An appraisal of the role of laparoscopy: past, present, and future.

OBJECTIVE

To review the role of laparoscopy in the management of chronic pelvic pain (CPP).

METHOD: A literature search was conducted to obtain a clear perspective on the role of laparoscopy for CPP.

RESULTS

Laparoscopy has been widely used as a diagnostic tool in CPP, but often falls short in defining the type and activity of ectopic endometrial-like tissue. Because pelvic endometriosis includes a wide range of lesions, histological confirmation varies greatly. The evaluation of peritoneal endometriosis at laparoscopy can be misleading. In one study 43% of the patients with minimal or mild endometriosis were found at second-look laparoscopy to be free of lesions. Finally, laparoscopy is not without major complications and the risk of undiagnosed bowel injury is likely to be underestimated.

CONCLUSION

The diagnosis of endometriosis can no longer be limited to the visual inspection of the pelvis but requires a wider range of investigations to assess the reproductive system and the role of endometriotic lesions and adhesions in CPP.