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What is Laparoscopic Excision of Endometriosis?

Endometriosis affects up to 10% of women between 15 and 44 and can cause a wide range of symptoms. It can negatively impact your life in many ways: severe pain, bowel and bladder dysfunction, severe fatigue, and complications with reproductive health are the most common.

Here at the Center for Advanced Gynecology, we believe that Laparoscopic Excision is the best option for increasing the chances of pain-free existence. Excision offers the lowest rates of recurrence and the lowest risk for future surgery.

In this comprehensive guide, we will delve into what laparoscopic excision entails, its benefits, and how it plays a crucial role in managing endometriosis.

What Is Endometriosis?

Endometriosis is a condition where abnormal endometrial tissue (similar to the lining of the uterus), grows outside the uterus. This can lead to severe pain, scar tissue formation, and reproductive organ complications.

Common Symptoms of Endometriosis:

  • Severe pelvic pain
  • Painful menstrual cramps
  • Painful bowel movements
  • Chronic pelvic pain
  • Painful periods
  • Other abdominal pain
  • Pain during or after sex
  • Irritable bowel symptoms
  • Painful urination
  • Pain with a full bladder
  • Infertility

Diagnosing Endometriosis

Endometriosis is notoriously tricky to diagnose, with many women undergoing a frustrating number of office visits before being diagnosed. At the Center for Advanced Gynecology we always obtain a thorough history, physical exam and do our own endometriosis-specific vaginal ultrasound unless you have had a recent MRI.  In Dr. Barron's hands, subtle signs of endometriosis can be detected on ultrasound and the disease can be ruled in.  These include findings such as nodules, adhesions between the uterus, the rectum, the bladder, the ovaries, or the pelvic sidewalls, or endometriosis cysts in the ovary.  An ultrasound cannot, however, rule out endometriosis. Ultrasound technologists at a general ob/gyn practice or a hospital are not typically trained to detect these findings.

Consider reaching out to your doctor if you have:

  • Family history of endometriosis
  • Painful menstrual periods
  • Deep pain with sex
  • Uterine abnormalities
  • The Role of Laparoscopy with Biopsy

Laparoscopy with biopsy is the most accurate way to diagnose endometriosis and is considered the gold standard for doing so. This minimally invasive procedure involves inserting a narrow viewing instrument (laparoscope) into the abdomen through a small surgical incision. With a clear and magnified view, your doctor can then view and take samples of suspicious tissue. The biopsy sample is then sent for testing, allowing for a definitive endometriosis diagnosis. HOWEVER, laparoscopy should NEVER just be about getting a diagnosis. At the Center for Advanced Gynecology we never plan for a diagnostic laparoscopy or only getting a biopsy. We strongly believe that surgery should always include a plan for full surgical resection.

Imaging and Laboratory Studies

In well-trained hands, MRI and ultrasound can diagnose endometriosis cysts (endometriomas) of the ovary and nodular disease when there are large nodules (greater than 1 cm). However, there can also be false positives. For example, ovarian cysts may not be endometrioma. Most importantly, a normal MRI or normal ultrasound does NOT rule out endometriosis!

Similarly, there are no accepted laboratory tests that can diagnose endometriosis. Instead, laboratory testing, ultrasound, and MRI are important tools for ruling out other causes of pain and infertility, as well as planning for surgery. One test that has been shown to accurately predict endometriosis in infertility patients is an endometrial biopsy looking at BCL6 level called ReceptivaDx.

What Is Laparoscopic Excision?

A valuable surgical technique, laparoscopic excision involves removing abnormal growths, scar tissue and endometriosis tissue to treat endometriosis. Similar to the laparoscopy with biopsy, this procedure is performed using a laparoscope, allowing the surgeon to visualize and operate on the affected area with minimal invasiveness.

Key Steps in Laparoscopic Excision:

  • Anesthesia: general anesthesia is administered to the patient, putting them in an unconscious and pain-free state during the procedure.
  • Incision: Small incisions (1 cm in size) are made in the abdominal region to insert the laparoscope and surgical instruments.
  • Visualization: The laparoscope provides a magnified view of the pelvic organs and allows the surgeon to identify endometriosis.
  • Excision: The surgeon uses specialized instruments to carefully excise the abnormal tissue.
  • Closure: The incisions are closed with sutures or surgical glue.

The Importance of Surgical Expertise

If a surgeon is not familiar with less obvious signs of endometriosis such as subtle tissue changes, clear lesions, and extrapelvic locations, the disease can be left untreated. Excision itself is a difficult surgical technique that requires significant training and experience.

In skilled hands, excision carefully removes problematic endometriosis tissue without damaging underlying structures or removing otherwise healthy reproductive organs (i.e. the uterus, ovaries, or parts of the colon).

Dr. Barron, the Center for Advanced Gynecology’s leading expert, most often uses a carbon dioxide laser (CO2) during treatment. This device has a very shallow penetration, allowing precision with a decreased risk of damage to underlying structures. Abnormal tissue can be removed layer by layer, limiting damage to normal tissue and decreasing the risk of postoperative adhesions and scarring.

