Robotic Laparoscopic Excision of Endometriosis

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Sometimes normal uterine lining (endometrial) cells seep through the fallopian tubes and implant into and proliferate through the inner coating of the pelvis (peritoneum). This results in different degrees of irritation of the pelvic peritoneum, causing pelvic pain. Such a phenomenon is called endometriosis.

It is estimated that approximately 10% of women in their reproductive years, or nearly 90 million women world-wide, suffer from endometriosis.

The fact is that there is no way to establish accurate figures because the only way to confirm
a diagnosis is by performing a surgical procedure, usually via laparoscopy. Since at least 10% of women have endometriosis, it is one of the most common diseases worldwide; it is even more common than HIV/AIDS and cancer. In addition to affecting the lining of the pelvis, endometriosis may also affect one or more of the pelvic organs, including the uterus (adenomyosis), tubes, ovaries, bowel and bladder. Endometriosis may cause the formation of large ovarian “chocolate” cysts (endometriomas), pelvic adhesions/scarring, infertility, and bowel and bladder dysfunction. Sometimes, it may even invade bladder, bowel and other pelvic structures, causing severe complications.

Pain is the main symptom of endometriosis and women often experience chronic pelvic pain, painful periods, and/or painful intercourse. Pain is perceived by the brain when endometriosis invades the nerves that supply the pelvis. Prostaglandin activity in the uterus also aggravates deposits of endometriosis in the abdomen and pelvis causing significant pain. Ultimately, estrogen promotes growth and expansion of endometriosis. Therefore, the mainstay of treatment is aimed at counteracting or eliminating the effects of estrogen and prostaglandins.

Conservative treatment of endometriosis should be attempted first and surgery is the last resort after exhausting conservative options. A minimally invasive surgical option includes Laparoscopic Excision of Endometriosis and the pelvic adhesions it may form. Uterine and pelvic innervations travel through particular ligaments called the uterosacral ligaments, which are located adjacent to the uterus and are usually accessible during laparoscopic surgery. Sometimes LUNA(Laparoscopic uterine nerve ablation) is performed as well during laparoscopy and involves resection of the uterosacral ligaments and nerves. If pelvic adhesions are severe and involve/invade the bowel and/or bladder, additional concomitant procedures may be required. Sometimes assistance from a Urologist or Colorectal surgeon is requested. A Urologist can place illuminating ureteral stents to aid in identification of the ureters and decrease the risk of injury. A Colorectal surgeon can perform a proctosigmoidoscopy and possible bowel surgery. Laparoscopic excision or laser ablation of endometriosis is the recommended approach if the patient wishes to preserve her fertility/pregnancy potential.

Learn more about Endometriosis and the available treatment options.