Patients or Participants Cases previously published. Interventions Laparoscopic laser and non-laser vaporization and coagulation. Measurements and Main Results A 2018 YouTube on non-laser vaporization demonstrated a problem with field distortion and incomplete vaporization that was seen in the 1980s with lasers. This presentation uses images and illustrations to review and discuss what we learned 30 years ago and how that applies to laser, electrosurgical, and kinetic energy by contrasting the outcomes for superficial and deep endometriosis. Those observations encouraged some of us adopted Kurt Semm's 1980 approach to excision of deep nodules. The discussion includes single finger exams, exam under anesthesia before initiating surgery, exam during surgery, exam after ablation or excision, delineation of margins, appropriate power density, thermal damage, carbonization, techniques that obscure endometriosis, and complications including unnecessary repeat surgery. Single finger exam, discussed as early as 1869, was taught by Richard “Pete” Hollis (ACOG president 1993) by 1985 and reinforced in Steege & Siedhoff's 2014 approach to pelvic pain evaluation. Dr. Hollis discussed this with respect to excision of endometriotic nodules at laparotomy using vaginal examination before excision to localize a nodule, during excision to push lesions into the field, and after excision to confirm removal. It is important to use techniques that adequately identify and remove deep endometriosis. Low power density laser and non-laser techniques can create problems including thermal burn, inconsistent depth, and carbonization that can increase the chance of leaving endometriosis behind. Carbonization can obscure endometriosis at initial surgery, increase the chance of reoperation, and obscure endometriosis at subsequent surgery. Conclusion Vaporization and coagulation techniques may be useful for small, focal, endometriotic lesions, but can be inadequate for deep infiltrating endometriosis.