Endometriosis is a chronic gynecological disorder where endometrial-like tissue grows outside the uterus, most commonly on the ovaries, fallopian tubes, pelvic peritoneum, and sometimes even beyond the pelvic cavity. It causes pain, dysmenorrhea, dyspareunia, and infertility in millions of women worldwide. Laparoscopy has emerged as the gold standard for both diagnosis and treatment of endometriosis.

Among the minimally invasive management techniques, fulguration, ablation, and the application of adhesion-preventing barriers like Interceed are widely practiced to alleviate symptoms, restore fertility, and improve quality of life.

Fulguration of Endometriosis

Fulguration refers to the destruction of endometriotic lesions using electric current or energy sources without physically removing the tissue.

Procedure

Performed laparoscopically using a monopolar or bipolar electrosurgical probe.

Endometriotic implants are identified on the peritoneum, ovaries, or pelvic sidewalls.

Controlled bursts of electric current are applied to burn or coagulate the lesions.

Advantages

Quick and effective for small, superficial peritoneal implants.

Minimally invasive with less bleeding.

Shortens operative time compared to excision.

Limitations

Not suitable for deep infiltrating endometriosis.

Risk of incomplete destruction leading to recurrence.

Thermal spread may damage surrounding healthy tissue.

Ablation of Endometriosis

Ablation involves destroying endometriotic tissue using thermal or non-thermal energy sources. Unlike fulguration, ablation techniques are broader and may include:

Laser Ablation – CO₂ laser or Nd:YAG laser vaporizes endometriotic implants precisely.

Plasma Energy Ablation – Argon plasma or helium plasma ablation for superficial lesions.

Thermal Ablation – Using electrocautery, harmonic scalpel, or radiofrequency energy.

Procedure Steps

Surgeon inspects the pelvis systematically.

Small lesions are vaporized until only normal peritoneum remains visible.

Care is taken to preserve ovarian tissue, especially in women desiring fertility.

Advantages

Precise targeting of lesions with minimal collateral damage (especially with lasers).

Useful for superficial lesions on sensitive sites like the bladder peritoneum.

Less risk of scarring compared to fulguration.

Disadvantages

May not be effective for deep nodular endometriosis.

Requires specialized equipment (like laser units) which may be costly.

Potential for recurrence if ablation is incomplete.

Application of Interceed

One of the major complications following endometriosis surgery is postoperative adhesion formation, which may itself contribute to pain and infertility. To reduce this risk, adhesion barriers such as Interceed are applied at the end of surgery.

What is Interceed?

Interceed is an oxidized regenerated cellulose (ORC) fabric.

It acts as a temporary physical barrier between adjacent tissues during the healing process.

Absorbed naturally within 2–4 weeks without the need for removal.

Method of Application

After completing fulguration or ablation, the peritoneal cavity is irrigated thoroughly.

Hemostasis must be ensured, as Interceed works best in a blood-free field.

Sheets of Interceed are cut and placed over raw surfaces, ovaries, or pelvic sidewalls.

The material conforms to the underlying anatomy and prevents tissue adherence.

Advantages

Reduces adhesion formation significantly.

Improves fertility outcomes in women undergoing endometriosis surgery.

Biocompatible and safe, with no long-term foreign body reaction.

Limitations

Ineffective in the presence of active bleeding.

Must be handled carefully to prevent folding or displacement.

Adds to the cost of surgery.

Combined Role in Endometriosis Management

Using fulguration or ablation followed by application of Interceed provides a comprehensive treatment strategy:

Lesion Destruction – Fulguration and ablation eliminate visible endometriotic implants, reducing pain and disease burden.

Prevention of Adhesions – Interceed minimizes postoperative adhesions that could compromise fertility or cause recurrent pain.

Preservation of Fertility – These techniques, when carefully applied, maintain ovarian reserve and tubal function.

Improved Symptom Control – Patients report reduced pelvic pain and dysmenorrhea post-surgery.

Postoperative Care

Patients are usually discharged within 24–48 hours.

Analgesics are prescribed for pain management.

Hormonal therapy may be recommended to suppress recurrence.

Follow-up includes monitoring for recurrence of symptoms and evaluation of fertility status.

Conclusion

Endometriosis fulguration, ablation, and application of Interceed together form an effective minimally invasive strategy to manage pelvic endometriosis. While fulguration and ablation focus on destroying visible implants, Interceed prevents the adhesions that often complicate surgical recovery. This combined approach not only relieves pain but also enhances fertility outcomes, making it a valuable option for women of reproductive age.

Careful patient selection, meticulous surgical technique, and use of adhesion barriers ensure the best possible results. As laparoscopy advances, these methods continue to play a vital role in improving the lives of women suffering from endometriosis.