Expert advocates patient-assisted laparoscopy. (Said to Help Pinpoint Location of Pain).

MONTREAL -- Keeping pelvic pain patients fully conscious during laparoscopy can be very useful to physicians who are trying to locate the source of that pain, according to one specialist.

"The current standard of care is to anesthetize the patient and then assume that any pathology we see during the laparoscopy is the source of her pain. But you would be surprised how often this is the wrong assumption," Dr. Larry Demco said at the 11th World Congress on Human Reproduction.

Dr. Demco of the University of Calgary (Alta.) described his experience performing about 350 patient-assisted laparoscopies (PALs) in which laparoscopic pain mapping was done while the patient was fully conscious.

In one study of 100 patients, only 5% had negative findings (meaning no explanation of their pain) after PAL, compared with the generally accepted negative finding rate of 35% in pelvic pain patients undergoing anesthetized laparoscopy (JSLS 1[4]:319-21, 1997).

One of the advantages of PAL is that it gives a keener sense of the location of patients' pain, which is often quite different from where they describe it.

"We have found that one-third of patients have referred pain, so their pain may be on the left, but we may find the endometriotic lesion on the right," he said in an interview.

In a comparison of PAL in 225 pelvic pain patients and 100 controls with no pelvic pain who were undergoing tubal sterilization or infertility investigations, pain sensation in both groups was often perceived in unexpected ways.