Laparoscopic Excision of Endometriosis
Laparoscopic Excision of Endometriosis
The diagnosis of endometriosis only requires that the surgeon look surgically, usually by laparoscopy. Like anything else in medicine, there can be false-positives and false-negatives. Sometimes a lesion can look classic for endometriosis and on pathology exam there is no endometriosis seen. Other times there can be a lesion that is very subtle and easy to miss, and on Pathology it is confirmed to be endometriosis. With laparoscopic excision, all areas of suspected endometriosis are excised completely down to normal tissue with adequate margins, and all specimens are sent to Pathology for confirmation. In addition to an excellent chance for long-term pain relief and minimizing the need for repeat surgeries, with excision you get to know what you do and do not have. This way a person is not labeled with a condition that they may not actually have.
Sometimes all specimens come back negative for endometriosis, but the patient feels fine. As long as you get pain relief, then it really doesn’t matter if we understand it. I excise areas that look abnormal, areas that are scarred and fibrotic, and/or are in locations that could explain the distribution of pain that the patient is experiencing. Sometimes, most or all of the specimens come back positive for endometriosis, but the patient still has pain. In these cases there may be some other factor that is responsible for their pain. If pain is not due to endometriosis, then laparoscopic excision will not help your pain. If their pain is due to endometriosis, then they may achieve the pain relief they are hoping for. The only way to find out is to look with laparoscopy.
Pelvic floor muscles respond to chronic pain conditions, so even after disease is thoroughly removed some patients need Physical Therapy / Biofeedback. Physical Therapy has a better chance of being successful after the underlying cause for the pain is removed.
Frequently Asked Questions About Laparoscopic Excision of Endometriosis
What is laparoscopic excision of endometriosis?
There are four options for treating endometriosis with laparoscopic surgery which include: 1) laser vaporization, 2) electrical cautery/fulguration, 3) ultrasonic coagulation, or the most effective, 4) laparoscopically excising the endometriosis by means of going around, underneath, and completely removing the endometriosis and fibrosis entirely. This last option, laparoscopic excision of endometriosis, is the specialty of Dr. Robbins, head surgeon of the New England Center for Endometriosis.
Why is laparoscopic excision of endometriosis the best option for surgically removing the endometriosis?
Endometriosis starts out superficial in the lining of the body cavity. Endometriosis will then invade progressively deeper into the tissues. Endometriosis invades deeper than superficial application of laser or electrical energy penetrates. These treatment options leave recurring pain for the patient (because the endometriosis never actually left the body), and the patient ends up with surgery after surgery. Almost all centers that specialize in endometriosis, in and out of the USA, perform laparoscopic excision. Excision gives the best chance for long-term pain relief, and minimizes the need for repeat surgeries. There can be subclinical endometriosis in the tissues beyond the visible border of the endometriosis implant. With excision Dr. Robbins always tries to take adequate margins.
What are endometriotic lesions and how can laparoscopic surgery help?
As endometriosis invades progressively deeper into the tissues, the endometriotic lesions will bleed into themselves, creating a blood-filled cyst, or endometrioma ("endometri" refers to endometriosis, and "oma" means new growth). Ovarian endometriomas do not occur as isolated findings, and there is usually endometriosis involving the pelvic sidewalls and ligaments that needs to be excised. It is necessary for the surgeon to excise the cyst wall from the ovary, and repair the ovary, to have the best chance of saving the ovary and avoiding recurrence of the endometrioma.
What are "adhesions" in endometriosis?
The most common surgical finding of endometriosis is the fibrosis and scarring ("adhesions") it leaves behind. If adhesions are felt to be due to previous surgery, then the adhesions can be just divided. If adhesions are felt to be related to endometriosis, then it is necessary for the surgeon to come around both sides of adhesions and take the scarring/adhesions as specimen.
Do you have a question about your endometriosis and how laparoscopic surgery could help?
Let us know using this form. Dr. Robbins will be happy to answer any questions you have about your endometriosis today.