Current practice for the laparoscopic diagnosis and treatment of endometriosis: a national questionnaire survey of consultant gynaecologists in UK


Mr T. J. Clark, Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, B15 2TG, UK.


Objective  To determine current practice regarding laparoscopic diagnosis and treatment of endometriosis.

Design  A prospective questionnaire survey.

Setting  The United Kingdom.

Population  All 1411 UK consultant gynaecologists identified from a Royal College of Obstetricians and Gynaecologists database.

Methods  A postal questionnaire was sent to all consultants with reply paid envelopes. A postal reminder was sent three months following the initial questionnaire.

Main outcome measure  Current practice for the laparoscopic diagnosis and treatment of endometriosis and willingness to participate in a randomised trial.

Results  The response rate was 66% (893/1411). Diagnostic laparoscopy was performed by 87% (772/893) of respondents. Seventy-six percent of these (58/772) were confident to visually diagnose endometriosis and 6% (47/772) routinely verified the diagnosis histologically. Laparoscopic surgery was routinely undertaken by 41% (318/772) of respondents. Ablative therapy was the most frequently employed technique utilised [620/653 (95%)] and electrodiathermy was the most popular energy modality (80%). Among respondents expressing a preference, excision of disease was believed to be more effective, but less safe compared with ablation. One-third of respondents (273/893) were willing to enter patients into a randomised controlled trial to compare laparoscopic treatments for pelvic pain associated with endometriosis.

Conclusion  Laparoscopic surgery for endometriosis associated with pelvic pain is routinely undertaken by a large number of UK consultant gynaecologists, but techniques used and beliefs about efficacy vary. In view of this division of opinion regarding the relative roles of laparoscopic treatment methods, a randomised trial comparing the efficacy and safety of these methods is urgently needed.