Endometriosis is, unfortunately, a disease that affects one of the most unrecognized parts of a woman’s life, her period. It is a very personal and intimate aspect of women’s health, particularly considering its involvement with menstruation. Endometriosis can thus be thought of as a disease of menstruation in a woman’s life. It is mostly unrecognizable, misdiagnosed, and very often mistreated. For these reasons, it is important to be an advocate for one’s own health. Patients must feel comfortable and unafraid to ask their provider questions to ensure proper diagnosis and treatment.
In terms of diagnosis, it is widely agreed that the only way to formally diagnose endometriosis is through laparoscopy. However, when it comes to treatment, there are many options a patient can consider. First and foremost, it is important to understand that there is no cure for endometriosis, but it is treatable. What this means is that while there is no definitive way to ensure one’s endometriosis will never return once treated, there are effective ways to treat the disease itself to relieve the symptoms and reduce one’s risk of experiencing further development of the disease. Laparoscopic excision surgery is the gold standard for doing this.
While there are many non-surgical treatment options, ranging from holistic approaches such as diet changes to hormonal therapy in the form of birth control, surgery is the most definitive way to treat endometriosis. Surgery focuses on the endometriosis lesions themselves, whereas non-surgical methods tend to look for short-term symptom prevention. Surgery, however, should not be performed without a recommendation from one’s OB/GYN or without the patient’s comfort and consent. For these reasons and the mysteries still surrounding the etiology of endometriosis, it is important for patients to fully understand the nature of the surgery they undergo, particularly why excision surgery is the most preferred technique.
What Is Laparoscopic Excision Surgery?
Laparoscopic excision surgery is a procedure in which endometriosis lesions are “cut-out” individually using a laparoscopic visual aid. It is modeled after the mastectomy procedure used in breast cancer operations, which removes all damaged, cancerous tissue in the breast. Like the former, excision aims to remove all diseased tissue in its entirety, in order to prevent future growth and spreading of endometriosis tissue, while also preserving healthy tissue surrounding the lesions removed. Using laparoscopy for visualization, surgeons are able to navigate throughout the abdominal and pelvic cavity and excise suspected endometriosis lesions using cold excision clippers. These specimens are then collected and sent to pathology to confirm the extent of the disease. This laparoscopic excision technique is the most preferred method of endometriosis surgery for a number of reasons.
The Advantages Of Excision Surgery
1. Ensures Each Endometriosis Lesion Is Removed Completely
The first advantage of excision surgery lies in the fact that it removes each suspected endometriosis lesion in its entirety, which cannot be said of such procedures as fulguration and laser ablation. Proper surgical removal of endometriosis can be thought of as an iceberg. While appearing very large above the surface of the water, the iceberg is actually only ⅓ of its actual size. The majority of the mass lies beneath the surface of the water. An endometriosis lesion can be thought of in the same way.
Many surgeons will perform “endometriosis surgery,” but their techniques will only remove the surface region of the disease while leaving the endometriosis lying underneath very much intact. It increases the likelihood that symptoms will resurface following surgery as disease can re-grow and further spread.
In “deep-excision” surgery, the lesion is removed fully, including below the surface. This is the only way to truly guarantee the removal of each lesion, and thus gives patients their best chance of symptom relief and prevents the further spread of the disease.
2. Allows For A Pathology Report
Another advantage of excision surgery is that it preserves the lesion itself, allowing for specimen culture and study. By collecting the lesion, surgeons are able to ship the culture off to pathology, where another well-experienced physician can confirm if the tissue is indeed positive for endometriosis, as well as the severity. This is the only way to concretely diagnose endometriosis. This meticulous study requires the suspected endometriosis not only be removed but also preserved to the best of the surgeon’s ability. “Cold excision” surgery stresses the importance of this. It aims to use minimal electricity, only utilizing high levels of heat under copious irrigation for cauterization purposes (prevent bleeding), and not for the removal of the lesions themselves.
If surgery is the right choice for you, then “cold excision” with an accompanying pathology report is what every endometriosis patient both needs and deserves.
Other endometriosis surgery techniques, such as fulguration and laser ablation, use electricity and heat to destroy the endometriosis itself. This can be harmful to the surrounding healthy tissue and it does not fully remove the endometriosis lesion that lies beneath the surface. Most importantly, it prevents the sample from being collected. Thus, no pathology report is often obtained in these types of procedures. For financial and personal reasons, endometriosis surgery is not something a patient wants repeated. Therefore, it is important to be meticulous in one’s choice of surgery.
3. Focuses On Sparing No Organ
The last factor that makes excision surgery worthwhile is its ability to promote “team surgery.” Endometriosis can affect a variety of organs, both reproductive and non-reproductive. For this reason, more severe endometriosis cases can be a multi-specialty surgery. Each organ that has been infiltrated must be reviewed, repaired, and preserved pertaining to said organ’s unique function and anatomy.
The insight of each expert in the organ’s function is highly beneficial.
Urologists and gastrointestinal specialists are some of the most common specialists working under the direction of the primary gynecological surgeon in endometriosis cases. The endometriosis surgeon will still be operating on all affected organs, but to have the referral of the other specialists is very much needed in severe cases of deep infiltrating endometriosis. Without other specialists on hand, the surgeon may not be trained to operate on said areas and the non-reproductive organs that are affected may go untreated. By promoting the repair, reconstruction, and restoration of affected organs, excision surgery highlights the great need and use of a “team surgery” dynamic.
While there is still much research needed to understand how to properly diagnose and treat endometriosis, there are still effective treatment options that exist. Birth control and holistic approaches can be good short-term ways of improving one’s symptoms, making note that what works best for some may not be as effective for others. However, laparoscopic surgery is the only definitive way to treat the endometriosis itself, with excision surgery being among the most effective. It focuses on removing suspected diseased tissue and inflammation, allowing the surgeon to remove each lesion fully, preserve the specimen for an accompanying pathology report, and utilize a form of “team surgery” enabling proper repair and restoration of non-reproductive organs that are affected.
While excision surgery strives to be highly thorough its form of operative treatment, it is important to note that no surgery guarantees with certainty a total relief from endometriosis. This is why it is still so important for further funding and research on such unrepresented diseases such as endometriosis. Nevertheless, it is key to not lose hope in this battle and remember that there are effective forms of treatment with excision surgery being the “gold standard.”