***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery  compared with placebo surgery . DESIGN A r and omized , blinded , crossover study . SETTING A tertiary referral unit in a district general hospital . PATIENT(S ) Thirty-nine women with histologically proven endometriosis completed the 12-month study . INTERVENTION(S ) Women were r and omized to receive initially either a diagnostic procedure ( the delayed surgical group ) or full excisional surgery ( the immediate surgery group ) . After 6 months , repeat laparoscopy was performed , with removal of any pathology present . MAIN OUTCOME MEASURE(S ) The end points were changes from baseline values of visual analogue pain scores , vali date d quality -of-life instruments ( EQ-5D and SF-12 ) , and sexual activity question naire scores . Patients and assessors of outcomes were blinded to the treatment-group assignment . RESULT ( S ) Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo : 16 of 20 ( 80 % ) vs. 6 of 19 ( 32 % ) ; chi(2)(1 ) = 9.3 . Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo .  Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45 % of cases , with disease remaining static in 33 % and improving in 22 % of cases . Nonresponsiveness to surgery was reported in 20 % of cases . CONCLUSION ( S ) Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life . Surgery is associated with a 30 % placebo response rate that is not dependent on severity of disease . Approximately 20 % of women do not report an improvement after surgery for endometriosis Background Endometriosis is the presence of endometrial gl and s and stroma in sites other than the uterine cavity , which is associated with infertility . The objective of this study was to evaluate the effect of laparoscopic surgical treatment on clinical pregnancy in infertile women with minimal or mild endometriosis . Material s and Methods This clinical trial study was performed in infertile women who were referred to the gynecological clinic between April 2008 and March 2009 . After confirmation of minimal or mild endometriosis by diagnostic laparoscopy , patients were r and omly assigned into two groups using consecutively numbered , opaque sealed envelops . The first group consisted of women who only underwent diagnostic laparoscopy ( no treatment ) before r and omization . The second group of patients underwent operative laparoscopies . T-test and chi-square test were used when appropriate . A p-value less than 0.05 was considered statistically significant . Results Analysis with 38 patients in each group showed characteristics such as age , body mass index ( BMI ) , and duration of infertility were statistically similar in both groups . At 9 months follow- up , 9 ( 24 % ) women who had operative laparoscopies became pregnant compared with 7 ( 18 % ) women in the diagnostic laparoscopy group . The pregnancy rate showed no statistically significant difference between both groups ( p=0.49 ) . No complications were reported in either group . Conclusion The present study suggested that laparoscopic surgical treatment was not superior to diagnostic laparoscopy in pregnancy occurrence in infertile women with minimal and mild endometriosis . ( I RCT Number : I RCT 201012311952N2 ) Objective : We report the first r and omized trial of laparoscopically assisted versus open colorectal resection for endometriosis focusing on perioperative complications , improvement in symptoms , quality of life , and fertility . Summary of Background Data : Bowel endometriosis is one of the most severe forms of endometriosis . Although laparoscopically assisted surgery is a vali date d technique for colorectal cancer , there are serious concerns about its appropriateness for endometriosis in young women wishing to conceive because it is almost invariably a traumatic procedure . Methods : We conducted a noninferiority trial and r and omly assigned 52 patients with colorectal endometriosis to undergo laparoscopically assisted or open colorectal resection .  The median follow-up was 19 months . The primary end point was improvement in dyschesia . Results : Overall , a significant improvement in digestive symptoms ( dyschesia P < 0.0001 , diarrhea P < 0.01 , and bowel pain and cramping P < 0.0001 ) , gynecologic symptoms ( dysmenorrhea P < 0.0001 and dyspareunia P < 0.0001 ) , and general symptoms ( back pain P = 0.001 and asthenia P = 0.0001 ) was observed . No difference in the symptom delta values and quality of life was noted between the groups . Median blood loss was lower in the laparoscopic group ( P < 0.05 ) . Total number of complications was higher in the open surgery group ( P = 0.04 ) , especially grade 3 ( P = 0.03 ) . Pregnancy rate was higher in the laparoscopic group ( P = 0.006 ) , and the cumulative pregnancy rate was 60 % . Conclusion : Our findings support that laparoscopy is a safe option for women requiring colorectal resection for endometriosis . Moreover , laparoscopy offers a higher pregnancy rate than open surgery with similar improvements in symptoms and in quality of life OBJECTIVE To compare reduction of pain following laparoscopy after ablation or excision of endometriosis . DESIGN A prospect i ve , r and omized , double-blind study . SETTING Endometriosis and pelvic pain clinic at a university teaching hospital . PATIENT(S ) Women of reproductive age presenting with pelvic pain and visually proved endometriosis . INTERVENTION(S ) Subjects completed a question naire rating their various pains using visual analogue scales ( VASs ) . After visual identification subjects were assigned r and omly to treatment with ablation or excision by supervised training gynecologists as primary surgeon . Follow-up question naires at 3 , 6 , 9 , and 12 months documented pain levels . MAIN OUTCOME MEASURE(S ) Change in overall pain VAS score at 12 months after operation . RESULT ( S ) There was no significant difference in reduction in overall pain VAS scores at 12 months when comparing ablation and excision . CONCLUSION ( S ) This study has not been able to demonstrate a significant difference in pain reduction between ablation and excisional treatments . Nonsignificant trends suggest that a larger study may find a difference in outcomes looking at dyspareunia or dyschezia OBJECTIVE To assess the efficacy of laser laparoscopic surgery in the treatment of  pain associated with minimal , mild , and moderate endometriosis . DESIGN A prospect i ve , r and omized , double-blind , and controlled clinical study . SETTING Royal Surrey County Hospital , Guildford , United Kingdom , a referral center for the laser laparoscopic treatment of endometriosis . PATIENTS Sixty-three patients with pain ( dysmenorrhoea , pelvic pain , or dyspareunia ) and minimal to moderate endometriosis . INTERVENTIONS The patients were r and omized at the time of laparoscopy to laser ablation of endometriotic deposits and laparoscopic uterine nerve ablation or expectant management .  