Endometriosis

What is Endometriosis?
Endometriosis is a disease in which the tissue that normally lines the inside of the uterus (endometrium) grows outside the uterus. More specifically, it occurs when endometrial glands and stroma are found in locations other than the lining of the uterus.

What are the symptoms of Endometriosis?

• Pelvic pain during menses, before menses, after menses and/or anytime during the month
• Constipation
• Bloating
• Painful intercourse usually with deep insertion or certain positions
• Infertility
• Right and/or Left sided pelvic and abdominal pain
• Diarrhea
• Painful bowel movements
• Urinary frequency, and/or urgency, and/or painful voiding
• Fatigue
• Malaise
• Lower back pain
• Heavy or irregular periods

The symptoms of endometriosis are related to the areas where endometriosis invades. Endometriosis of the uterosacral ligaments/cul-de-sac leads to painful intercourse, constipation, diarrhea and painful defecation. Endometriosis on the ovary can lead to left sided or right sided pain. Bladder endometriosis may lead to urinary frequency or urgency. You may have only one of the above symptoms or many. Even one symptom can be suggestive of Endometriosis.  Some women have no symptoms yet only suffer from infertility.  Endometriosis is the culprit in 40-50% of cases of unexplained infertility.

How is Endometriosis diagnosed?

Imaging (Ultrasound, CT, MRI) is usually normal and does not show endometriosis.  This is the reason for a delay in diagnosis in many women.  Can you believe in the United States, there is a lag of 10-11 YEARS from symptom onset to diagnosis!! The diagnosis of endometriosis can only be made by laparoscopic excision of tissue with pathological confirmation. Laparoscopy is both diagnostic and therapeutic.  Dr. Orbuch will take and extensive history and perform a thorough physical exam before deciding whether surgical therapy is beneficial. Surgery is day surgery, meaning on most occasions you go home on the same day as surgery.

Treatment of Endometriosis

Laparoscopic surgery is the definitive method to diagnose and treat endometriosis. Excision of Endometriosis is the gold standard treatment for endometriosis. Ideally all endometrial lesions should be excised. Unfortunately most gynecologists are not trained in advanced endometriosis cases. Others approach endometriosis with cautery or a laser or burning, two modalities shown to be far inferior to excision using scissors, the method performed by Dr. Orbuch. With scissors, the endometrial implants are removed, but with cautery or a laser or the lesion remains and continues to cause pain necessitating more surgery. A doctor utilizing laser may vaporize the surface of the lesion, but still leaves active endometrial tissue below. Deep fibrotic endometriosis usually does not respond well to hormonal suppressive therapy. Adequate surgical excision of endometrial implants provides the best symptomatic relief and long term results. In addition, surgical excision has been shown to improve fertility rates in women. Drug therapy can suppress endometriosis, not eradicate endometriosis. The definitive treatment of endometriosis is NOT hysterectomy or removal of both ovaries; rather it is complete excision of endometrial lesions.

da Vinci Hysterectomy

Dr. Orbuch performs da Vinci Hysterectomy for many benign (non-cancerous) conditions such as heavy bleeding, fibroids, pelvic prolapse, or adenomyosis. The da Vinci System enables Dr. Orbuch to perform a minimally invasive hysterectomy even for complex conditions with enhanced vision, precision, dexterity and control. Using state of the art technology, a da Vinci Hysterectomy requires only a few incisions so you can get back to your life faster. With traditional open surgery, recovery time is often 6-8 weeks with patients’ remaining in the hospital for 2-3 days. In contrast, after a robotic hysterectomy, a patient only stays in the hospital overnight and can expect a 2 week recovery. An interesting fact is that one in three women in the U.S. will have a hysterectomy before she turns 60. If your doctor recommends a hysterectomy to treat your condition, you may be a candidate for da Vinci Surgery. In addition, da Vinci hysterectomy offers women many potential benefits over traditional surgery, including:

• Less Pain
• Fewer complications
• Less Blood loss
• Shorter hospital stay
• Low risk of wound infection
• Quicker recovery and return to normal activities

da Vinci Myomectomy

Uterine Fibroids are benign tumors normally occurring in about 30% of women. They grow in the uterine muscle (intramural myomas), on the outside of the uterus (subserosal myomas), or in the uterine lining (submucosal myomas). Some women are asymptomatic while others experience heavy bleeding, pain, frequent urination, or infertility.

The da Vinci robot enables precise dissection of fibroids using the endowrist instruments. The robots’ wrist can turn nearly 360 degrees, allowing great flexibility. In addition, this helps to access fibroids in difficult anatomic locations. Because the da Vinci robot allows Dr. Orbuch to view the fibroid and uterus in a magnified 3-D view, very small blood vessels can be seen to minimize blood loss. The robot also eliminates any tremor in a surgeon’s hands, and for delicate work, “motion scaling” software reduces a surgeon’s actual hand movements to much smaller, finer instrument movements.

The da Vinci robotic myomectomy is providing women an opportunity to retain their uterus and subsequently, retain their fertility. Laparoscopic myomectomies often take longer than open abdominal myomectomies, and many are converted during surgery to an open abdominal incision if the fibroids are too large and/or there are many fibroids.

Robotic myomectomies are performed on an outpatient basis and women can return to work in about a week. Da Vinci myomectomy offers women many potential benefits over traditional surgery, including:

• Less Pain
• Fewer complications
• Less Blood loss
• Shorter hospital stay
• Low risk of wound infection
• Quicker recovery and return to normal activities

If you have fibroids and are interested in preserving your uterus, you may be a candidate for a new uterine-preserving, minimally invasive procedure – da Vinci Myomectomy. Using the assistance of the most advanced combination of surgical and robotics technology available, Dr. Orbuch is able to perform this delicate operation with unmatched precision and control.

Ovarian Cystectomy

Dr. Iris Orbuch uses the da Vinci robot system to treat ovarian cysts using minimally invasive surgery. The da Vinci system with its 3-D High Definition Camera allows for precise removal of ovarian cysts.  The da Vinci system is utilized for Ovarian Cystectomy (removal of an ovarian cyst) or Oophorectomy (removal of an ovary).  Using state of the art technology, a da Vinci Cystectomy or Oophorectomy requires only a few incisions so you can get back to your life faster. With traditional open surgery, recovery time is often 6 weeks with patients’ remaining in the hospital for 2-3 days.  In contrast, after ovarian cyst removal utilizing the da Vinci Robot, a patient only goes home the same day.  If your doctor recommends an Ovarian Cystectomy or Oophorectomy to treat your condition, you may be a candidate for da Vinci Surgery.  Common types of cysts removed utilizing the da Vinci Robot include Endometriomas, Dermoids, Serous/Mucinous Cystadenomas, as well as many others.

The da Vinci surgery offers women many potential benefits over traditional surgery, including:

• Less Pain
• Fewer complications
• Less Blood loss
• Shorter hospital stay
• Low risk of wound infection
• Quicker recovery and return to normal activities