{
    "abstract": "In this review, the pitfalls that still exist with the surgical treatment of endometriosisassociatedpelvic pain have been discussed and the best evidence regarding various aspects of surgical techniques have been reviewed. When laparoscopy is performed to evaluate a woman with pelvic pain symptoms, it is important she be counseled that the primary function of the surgery is to confirm the presence (and allow surgical treatment) of endometriosis, and that it is not the penultimate diagnostic modality for her pelvic pain. There are many etiologies of pelvic pain that present with symptoms resembling those of endometriosis-associated pelvic pain that are not diagnosable with laparoscopy, such as interstitial cystitis and irritable bowel syndrome. It is unfortunate that many women are left with the belief that if a laparoscopy fails to provide a diagnosis of a pain generator, then it means there are no diagnoses other than that the \u201cpain is in her head,\u201d often disparagingly termed \u201csupratentorial\u201d byclinicians. In fact, the pain-related diagnoses that are amenable to and possibly require a laparoscopy are quite limited, a group of diagnoses that this author terms the \u201cdirty dozen\u201d because there are just 12, and only the first 4 have good evidence to clearly associate them with chronic pelvic pain:1. Endometriosis 2. Ovarian remnant syndrome 3. Pelvic inflammatory disease 4. Tuberculous salpingitis 5. Adhesions 6. Benign cystic mesothelioma 7. Postoperative peritoneal cysts 8. Adnexal cysts (nonendometriotic)9. Chronic ectopic pregnancy 10. Endosalpingiosis 11. Residual accessory ovary 12. Hernias: ventral, inguinal, femoral, spigelian.I would argue that diagnostic laparoscopy in modern gynecology has a limited, if any role, and that when laparoscopy is planned for women with chronic pelvic pain, it should be with a very high suspicion of a diagnosis and with plans to treat the disease operatively. In this era, a negative diagnostic laparoscopy should be a rare event.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. fred_howard@urmc.rochester.edu",
            "firstname": "Fred M",
            "initials": "FM",
            "lastname": "Howard"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1016/j.ogc.2011.09.004",
    "journal": "Obstetrics and gynecology clinics of North America",
    "keywords": [],
    "methods": null,
    "publication_date": "2011-12-03",
    "pubmed_id": "22134016",
    "results": null,
    "title": "Surgical treatment of endometriosis.",
    "xml": "<Element 'PubmedArticle' at 0x788506bd7290>"
}