Use of the potassium titanyl phosphate laser in the laparoscopic anterior rectum slicing operation.

OBJECTIVE: To evaluate the efficacy of the potassium titanyl phosphate (KTP) laser used during the laparoscopic anterior rectum slicing (LARS) operation. DESIGN: Retrospective study. SETTING: National Hospital Organization Kyoto Medical Center, Kyoto, Japan. PATIENT(S): All 46 patients who underwent the LARS operation using the KTP laser. INTERVENTION(S): The LARS operation using the KTP laser for treatment of deep rectal endometriosis. MAIN OUTCOME MEASURE(S): Operative and postoperative outcome. RESULT(S): Meaningful improvements in clinical symptoms were obtained with the LARS operation using the KTP laser with acceptable levels of postoperative morbidity. Bowel leakage did not occur in any of the patients. CONCLUSION(S): Deep rectal endometriosis can be treated effectively with the LARS operation using the KTP laser.

Complete removal of endometriosis improves fecundity.

Endometriosis is one of the causative factors of impaired fecundity. Whatever the mechanisms are of this impairment, surgical removal of endometriosis appears to increase postoperative fecundity. Our strategy in laparoscopic surgery for symptomatic endometriosis is to completely remove endometriosis. However, despite this strategy, laparoscopic surgery nonetheless creates two categories of patients; complete and incomplete surgery groups. We found by comparing the two groups that both were comparable in terms of fecundity during the early postoperative phase, whereas unlike the complete surgery group, fecundity in the incomplete surgery group stayed low during the late postoperative phase. Deep rectal endometriosis and deeply invading pelvic endometriosis are conditions wherein complete removal of endometriosis is difficult. We have developed laparoscopic surgeries for these conditions: laparoscopic anterior rectum slicing (LARS) and laparoscopic pelvic wall slicing (LPWS) operations, respectively. Both operations are effective in alleviating disease-related symptoms with minimal surgical invasiveness.