What is the best way to surgically treat endometriosis?
Endometriosis Excision Surgery, also, known as Laparoscopic Deep-Excision Surgery, is the gold standard of endometriosis treatment and is the most effective surgical means of treating endometriosis because it offers the longest symptomatic relief.
What does "laparoscopic surgery" mean?
Laparoscopy enables a surgeon to visualize the abdominal/pelvic cavity using an instrument known as a laparoscope. A laparoscope is a long, thin tube with a telescopic lens, multiple light sources, and a miniature video camera. This device is inserted into the abdomen and pelvic cavity through small incisions. The video from this device is projected onto a large monitor set-up across from surgeon, on the other side of the patient, so they can get a clear visualization into the pelvic region. Thus during laparoscopic surgery, the surgeon is able to get a clear image of inside the abdomen and pelvis, while they operate on the patient.
What is Excision Surgery?
In concise terms, true excision allows the surgeon to safely and successfully remove the disease - from all areas - with minimal risk of damage to underlying vital structures. Utilizing sharp dissection and laparoscopy for visualization purposes, the surgeon is able to thoroughly eradicate all forms of Endometriosis (including deeply infiltrating) and adhesions. The outcome is restored fertility, reestablishment of normal pelvic anatomy, and eradication of symptoms. Excision can be performed with any surgical tool, depending on the surgeon's preference.
Are there non-surgical ways to treat Endometriosis?
Primary care physicians will often prescribe medication as a form of conservative treatment for endometriosis, before referring patients to a referral center such as us. Like with all drugs, some patients find relief with medication, while others do not. It is truly a case by case basis. Nevertheless, these drugs usually only provide patients with temporary symptom relief at best. But they can be useful when used following a thorough and successful excision surgery, in order to ensure full relief of symptoms, with low risk of return. Thus the following medications and methods should be seen as additional treatment options that can be utilized pre or post surgery, as opposed to substitutes for surgical treatment.
- Pain medication: Painkillers are drugs that are supposed to "kill the pain." They are most often the option that many doctors and patients elect to try first to provide temporary relief. Nonsteroid anti-inflammatory drugs such as ibuprofen are amongst the most common. Narcotics can also be prescribed in more severe cases, but these bring the risk of dependency and addiction and are thus not recommended if the patient finds they have no effect, their pain has gone away, their side effects are worse than their symptoms or they need to take a higher dosage.
- Progesterone antagonist (hormone therapy): Progesterone is a hormone released from the ovaries, whose changing levels dictate menstrual periods. Because a high rate of retrograde menstruation is one of the believed primary causes of endometriosis, controlling this process through progesterone agonist drugs can be very useful, especially in cases of fibroids. This can be taken via oral medication, injection or even as an intrauterine device (IUD) such as the Mirena coil.
- Birth control: These pills, most of which contain the hormones estrogen and progestin, prevent a woman's ovaries from performing ovulation. Thus taking these pills can reduce the heavy bleeding that an endometriosis patient may experience during her period. This will also decrease retrograde menstruation, a probable cause of endometriosis.
- Nutrition: Like medication, a diet that works well for one patient may not for another. If part of your body is telling you that it doesn't want a certain food, you would be smart to remove that food from your diet. Generally, endometriosis patients should consider cutting out inflammatory foods such as white sugar, dairy products common cooking oils, trans fats, deep-fried foods, processed foods, red meat, alcohol, and wheat. While antioxidant (berries, pineapple, etc.) and organic foods are advised.
- Acupuncture: Acupuncture is a whole system of medicine based on energy flow concepts and the bodies need to maintain homeostasis (physiological balance). Pain caused by endometriosis causes an imbalance in the body, and while we are in no ways stating that this method can rid the patient of the cause of said disorder, acupuncture can be useful to relieve symptoms. In fact controlling associated pelvic pain and infertility through this method has been proven to be most effective by several scientific studies.
- Freezing eggs: Pain is not the only endometriosis symptom that one should look to provide relief to. In fact, women often discover they have endometriosis due to their inability to conceive children. Thus for women looking to have children at some point in their life, it can be very useful to freeze one's eggs early if they have a family history of endometriosis or are concerned.
So, can surgeons treat and "cure" my endometriosis?
This is a great question for clarification purposes. While there is no cure for endometriosis, there are treatment options that can help to relieve symptoms that many patients report has drastically improved their quality of life. After receiving the proper surgical treatment for their particular case, many patients have found relief from symptoms such as painful periods, GI abnormalities, painful sex, painful bowel movements and even in some cases, infertility. Nevertheless, endometriosis treatment is a field that still requires a great deal of research, which is why there is never a sure guarantee of relief of symptoms when treating endometriosis.
What is Our Approach in treating Endometriosis?
Unfortunately, women and girls are often left to "manage" discomfort from their Endometriosis with powerful painkillers and hormones, which merely mask the disease. Moreover, many patients are incorrectly informed by their doctors and treated for symptoms but not the actual disease, which consequently causes a long delay in effective treatment. This has led to many "hit or miss" surgeries with high recurrence rates and sadly, thousands of unnecessary hysterectomies.
We believe that early diagnosis and intervention is the best approach. Because of our unique, specialized training and skill, we are able to effectively diagnose, manage and treat Endometriosis through the gold standard method of advanced laparoscopic deep excision surgery. Laparoscopic excision surgery is an effective, less invasive option, which confers the maximum results for total removal of all disease.
How do we provide "minimally invasive surgery"?
