Robotically Assisted Laparoscopic Excision of Severe Endometriosis

Normally, endometrial (uterine lining) cells are present only in the uterine cavity. These cells are shedding once a month resulting in a menstrual period flow. Sometimes (abnormally), these cells are growing outside the uterine cavity. Such phenomenon is called Endometriosis (if it happens outside the uterus) and Adenomyoisis (if it happens inside the uterine wall). Endometriosis/Adenomyiosis are considered benign, noninfectious disorders. Still, they often cause significant, and sometimes debilitating disruption in quality of life. Women afflicted with Endometriosis/Adenomyiosis may experience the following symptoms:

• Constant pelvic pain
• Heavy, prolonged and painful menstrual periods
• Painful intercourse
• Painful bowel movements

In most extreme cases high amount/mass of Endometriosis cells may infiltrate the entire pelvis, causing what doctors call “frozen pelvis”. These cells secrete blood and create a strong adhesive (“glue like”) effect attaching different pelvic organs to each other. This may include the uterus, ovaries, fallopian tubes, sigmoid colon, rectum, bladder, ureters (tubes connecting the kidneys to the bladder) or any combination between them. Sometimes, Endometriosis may penetrate pelvic organs, such as bladder, rectum and ureters.

Treatment for severe endometriosis and/or frozen pelvis is allways challenging. Conservative measures, such as birth control pills, progesterone agents and Lupron need to be exhausted first before resorting to surgical intervention. Surgeons need to be able to recognize the distorted pelvic anatomy and safely remove the vast endometriotic implants. Sometimes, in addition to excision of endometriosis, some badly affected organs need to be removed as well. This may include ovary(ies), tube(s), uterus, and even portion(s) of sigmoid, rectum or bladder. Robotically assisted laparoscopic excision of endometriosis/adenomyiosis is the best surgical approach available to date. Robotics provide superb surgeons dexterity, three dimensional and zoomed in visualization of the surgical field, simultaneous surgeons control of two surgical instruments and the camera. This enables precise and safe execution of the operation, still performed in a minimally invasive way (4-5 third to half an inch incisions), most of the time on an outpatient basis. Patients recover much faster compared to the traditional, laparotomy (open incision) way.

Author

Dr. Nathan Mordel, MD Nathan Mordel, MD, is a board-certified gynecological surgeon at Atlanta Minimally Invasive Gynecologic Surgery Center in Atlanta, Georgia. He specializes in advanced robotic, laparoscopic, vaginal pelvic surgery, including for fibroids, endometriosis, heavy and/or painful menstrual periods, pelvic organ prolapse, and urinary incontinence.