Laser laparoscopy is used to perform a multitude of gynaecologic operative procedures in the treatment of pelvic pain, painful periods and infertility. It has been used around the world and in Australia for over 20 years, and has proven to be one of the most versatile, safe and effective modalities in gynaecology. Different lasers are used in gynaecology but the most precise is the carbon dioxide laser and this is the one that we use at Beleura and Peninsula Private Hospitals.

Conditions that can cause pelvic pain and infertility include endometriosis, adhesions, blocked tubes, ovarian cysts and other abnormalities of the pelvis. Many authors have reported on the use of the carbon dioxide laser in treating these disorders and one can vapourise and excise endometriosis, divide adhesions and unblock tubes. The laser can also be used to treat period pain by doing a procedure called laser uterine nerve ablation (LUNA). This is where the laser is used to divide the pelvic nerves associated with period pain.

Advantages of CO2 Laser

The advantages of CO2 laser laparoscopy are related to the qualities of the laser which is an extremely precise high energy light beam:

• The diseased tissue is vapourised and excised leaving a very clean result.
• The spread of thermal damage is only about 100 microns, far less than diathermy (cautery).
• The haemostatic properties will prevent bleeding  (heat seals the blood vessels).
• Diseased tissue is vapourised away into smoke which is suctioned away, therefore no dead tissue remains and subsequent healing is much faster.
• Laser wounds appear to heal with virtually no scar tissue formation, therefore also less post- operative adhesions.
• As most endometriosis is in multiple diffuse areas, the CO2 laser is faster surgery than individually cutting/ excising these areas.
• The energy is only in the precise area of the laser beam and therefore there should be no accidental spread to other organs, unlike electrical diathermy where there can be a risk of electrical sparking and damage to other organs (recognised or unrecognised). 
• For most endometriosis surgery the CO2 laser only requires two small secondary ports which are below the bikini line.
• The cutting action of the laser can be used to divide adhesions or unblock tubes very precisely.
• The cleaner field of surgery resulting from CO2 laser treatment means that depth of treatment can be confirmed accurately, thus ensuring complete removal of the endometriosis/ disease.
• The precision of CO2 laser surgery allows vapourisation excision of endometriosis on delicate structures such as ureter, bowel, ovary and fallopian tubes.

The above properties/ advantages of CO2 laser laparoscopy allow precise excisional surgery with very high safety and a very clean result.    

Hospitalisation

Although laser laparoscopy is generally a day case procedure it is performed under a general anaesthetic and you may be asleep from one to two hours. If you feel too tired after this, or if there is a lot of disease treated (advanced surgery), you may want to stay an extra day. Pain and tenderness is usually related to the severity of disease and the amount of surgery that is necessary. A simple gas is used to fill the abdomen to enable the surgeon to see inside and this is released at the end of the operation. However any residual gas can sometimes cause mild abdominal bloating and shoulder pain. Complications such as bleeding, infection or damage to bowel or other organs are very uncommon. 

Post-Operative

When you are discharged home you should rest up completely for at least two to three days. After this time you can gradually return to normal activities. It is very important that you listen to your body and do not push yourself. You can usually return to full activities and work after one to two weeks. Over the following weeks you may get some intermittent spotting or bleeding. Your next period can sometimes be rather painful or abnormal. Attached is a laser laparoscopy post operative guidelines sheet. A review appointment should have been made for you to see me in about six weeks time. If this has not already been arranged, please phone my secretary after being discharged from hospital. If there are any problems or questions at all, please do not hesitate to contact me on the above phone numbers.