Why is Excision More Effective in Treating Endometriosis than Other Surgical Techniques?

Excision has THREE key advantages over other surgical techniques:

1. It enables the surgeon to quickly remove large amounts of tissue without damaging or altering the appearance of the underlying healthy tissue.
By observing the underlying tissue during the process of excision to see whether clean, healthy margins have been reached, the surgeon can see whether excision is complete or needs to continue deeper. Often excising deep disease is like digging for buried treasure. The true extent of the depth of the disease may only become apparent during the process of removal itself. Comparing excision with burning techniques (ccoagulation and fulguration), the latter techniques do not leave clean margins of healthy tissue and the surgeon is unable to assess whether the areas of disease have been fully eradicated or not. Furthermore, these techniques are only suited to treating very superficial areas of disease, leaving deeper disease untreated. These areas of untreated underlying disease may then become obscured by scar tissue, making subsequent excision surgery more challenging. For this reason, “burning” techniques should be avoided: they are an ineffective, unpredictable and unreliable means of treating endometriosis, they may hamper subsequent surgery and they often result in a patient entering an ongoing cycle of ineffective procedures, each time with her pain persisting or recurring despite the surgery.

2. Because excision does not damage the underlying tissues it can be safely applied to almost any location within the pelvis.
Other techniques, such as coagulation and fulguration that burn the tissue using a low-intensity heat source run the risk of damaging underlying tissues through a process of thermal spread. In cases where a surgeon is required to operate close to vital structures, there is a risk that burning techniques could inadvertently result in undetected thermal damage to these underlying structures, potentially resulting in serious post-operative complications. For this reason, surgeons who primarily rely on low-intensity thermal techniques (burning the tissue rather than excising it) typically leave areas of disease that are close to the bowel, bladder and ureters (the tubes that carry urine from the kidneys to the bladder), resulting in incomplete surgery.

3. Excision of endometriosis provides tissue biopsies for the pathologist to check under the microscope and confirm the diagnosis of endometriosis (or other forms of disease).
Burning techniques char and distort the diseased tissue, causing the proteins within the tissue to clump together. No tissue is removed from the body and so no biopsy is available to send to a pathologist for a confirmation of the diagnosis. Biopsy confirmation is necessary for confirming the diagnosis of endometriosis and is an essential step in the treatment process.