The term "minimally invasive surgery" is thrown around quite commonly in the field of reproductive surgery. As a patient, it is important to ensure that your surgeon is able to both come up with a form of treatment that is most effective for you, while also ensuring minimal invasion.
We believe that robotic surgery is never the way to treat your endometriosis. Though it may be on the forefronts of minimally invasive technological development, we consider robotic surgery to be the "the most maximally invasive" form of minimally invasive surgery. This is because it typically requires more incision sites that are larger in diameter than in normal excision surgery. On top of this, there is a larger rate of robotic error than with humans. In fact, in an article from 2011's Journal for Healthcare Quality researchers from John Hopkins University found that promotional materials on robotic surgery listed on hospital websites generally overstated the benefits of robotic surgery, ignored the associated risks and may have been influenced by manufacturers. For these reasons, we strongly believe that hand done incisions and excision surgery are the proper way to ensure our patients the minimally invasive surgery that they deserve.
How do we make sure we excise all endometriosis lesions?
Using our patented Aqua Blue Contrast (ABC) technique, we ensure no endometriosis lesion goes undetected. To a surgeon's eye, this aqua blue contrast makes endometriosis "shine" like stars in the night sky. Thus by administering ABC during surgery, we are able to clearly identify and thus excise all believed endometriosis scar tissue.
How do we ensure we excise a sample of endometriosis scar tissue fully?
One of the key aspects of surgically removing endometriosis that is often overlooked amongst surgeons is the need to remove endometriosis lesions in their entirety. When surgeons conduct procedures such as laser ablation (use of a laser beam) and fulguration (use of electricity to produce heat) in order to "destroy" these lesions, they are only removing the scar tissue from a superficial level, not the nodule. Endometriosis lesions usually extend far deeper down than just the surface of the tissue and it is crucial that the nodule is removed in its entirety if the patient is truly going to have a relief of symptoms.
In the most simplistic of analogies, one can think of an iceberg. Picturing the peak, one can visualize the removal of the iceberg's bulk above the water. "Shaving" off the top of the iceberg would appear to leave behind a smooth surface. What actually occurs, however, is that the largest - and most dense - portion of the iceberg has been left behind beneath the surface. This is analogous to the superficial removal of Endometriosis implants through the techniques of ablation, vaporization, cauterization or fulguration. The disease is left to thrive and symptoms will recur.
By contrast, with deep excision, all of the "iceberg" - the Endometriosis nodule - is "cored" out down to the clean margins, leaving no residual disease, conferring low reoperations rates and a highly successful outcome for very long-term, Endometriosis-free relief. This is why we strongly believe there is no better method than deep excision surgery when it comes to fully removing endometriosis.
How do we preserve your anatomy through excision surgery?
Many surgeons preferred method of surgical removal is through laser ablation or fulguration. Both of these methods look to "destroy" endometriosis whether it is by means of laser beam irradiation or heat produced by high-frequency electric currents. However by conducting these type of destructive surgeries, the surgeon is not only not fully removing all endometriosis, but they are also jeopardizing surrounding healthy tissue. Also, by destroying the endometriosis scar tissue specimen, they lose the opportunity to formally confirm with pathology that the believed scar tissue does, in fact, contain endometrium tissue, thus confirming endometriosis. We believe that it is crucial to treat your body with the sensitivity and care it deserves, which includes providing our patients with a thorough and complete diagnosis along with treatment. Thus our expertise in excision surgery coupled with our strong sense of teamwork with the pathology lab, allows us to harmlessly remove all believed endometriosis lesions as well as confirm the proper diagnosis.
What is the recovery time for endometriosis surgery?
A patient's recovery period after endometriosis excision surgery will vary. A woman who undergoes a three-hour surgery to have endometriosis removed from a small area will likely recover much more quickly than a woman who has an eight-hour surgery to remove lesions from several organs. Our goal with every patient is to have them out of the hospital within twenty-four hours. We believe that it is better for patients to be moving around and getting their strength back in their home rather than in the hospital, where patients are still in proximity to other sick people.
Will we be able to relieve all pain and other symptoms?
In the end, we never promise a patient that her pain will be reduced to a specific level; no doctor can guarantee a precise result with any treatment. We don't perform miracles, and there is no magic here. We cannot control a woman's pain. But we can promise our patients that we will remove each adhesion separately and as much endometriosis as we possibly can, while not removing any organs unless it is absolutely necessary.
What do you do if my symptoms return?
There are some rare instances, where a patient's symptoms resurface. We videotape all of our surgeries so that they can be reviewed if needed and so you can get your own copy of the surgery. This is especially helpful for us if a patient's pain comes back. Step-by-step your surgeon will review the videotape with their team to try and figure out why you may still be having pain. We always do our best to ensure that patients receive the individual care and treatment that their body needs.
We pride ourselves on having a low rate of patients with symptom return. We work tirelessly the first time you walk into our office to fully understand your case. However, no one knows their symptoms more than the patient themselves. By opening up the doors of communication, patient to surgeon, we are able to come up with a proper diagnosis and treatment plan in order to ensure you have the highest chance of symptom relief. We cannot tell you how many patients come to us after having multiple surgeries elsewhere, only to have minimal relief of their symptoms. We want to work with you in order to ensure Seckin MD is your final stop in the battle against endometriosis, and the first step to that is through communication.
You may call us at 212-988-1444 or have your case reviewed by clicking here.
- Surgical Excision: "The Gold Standard Treatment for Endometriosis"
- Review My Case
- 5 Things to Do Before Your Endometriosis Surgery
- What to expect
- After Surgery
- Book: Recognizing and Treating Endometriosis
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