Pain symptoms were recorded subjectively and by visual analogue scale . The women were unaware of the treatment allocated as was the nurse who assessed them at 3 and 6 months after surgery . MAIN OUTCOME MEASURE Improvement or resolution of pain symptoms assessed subjectively and by visual analogue score . RESULTS Laser laparoscopy results in statistically significant pain relief compared with expectant management at 6 months after surgery . Sixty-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6 % in the expectant group . Results were poorest for minimal disease and , if patients with mild and moderate disease only are included , 73.7 % of patients achieved pain relief . There were no operative or laser complications . CONCLUSIONS Laser laparoscopy is a safe , simple , and effective treatment in alleviating pain symptoms in women with stages I , II , and III endometriosis In order to analyse the efficacy of resection/ablation of minimal/mild endometriotic lesions for improving fertility , we conducted a r and omized clinical trial . Eligible patients were women aged < /=36 years who were trying to conceive and had a laparoscopically confirmed diagnosis of minimal/mild endometriosis ( stage I or II of the revised American Fertility Society classification ) and otherwise unexplained infertility for > /=2 years . Eligible women were r and omly assigned to resection or ablation of visible endometriosis ( 54 patients ) or diagnostic laparoscopy only ( 47 patients ) . After laparoscopy women tried to conceive spontaneously for 1 year ( follow-up period ) . A total of five women withdrew from the study : three for personal reasons , and two were lost to follow-up . Considering 51 women in the resection/ablation and 45 in the no-treatment group who ended the follow-up period , 12 ( 24 % ) in the resection/ablation group and 13 ( 29 % ) in the no treatment group conceived ; the difference was not significant . Two spontaneous abortions were observed in the resection/ablation group and three in the no-treatment one . Thus the 1 year birth rate was 10 out of 51 women ( 19.6 % ) in the resection/ablation group and 10 out of 45 women ( 22.2 % ) in the no-treatment group . In conclusion , the results of this study do not support the hypothesis that ablation of endometriotic lesions markedly improves fertility rates BACKGROUND Minimal or mild endometriosis is frequently diagnosed in infertile women . It is often treated by resection or ablation of the lesions , but whether this improves fertility has not been established . We carried out a r and omized , controlled trial to determine whether laparoscopic surgery enhanced fecundity in infertile women with minimal or mild endometriosis . METHODS We studied 341 infertile women 20 to 39 years of age with minimal or mild endometriosis . During diagnostic laparoscopy the women were r and omly assigned to undergo resection or ablation of visible endometriosis or diagnostic laparoscopy only . They were followed for 36 weeks after the laparoscopy or , for those who became pregnant during that interval , for up to 20 weeks of pregnancy . RESULTS Among the 172 women who had resection or ablation of endometriosis , 50 became pregnant and had pregnancies that continued for 20 weeks or longer , as compared with 29 of the 169 women in the diagnostic-laparoscopy group ( cumulative probabilities , 30.7 percent and 17.7 percent , respectively ; P=0.006 by the log-rank test ) . The corresponding rates of fecundity were 4.7 and 2.4 per 100 person-months ( rate ratio , 1.9 ; 95 percent confidence interval , 1.2 to 3.1 ) . Fetal losses occurred in 20.6 percent of all the recognized pregnancies in the laparoscopic-surgery group and in 21.6 percent of all those in the diagnostic-laparoscopy group ( P=0.91 ) . Four minor operative complications ( intestinal contusion , slight tear of the tubal serosa , difficult pneumoperitoneum , and vascular trauma ) were reported ( three in the surgery group and one in the control group ) . CONCLUSIONS Laparoscopic resection or ablation of minimal and mild endometriosis enhances fecundity in infertile women OBJECTIVE To assess whether infertile women with minimal or mild endometriosis have lower fecundity  than women with unexplained infertility . DESIGN Prospect i ve cohort study . SETTING Twenty-three infertility clinics across Canada . PATIENT(S ) Three hundred thirty-one infertile women aged 20 - 39 years . INTERVENTION(S ) Diagnostic laparoscopy for infertility . Infertile women with minimal or mild endometriosis ( n = 168 ) were compared with women with unexplained infertility ( n = 263 ) . Both groups were managed expectantly . The women were followed up for 36 weeks after the laparoscopy or , for those who became pregnant , for up to 20 weeks of the pregnancy . MAIN OUTCOME MEASURE(S ) Fecundity refers to the probability of becoming pregnant in the first 36 weeks after laparoscopy and carrying the pregnancy for > or = 20 weeks . The fecundity rate is the number of pregnancies per 100 person-months . RESULT ( S ) Fecundity was 18.2 % in infertile women with minimal or mild endometriosis and 23.7 % in women without endometriosis ( log-rank test ) . The fecundity rate was 2.52 per 100 person-months in women with endometriosis and 3.48 per 100 person-months in women with unexplained infertility . The crude and adjusted fecundity rate ratios were 0.72 and 0.83 ( 95 % confidence interval = 0.53 - 1.32 ) , respectively . CONCLUS 
    Output:
    
There is moderate quality evidence that laparoscopic surgery to treat mild and moderate endometriosis reduces overall pain and increases live birth or ongoing pregnancy rates .