Is Surgical Excision Optimal for the Treatment of All Areas of Disease?

While excision can arguably be applied to any location, there are situations where it may not represent the best approach in terms of minimizing the risk of surgical complications and preserving delicate pelvic structures.

Endometriosis can involve vital and delicate pelvic structures, removal of an area of tissue via excision may in certain instances result in damage to a delicate structure. In the case of preserving a patient’s fertility, if superficial endometriosis is found to involve the fallopian tubes or the surface of the ovaries, excision may be unnecessarily crude. Given the wall of the fallopian tube is so thin, excising tissue from the outside of the tube would entail cutting right through the tube wall, requiring repair of the damage via sutures. Opening and reclosing/repairing a fallopian tube in the process of excising disease could easily compromise the function of the tube by causing scarring inside the tube at the site of the repair, causing an obstruction. In the case of the ovary, removing a large area of superficial surface endometriosis could well result in unnecessary damage to the delicate ovarian tissue, reducing ovarian reserve and potentially impacting upon the patient’s fertility.

The mainstay of endometriosis surgery is excision and excision should be the primary and very often the sole technique utilized.
-Dr. Cook

Area vaporization

An alternative to excision in situations such as these is a technique called area vaporization. Instead of using a high-energy heat source to vaporize in a linear fashion, creating a “cut” in the tissue, the surgeon directs the concentrated heat source over the area of diseased tissue, rather than around it, vaporizing the surface cells layer by layer. This enables the surgeon to remove the superficial disease without compromising the underlying structures. The area over which this high intensity heat source is applied is very small, so this technique is only suitable for very specific and limited areas of disease. It is not an effective way of removing large areas of disease quickly and reliably. For this reason, the mainstay of endometriosis surgery is excision and excision should be the primary and very often sole technique utilized. Area vaporization is a special technique for highly specific situations with the aim of eradicating the disease while preserving the patient’s vital organs and structures. Unlike excision, area vaporization does not allow the surgeon to obtain a biopsy specimen to send to the pathologist.

Superficial small bowel disease
Uretereal endometriosis

Confusion & controversy

Use of area vaporization in endometriosis surgery remains somewhat of a controversy in the endometriosis community. Well-meaning lay endometriosis advocates explain to patients that vaporization is the same as burning the tissue and should be avoided at all costs, “vaporization is bad!!!”

Few endometriosis specialists publicize or explain their use of this special technique to their patients, perhaps because of the bad press it has received and the resulting misconceptions; perhaps they are concerned that “admitting” to the use of this technique could put off potential patients.

“But I thought vaporization was just the same as burning, and that burning is something to avoid!”
-A common misconception

On occasion an endometriosis patient who has undergone specialist excision surgery will come across the word “vaporization” in her surgical report, having expected only excision to be used, and feels a betrayal of her trust. The truth is that ALL specialist endometriosis surgeons rely on area vaporization in certain situations even though excision should be the primary mode of surgery.

At Vital Health we recognize the absolute need for complete transparency about the techniques used during our surgeries. We uphold the fundamental principles of trust in the doctor-patient relationship and informed patient consent prior to undergoing treatment. Restoring and upholding trust could not be any more critical than in the case of endometriosis, where patients often come to us after years of feeling misunderstand and mistreated by the medical community.

Summary
Article Name
Is Surgical Excision OptimaIs Surgical Excision Optimal for the Treatment of All Areas of Disease?l for the Treatment of All Areas of Disease?
Description
While excision can arguably be applied to any location, there are situations where it may not represent the best approach in terms of minimizing the risk...

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Summary
Article Name
Is Surgical Excision OptimaIs Surgical Excision Optimal for the Treatment of All Areas of Disease?l for the Treatment of All Areas of Disease?
Description
While excision can arguably be applied to any location, there are situations where it may not represent the best approach in terms of minimizing the risk...