One in fifteen women have endometriosis, a prevalent condition that eventually necessitates surgery due to symptoms or abnormal ultrasound results. It is crucial to understand two things before having endometriosis surgery: first, if you absolutely need it now or if you can wait; and second, whether your surgeon has the expertise necessary to do advanced endometriosis surgery.
1.Does this Endometriosis surgery certainly need to be done now, or can wait?
As a Minimally Invasive Gynecological Surgeon with years of experience treating endometriosis cases on a daily basis, I sometimes feel that some cases of endometriosis surgery can be postponed, particularly in adolescents and in women who have already undergone surgery a few times.
It is great that nowadays there are more endometriosis awareness programs and public knowledge about endometriosis than ever before. On the bright side, this somewhat shortened the typical delay of 7 to 10 years in diagnosis of this condition, but on the downside side, many women with pelvic pain being scheduled for diagnostic laparoscopy before trying with proper medical line of treatment. There are several posts on social media from a variety of professional and public groups, most of which advocate laparoscopy as the gold standard for diagnosing endometriosis. I do agree with this, but not always.
Most endometriosis cases can be detected using ultrasound or MRI because to increased awareness among gynecologists and radiologists educated in endometriosis. But ultrasonography or MRI are unable to determine early peritoneal endometriosis or deposits.
In my perspective, a young woman with dysmenorrhea or pelvic pain who lacks any endometriosis-related imaging shouldn’t be directly advised for a laparoscopy. In these situations, medical therapy should be attempted first, and surgery should be deferred and only be considered if medical management fails. I should emphasize that not all radiologists and gynecologists are experts at using ultrasonography to diagnose endometriosis unless they have had particular training or have a keen interest in doing so. Therefore, if the scan is not performed by specialists in that subject, there is a good potential that the diagnosis of endometriosis might even be missed.
2.Does the Gynecological surgeon and team has the necessary expertise to do complex endometriosis surgery?
Unfortunately, there is no internationally accepted definition of an “endometriosis specialist”.
Most General obstetricians and gynecologists who deliver babies are typically only qualified to perform minor laparoscopic procedures for gynecological emergencies such tubal pregnancy, ovarian torsion, and straightforward gynecological procedures. Most operate 1 or 2 days per month and do fewer than 10 gynecologic operations annually; this experience is many a times not sufficient to perform even simple endometriosis cases.
It takes years of special training or a fellowship in minimally invasive surgery to become an advanced minimally invasive gynecological surgeon. After their training, the majority of these surgeons devote their entire practice to gynecology and rarely perform obstetric procedures ( delivering babies).
It takes more than just training or a fellowship to make a competent surgeon. Fine surgery, like any other skill, results from a surgeon refining such skills over years of practice performing more laparoscopic procedures.
Numerous studies have demonstrated that, High-volume surgeons demonstrate reduced perioperative complications, shorter operative times, and reduced blood loss during multiple modalities of benign gynecologic surgery. Furthermore, high-volume surgeons consistently demonstrate higher rates of minimally invasive approaches, low rates of conversion to laparotomy, and lower per-procedure case costs.
When it comes to endometriosis surgery, always the first surgery should be the best surgery with excision of all the possible endometriotic lesions. The symptom relief and recurrence of the disease is very much dependent on the expertise of the surgeon.
Why Consult an Endometriosis Expert Before Making a treatment Decision?
It is important to seek the advice from a specialist in endometriosis because they are more knowledgeable about this condition, and they will be able to provide various treatment recommendations. An experienced endometriosis surgeon can also help you understand your diagnosis, prognosis, and treatment options. They can also help you with your emotional needs during this difficult time. Finding a skilled endometriosis surgeon who can assist you in receiving the finest care for your illness is crucial.
Dr. Alphy S Puthiyidom
Head of the Department
Advanced Gynecological Laparoscopic Surgeon
& Pelvic Reconstructive Surgeon
MEDICLINIC WELCARE HOSPITAL
Al Garhoud, Dubai
MEDICLINIC PARKVIEW HOSPITAL
Umm Sequim, Al Barsha South 3, Dubai