Friday, October 30, 2009

Laparoscopy using Ultrapulse Laser for Endometriosis and Pelvic Adhesions

Laparoscopy with Ultrapulse Laser for Endometriosis and Pelvic Adhesions

The Ultrapulse CO2 laser is the best surgical instrument for the treatment of endometriosis since it can vaporize undesired tissue (such as endometriosis or pelvic adhesions) without producing char (carbonization that results from charring or searing tissue with heat), with minimal risk of lateral thermal damage, and with little drying (desiccation) of treated tissue. Char, thermal damage (burn injury), desiccation of tissues, and damage to surrounding normal tissues will result in poor tissue healing, scar (adhesion) formation, increased inflammation with greater postoperative pain, and destruction of normal tissue that surrounds the tissue being treated.

The Ultrapulse CO2 laser is the gold standard surgical instrument used by Plastic Surgeons for the removal of skin scars (including burn scars), wrinkles, and damaged skin since it provides the best cosmetic results and postoperative skin tone. For more information on this laser see their website at

The Ultrapulse CO2 laser has also been used for about 20 years for the treatment of pelvic endometriosis and pelvic scar tissue (adhesions) by many of the most experienced laparoscopic surgeons since the postoperative results following pelvic repair are similarly remarkable.

Many Reproductive Endocrinologists, including us, stress that endometriosis lesions must be removed in their entirety for longterm benefit.

Some of these surgeons claim that the lesions must be excised with scissors or other cutting instruments to insure that the base of the lesions are completely removed. The Ultrapulse CO2 laser is fully able to ablate abnormal tissue regardless of its depth or size with minimal lateral tissue damage. Manual excision with cutting instruments always damages underlying normal tissue since some of this normal tissue is removed along with the endometriosis lesion and the remaining tissue within the pelvis will have bleeding that must be controlled with cautery. Cauterization of bleeding vessels is designed to burn the bleeding vessels to form char, that then further damages the normal tissues surrounding the sites of excision and increases postoperative adhesion formation.

Other reproductive surgeons use instruments that are not as “delicate” for the surrounding tissues, including but not limited to the harmonic scalpel, monopolar or bipolar cautery devices, CO2 lasers with either continuous or superpulse waves (that cannot provide the same degree of safety and protection from lateral thermal damage when compared to the Ultrapulse CO2 laser), other non-CO2 lasers such as KTP or YAG lasers, and mechanical devices like scissors or cutting instruments.

The Ultrapulse CO2 laser is not available at most operating rooms, seemingly for a variety of reasons. The laser is extremely expensive and must be maintained properly so hospitals are very reluctant to purchase it. The laser requires significant time and experience by the surgeon in order to feel comfortable. Surgeons are often creatures of habit, so that when the surgeon becomes comfortable with a particular surgical tool it is inherently difficult to switch to a different surgical instrument.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has been using the Ultrapulse CO2 laser routinely since the early 1990s and has extensive laparoscopic experience over thousands of surgical cases treating endometriosis. Results in terms of reduction of pelvic pain and improved fertility have often been remarkable. For more information, consider a consultation with Dr. Daiter at 908 226 0250 or visit us on the web at or

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Monday, October 26, 2009

Laparoscopy for Pelvic Adhesions

Laparoscopy for Pelvic Adhesions

Pelvic adhesions (scars) develop as a normal tissue response to inflammation, which occurs whenever the tissue is damaged. Infertility surgeons make every attempt to limit or prevent pelvic adhesion formation following laparoscopy or laparotomy, and an experienced fertility surgeon may be able to significantly reduce the bulk of previously formed pelvic adhesions through meticulous care at laparoscopy.

Ideally, infertility surgery adheres to the principles of “microsurgical technique,” a set of surgical methods designed to reduce adhesion formation. Crush injuries to tissue can result in scar formation, so very gentle tissue handling is encouraged. Blood is very irritating to the lining cells overlying the pelvis, called peritoneum, so thorough control of even small amounts of bleeding and removal of any blood collected in the pelvis and abdomen is important. Identification of the proper tissue planes is important in order to avoid surgical damage to the tissues that are being separated so magnification should be available when needed. Tissues that dry out become damaged much more easily than tissues that are kept moist, and it is much easier to maintain adequate tissue moisture during laparoscopy as compared to laparotomy since the abdomen is essentially closed during the laparoscopy procedure. Infection should be avoided (and if inevitable then infection should be treated as early as possible) since a pelvic infection can rapidly destroy the very delicate reproductive tissues. Carbon deposits or char caused by the use (or overuse) of cautery to burn or sear abnormal tissues or control bleeding can result in adhesion formation and should be minimized whenever appropriate. Devascularization of tissue or ischemia can result from burn injuries that damage the blood vessels feeding tissues, so use of the ultrapulse CO2 laser is ideal for many infertility laparoscopy procedures since this tool allows vaporization of unwanted tissue with minimal lateral thermal damage to surrounding tissues.

Dr Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has personally performed over a thousand laparoscopy surgeries using the ultrapulse CO2 laser for the treatment of pelvic adhesions during the past 20 years. He would be happy to help you. Contact the office at 908 226 0250 for an appointment. Also, visit us on the web at or

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