Our laparoscopic excision is usually done with three small incisions on the abdomen. Sometimes a 4th incision is needed between the two lower incisions. Other times, surgery is done with a “robotic platform” from which ‘electro-surgical energy’ is used instead of a carbon dioxide laser to cut out endometriosis. Dr. Barron also uses a robotic platform in some cases. Both methods can equally address endometriosis.

Benefits of Laparoscopic Excision

Aside from being the most effective method for treating endometriosis, there are additional benefits to having a laparoscopic excision. These include:

Minimally Invasive Precision

Due to the precise removal of endometrial cells, your pelvic cavity and reproductive organs will be mostly untouched. The result of such a minimally invasive procedure is smaller incisions, less scarring, and a quicker recovery compared to traditional open surgery.

Reduced Pain

As someone who may already be suffering from severe endometriosis symptoms, including an irregular and painful menstrual period, pain during sex, and other chronic issues, having a minimally painful procedure is a huge relief. Excision patients typically experience less postoperative pain compared to open surgery, contributing to a smoother recovery process.

Shorter Recovery Time

The minimally invasive nature of laparoscopic excision often leads to a shorter recovery period, allowing patients to return to their routine activities sooner. Most patients go home the same day as their surgery and need 10-14 days to recover.

Laparoscopic Excision of Endometriosis FAQ

Can endometriosis be diagnosed without surgery?

The short answer is No. For the most part, endometriosis cannot be diagnosed without surgery. Laparoscopy with biopsy is the only accurate way to make a diagnosis and is considered the gold standard for diagnosing endometriosis. This fact is backed up by The American College of Obstetrician-Gynecologists, The American Society for Reproductive Medicine, and many more professionals and institutions.

How long does the surgery take?

The length of the surgery depends on how much disease is found. The average length of laparoscopic excision is between 2-3 hours, with most patients able to return home the same day. More significant growths can take longer to remove (3-6 hours) and require admission to the hospital for one or more days.

What if I have endometriosis in my intestine/bowel?

Deeply invasive endometriosis of the bowel occurs in only 10% of patients with endometriosis. Superficial endometriosis on the bowel is more common, and can be shaved off without damage to the underlying intestine and without a prolonged hospital stay.

If there is endometriosis invading the bowel wall, a segment of the intestine may need to be removed (bowel resection). This can be done laparoscopically. Dr. Barron works with a colorectal surgeon if this is needed. A bowel resection does require several days in the hospital until bowel function returns (usually 2-3 days).

Patients are often worried they may require a colostomy bag (where the intestine is diverted to the abdominal skin to allow healing from surgery in the pelvis). Rest assured, a colostomy bag is almost never needed in endometriosis surgery with skilled and knowledgeable laparoscopic surgeons.

What if I have endometriosis in my lung cavity/thoracic cavity?

Involvement of the lung cavity, or thoracic endometriosis occurs in an estimated 10% of patients with endometriosis. Symptoms are variable but most often include chest symptoms during menstruation: pain, lung collapse, blood in the lung cavity, and coughing up blood. These symptoms are typically prevalent on one side only with the right side the most common (90% of cases).

If there is suspicion for thoracic endometriosis Dr. Barron works with an experienced Thoracic surgeon to explore the lung cavity with a thoracoscopy--essentially laparoscopy in the lung cavity.

Is excision experimental or new?

Excision for endometriosis is neither new, experimental, nor investigational. It is a well-established surgical component of a multidisciplinary approach to treating the disease.

The first laparoscopic excision was performed in 1901, and is currently being taught as part of the curriculum in most of the fellowships in advanced laparoscopy accredited by the American Association of Gynecologic Laparoscopists (AAGL).

Moreover, well-established and commonly practiced treatment is crucial. If endometriosis is not removed at the time of surgery (excised), symptoms have a greater risk of persisting, even following hysterectomy and/or removal of the ovaries. Given the technically difficult and advanced surgical skills needed, we believe excision should be performed only in specialized high-volume centers by high-volume surgeons.

Is excision surgery the cure for endometriosis?

While it is nearly impossible to “cure” endometriosis, 78% of patients who undergo excision have some degree of pain relief. It is currently the best method for reducing symptoms, providing long-term relief and quality of life restoration for most patients.

Achieve Endometriosis Relief Today

1 in 10 women develop endometriosis in their lifetime, and if you believe you’re suffering from symptoms, there’s hope. The Center for Advanced Gynecology’s Dr. Barron offers life-changing laparoscopic treatment options. This excision treatment is highly effective in removing problematic endometrial tissue.

So, if you’re ready to start your journey toward a better life, contact us to schedule an appointment at (434) 234-4903, or visit our office in Charlottesville, VA.

Endometriosis Resources:

To learn more about endometriosis:

For online SUPPORT:

World Endometriosis Research Foundation Discussion Group – Lists all global groups