A Comparative Study of the use of Different Energy Sources in Laparoscopic Management of Endometriosis-Associated Infertility

Background: Although there is controversy about the mechanism by which endometriosis causes infertility, laparoscopic treatment for endometriosis-associated infertility is becoming popular. However, the optimal modality of energy sources used for dissection and ablation in infertile women remains unexplored. Objective: To study the best available evidence exploring the use of laparoscopic surgery in infertile women with endometriosis, compare various available energy sources, and their effect on surgical outcome and probability of pregnancy. Methods: A retrospective review of literature was done to explore the role of laparoscopic surgery and various energy sources in managing endometriosis-associated infertility, using keywords—endometriosis, laparoscopy, infertility, electrosurgery and ultrasonic energy. Results: Laparoscopic treatment of endometriosis using mechanical or electrical technologies was proposed in the 1980s. Later, use of lasers to vaporize endometriosis and to excise adhesions became popular. The invention of ultrasonic generator and tissue response electrosurgical generator has revolutionized laparoscopic surgery for endometriosis. Conclusion: No prospective randomized double-blind controlled trial has been conducted to date in this area. Current evidence suggests that laparoscopic excision or ablation, either by electrocautery or laser, improves pregnancy rates. However, the impact of newer energy sources and tissue dissection techniques in this field is yet to be explored.