PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, CONTROLLED TRIAL OF LASER LAPAROSCOPY IN THE TREATMENT OF PELVIC PAIN ASSOCIATED WITH MINIMAL, MILD,AND MODERATE ENDOMETRIOSIS

Objective: To assess the efficacy of laser laparoscopic surgery in the treatment of pain associated with minimal, mild, and moderate endomet riosis. Design: A prospective, randomized, double-blind, and controlle d clinical study. Setting: Royal Surrey County Hospital, Guildford, Un ited Kingdom, a referral center for the laser laparoscopic treatment o f endometriosis. Patients: Sixty-three patients with pain (dysmenorrho ea, pelvic pain, or dyspareunia) and minimal to moderate endometriosis . Interventions: The patients were randomized at the time of laparosco py to laser ablation of endometriotic deposits and laparoscopic uterin e nerve ablation or expectant management. Pain symptoms were recorded subjectively and by visual analogue scale. The women were unaware of t he treatment allocated as was the nurse who assessed them at 3 and 6 m onths after surgery. Main Outcome Measure: Improvement or resolution o f pain symptoms assessed subjectively and by visual analogue score. Re sults: Laser laparoscopy results in statistically significant pain rel ief compared with expectant management at 6 months after surgery. Sixt y-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6% in the expectant group. Results were poorest for minimal disease and, if patients with mild an d moderate disease only are included, 73.7% of patients achieved pain relief. There were no operative or laser complications. Conclusions: L aser laparoscopy is a safe, simple, and effective treatment in allevia ting pain symptoms in women with stages I, II, and III endometriosis.