2852 Long Term Follow up of Carbon Dioxide Laser Vaporisation Versus Harmonic Scalpel Excision in the Treatment of Superficial Endometriosis: A Randomised Controlled Trial

Abstract

Study Objective To evaluate if excision of endometriosis (rAFS stages I-III) with the harmonic scalpel, is superior to carbon dioxide laser vaporisation in terms of symptoms over a 3 year period. Design This was a randomized double blind controlled trial. Setting Set at a Tertiary referral unit. Patients or Participants 116 patients found to have endometriosis at laparoscopy were randomized in to the study. Interventions The study was powered for superiority, and patient's randomized with a 1:1 allocation into receiving treatment either with laser or harmonic scalpel. Data was analyzed using SPSS version 21. The primary outcome measure was the visual analogue scale (VAS) score for chronic pelvic pain score at 6 months. Secondary outcomes included core EHP-30, HADS anxiety and depression score and VAS scores for chronic pelvic pain, dysmenorrhoea, dyschezia and dyspareunia, up to 3 years. Measurements and Main Results Pre operative chronic pelvic pain (VAS) for the laser and harmonic groups were 57.1 (IQR: 28.1-75.6) and 50.6 (IQR: 0-75.0) respectively, and at 6 months 43 (IQR: 0-66.5) and 30 (IQR: 0-60.7). The difference between the two were not statistically significant, p=0.228. At 12 months the chronic pelvic pain VAS scores for laser and harmonic groups were 50 (IQR: 20-74.7) and 13.1 (IQR: 0-49.0) respectively. The difference between the two was significant, p Conclusion Excision of endometriosis with harmonic is effective at improving chronic pelvic pain up to 3 years. This does not appear to be the case with CO2 laser vaporisation. In terms of most secondary outcomes laser performs as well as harmonic at 6 months but the trend is in favor of harmonic up to 3 years.