Superficial Peritoneal Endometriosis Vaporization Using a CO2 Laser: A Long-Term Single-Center Experience

Abstract

Background: The validation of laser usage during laparoscopic procedures, notably by Camran Nezhat in the late 1980s, has been significant. Lasers offer precision and depth control in tissue vaporization without bleeding. Surgical intervention remains central in managing endometriosis-associated pain and infertility, especially for patients unresponsive to hormonal therapy. Methods: This retrospective cohort study included 200 patients with superficial peritoneal endometriosis (SPE) who underwent laparoscopic laser vaporization. Surgery was performed using a CO₂ laser, and histological confirmation of endometriosis was obtained for all cases. Pain scores and SF-36 questionnaire domains were assessed preoperatively and postoperatively. Fertility outcomes were evaluated among patients desiring pregnancy. Results: Significant improvements in pain score and SF-36 questionnaire domains were observed postoperatively (p-value < 0.01), indicating enhanced quality of life. Among infertile patients with an active desire for pregnancy, surgical treatment showed an overall pregnancy rate after surgery of 93.7% (p-value < 0.01), including 75.7% natural pregnancies and 24.3% IVF. Laser vaporization enabled precise lesion removal with minimal tissue damage, short operative time, and minimal blood loss. Conclusions: Laparoscopic laser vaporization is an effective treatment for SPE, offering pain relief, improved quality of life, and favorable fertility outcomes. Further research is needed to validate these results in terms of pain control and fertility.

Keywords: CO2 laser; endometriosis; fertility; pain; superficial peritoneal endometriosis.

Figure 1

Box plots presented significant differences between symptoms before and after surgery (* p < 0.01 vs. preoperative symptoms). Pain score divided into five categories: 5: severe (VAS 8–10), 4: modest (VAS 6–7), 3: moderate (4, 5), 2: mild (3–4), 1: no pain.

Figure 2

Differences in the patient’s quality of life, as assessed using SF36, before surgery, at 6-, 12-, and 24 months follow-up (* p < 0.01 vs. baseline).

Figure 3

Pregnancy data in infertile patients wishing to conceive with the recommendation, type of pregnancy, and delivery. IVF: in vitro fertilization; PCOS: polycystic ovarian syndrome.

Figure 4

Pregnancy data in patients wishing to conceive who have not attempted conception before surgery with the recommendation, type of pregnancy, and delivery.

Figure 5

CO₂ laser vaporization, (A1,A2,A3) and (B1,B2,B3) sequences show different lesions and the procedure for their removal from the beginning to the final result.