Endometriosis is a very prevalent disease worldwide, affecting about 170 million women. Endometriosis constitutes a medical condition where tissue, the lining of the uterine cavity, is found outside the uterine cavity. The lining of the uterine cavity, also called endometrium, leaves the uterus by means of retrograde menstruation during monthly menses. The most common location of endometriosis (endometriotic implants) is outside the uterus in the most dependent areas of the pelvis such as the ovaries, fallopian tubes, and the peritoneum. Also, occasionally the intrauterine tissue can be found on bowel or bladder.
Who should contact the doctor
If you have symptoms associated with endometriosis, you need to contact a physician who can help you first diagnose and then treat the medical condition. Depending on the extent of your symptoms, the doctor may initiate the treatment with more conservative measures such as oral contraceptive pills. If birth control pills are not effective, the next option may include intrauterine device containing hormones to decrease the cramps associated with endometriosis. Next option in the treatment of endometriosis entails surgical management which depends on the severity of the disease. To determine which surgical option would be the most effective, the most accurate method include diagnostic laparoscopy to visualize endometriosis. In cases involving endometriosis on the layer (lining) of the pelvis, one can consider excision of the endometriotic lesions. Various techniques are available to excise endometriosis and include bipolar or unipolar energy or laser beam energy.
Surgery for Endometriosis
Endometriosis surgery is performed to reduce pelvic and abdominal pain by removing all visible endometriotic lesions and any associated adhesions. Surgical procedures that may be performed during an operative laparoscopy or robotic procedure include:
- removal or destruction of endometriotic implants
- removal or destruction of ovarian cyst (endometriomas)
- removal of adhesions
- removal of the uterus (hysterectomy)
- removal of peritoneum
daVinci (Robotic Surgery)
Endometriotic lesions are more visible using robotic technology because of better visualization and magnification of surgical image; therefore daVinci robotic use became more popular in diagnosis and treatment of endometriosis in recent years. Combination of flexible CO2 laser fiber with robotic platform enables very precise approach to endometriosis treatment. Used together give an excellent opportunity to visualize, fulgurate and excise endometriotic lesions. An additional benefit of the combination of daVinci technology with the flexible CO2 laser fiber is the superb access to most intricate areas in the pelvis. The flexibility of robotic instruments enables lysis of adhesions and excision of pelvic structures. Because of much better visualization more endometriotic lesions are resected giving much better and longer lasting outcomes of treatment. Additional improvement of surgical management includes the use of Firefly technology which provides a good visualization of key anatomical landmarks. Near-infrared technology enables a more accurate approach to lesions of interest during daVinci procedure.