The Truth About the Surgical
Treatment of Endometriosis
|
I have devoted my professional life to providing the best-possible treatment for women with endometriosis and pelvic pain. I am trained both as an OB/GYN and as a Reproductive Endocrinologist and Infertility Specialist. Seventeen years ago, I finished my medical training at Johns Hopkins University School of Medicine. I then had several different offers to practice with some of the top doctors in the field, both in academic and private settings. I chose not to go into an academic career, one of the first Fellows from Johns Hopkins who did not do so. Instead, I had always wanted (and still prefer) to spend my time effectively treating patients, doing what I thought doctors were supposed to do – listening to patients with care and compassion, and then healing them. That is the image I grew up with: Physicians were people who were devoted to their patients. I believed they were compassionate, caring individuals with the highest of morals and ethics, and would do whatever was humanly possible to help heal their patients. What higher calling is there? I've always believed in healing people and giving them back their lives. Since I completed my training with some of the top leaders and institutions in our field, I have treated thousands of women with endometriosis and pelvic pain. As any of you know who suffer from endometriosis and pelvic pain, this is an area of medicine where the average treatment can be less than ideal; it's often confusing, and very frustrating. The scenario of a woman with endometriosis going year after year, to doctor after doctor, having surgery after surgery without resolution of her symptoms, is both all too common and simply unacceptable. I am not saying that I, or my team of health care professionals, have all of the answers to treat women with endometriosis and pelvic pain. At Vital Health Institute we work every day, doing what we can, to provide the best-possible treatment for our patients. We are absolutely devoted to finding answers to the vast array of problems that our patients encounter. I believe that the successful treatment of the endometriosis patient involves two distinctly different areas. This includes (1) the complete removal of the endometrial implants at surgery, and (2) medical treatment of the patient to restore her overall health, including the immune system and hormonal balance, using the best of both traditional and alternative medicine. The core concept in effective surgical treatment of endometriosis is the complete removal of the disease from the body. If all of the endometriosis is not removed, the remaining cells will continue to grow. Then over months or years, the patient eventually will have a recurrence of her symptoms. This is not to say that there is a cure for endometriosis – at present none exists. But it is important to differentiate between the likelihood of having a true "recurrence," which is very low (perhaps 15 percent over 5 years) and the persistence of endometriosis as a result of incomplete treatment. This latter instance results in a high percentage of patients experiencing a relatively rapid "recurrence" of endometriosis. I believe that the most important aspect of successful surgical treatment is the skill and experience of the surgeon. Any endometriosis expert understands that the primary method of treating endometriosis is via wide excision. This may be accomplished by mechanical scissors, high-current, pure-cut electro-surgery, or via Carbon 13 CO2 laser. Various surgeons will employ slightly different techniques in this process. I personally believe that in the hands of a few select, highly trained surgeons with advanced skills, the EVE (Excision and Vaporization of Endometriosis) Procedure with the Carbon 13 CO2 laser offers superior technical advantages, which is why I use this approach. This approach uses excision as the primary approach. In the majority of cases, excision is the only technique used. Ablative Vaporization should not be used laparoscopically as the primary method to remove endometriosis, but is an acceptable secondary method of removing endometriosis in conjunction with excision. In certain instances, I believe that combining vaporization with excision works better than relying on excision alone, because it removes all of the disease with less damage to normal tissue. But be careful about what you read about these surgical technique terms. There is much confusion and misinformation being promoted by well-intending individuals who do not understand what they are talking about. If you are interested in reading more detailed information, you can read more about Surgical Techniques Used in the Treatment of Endometriosis and the EVE Procedure. I have used the other approaches of excision, such as scissors and electrosurgery. There is nothing wrong with these techniques; many other endometriosis experts use them to effectively treat endometriosis. It is OK to have diversity in our field. I believe it is a good thing, as long as we can accept our different surgical preferences and respect the good, we as expert endometriosis surgeons, are doing for our patients. Remember, the most important aspect of surgery for endometriosis is the surgeon performing the surgery, not the particular surgical tool that he or she prefers. I understand the other surgical approaches, and will use them if required. But I personally prefer the laser and EVE approach, as I believe that it is the best for the patient. You will find articles on my web sites to help you further understand why I have come to these conclusions. Our data also show that EVE and the laser are quite effective in the treatment of endometriosis and pelvic pain, and that patients who undergo surgery using these techniques experience a very low recurrence rate of their endometriosis. |
