Laparoscopy is a minimally invasive low risk informative procedure in experienced hands. Laparoscopy allows the surgeon to examine the pelvic reproductive organs and surrounding pelvic structures thoroughly. Research suggests that up to 50% (1 in 2) of patients with no specific findings on preoperative evaluation (history, physical exam and laboratory work) have abnormal findings on laparoscopy. Therefore, laparoscopy often allows the operator to identify and treat problems that might reduce or eliminate the pelvic pain.
The usefulness of hysteroscopy in the evaluation of chronic pelvic pain is controversial. In two large series by very respected surgeons, about one third of women with chronic pelvic pain had abnormal uterine or cervical findings on hysteroscopy. It has been suggested that hysteroscopy should be done routinely at the time of laparoscopy for chronic pelvic pain since it is a quick, safe and informative procedure in qualified surgical hands. Opponents to this belief suggest that hysteroscopy puts an unfortunate population of patients at additional surgical risk without clear benefit. More research on this issue would be valuable.
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