Coagulation Surgery versus Wide Excision Surgery
Why is it so common to have an endo surgery fail? Could it be traced back to the type of surgery that is being performed, whether it’s Coagulation Surgery or Wide Excision Surgery?
Sometimes, it’s unfortunately not until a person has had several failed surgeries that she finally asks what the difference is between Coagulation Surgery and Wide Excision Surgery? Or what the advantages and disadvantages of Coagulation Surgery and Wide Excision Surgery are? Below, we will answer all of these questions for you as we watch part 1 of 3 in the “Why Did My Endo Surgery Fail?” series from Dr. Andrew Cook.
On average, by the time patients get to see me they’ve been through three or four surgeries previously. So a common question I get is “why did my surgery fail?” And, there’s a lot of reasons, but one reason that we – and the reason we’re going to talk about today – is that it was an outdated coagulation (or burning kind of) surgery. And so I want to talk briefly about
What is coagulation surgery? and What is wide excision surgery? and what are the differences between these two types of surgeries.
Coagulation surgery uses electrosurgery to burn the tissue. The problem with that is it’s very imprecise. There is also a lot of lateral spread of heat so the very center part (of the affected tissue) – it’s black – it’s a “crispy critter” (it’s dead). The tissue next to it there is what is called a “zone of necrosis”. It looks okay but it’s been heated enough that it’s dead. And so, in the pelvis where there’s endometriosis you have to make sure to stay away from any critical structure of the ureters blood vessels, bowel, bladder, that kind of stuff. And so the advantage of coagulation surgery is – “it is pretty easy, you just stick the thing in there and burn it a little bit and it doesn’t take too long”.
High recurrence rate and other disadvantages of coagulation surgery for endometriosis
The disadvantages are we now know that in the majority of cases it doesn’t remove all the endometriosis and so there’s a high recurrence rate with a coagulation surgery. It damages the tissue so the tissue that’s left behind is damaged, inflamed and – from what we’re starting to understand with how pain works with endometriosis – it may actually make that part of the condition worse (more painful).
What’s the difference between excision surgery and wide excision surgery?
Next, we’re going to talk about wide excision surgery. I’ve been asked, “What’s the difference between excision and wide excision?”
Excision means “to cut out or to remove”. Wide excision means we’re going to take a border of normal-appearing tissue. The inside of the body is lined by the peritoneum (you can think of it like Saran wrap that covers everything – there’s no skin inside) and if we had endometriosis, it could be thought of to be like chia seeds on the Saran wrap. Wherever the endometriosis has spread we need to make a cut surrounding all the peritoneum that has endometriosis, lift the edge up, and cut it out – that’s wide excision.
Just like if you had a mole, you know the doctor wouldn’t burn it or cut right around the little edge of it, but he’s going to take some normal tissue because if it (gets tested and) does come back as being cancerous, then we all want to know, “Did you get it all?”
And just so you know, endometriosis is not a cancer but we do have to get it all (to consider the surgery a success).
Why doesn’t everybody do excision surgery?
So why did why doesn’t everybody do wide excision surgery
There are several reasons:
- Wide excision takes a much higher technical skill level
- wide excision is not really a skill that’s taught routinely in that residency programs
- wide excision surgery does take longer
The advantages of wide excision
- lower recurrence rates of endometriosis
- wide excision surgery usually gets all the endometriosis
- there’s little or no conduction of heat so the tissue that’s left behind is good, healthy tissue and we’ve removed any excess nerve growth in the area.