Robotic/Laparoscopic Excision of Endometriosis

“In endometriosis excision, what you remove is important, but what you leave behind is critical.”

The diagnosis of endometriosis requires that the surgeon look surgically, usually by laparoscopy. Like anything else in medicine, there can be false-positives and false-negatives. Sometimes a lesion can look classic for endometriosis, but under the microscope, there is no endometriosis found.  Other times, there can be a lesion that is very subtle and easy to miss, but microscopic evaluation confirms endometriosis. With laparoscopic excision, all areas of suspected endometriosis are excised completely down to normal tissue with adequate margins, and all specimens are sent to pathology (microscopic examination) for confirmation.

Sometimes all specimens come back negative for endometriosis, but the patient feels fine. Dr. Lucas excises all areas that look abnormal, areas that are scarred (AKA “fibrotic” or “adhesive”) and/or are in locations that could explain the distribution of pain that the patient is experiencing. In these circumstances, the endometriosis may be gone, but the restriction and/or irritation of underlying/nearby structures left in its wake are likely the cause of the pain. 

Sometimes, most or all of the specimens come back positive for endometriosis, but the patient still has pain. In these cases there may be some other or supplemental factor(s) that is(are) responsible for their pain. This is why the NECPH care model focuses on addressing  your pain experience.  We will always investigate and provide options for addressing your pain, before AND after any and all interventions..

Frequently Asked Questions About Robotic/Laparoscopic Excision of Endometriosis

What is robotic/laparoscopic excision of endometriosis?

There are four options for treating endometriosis with laparoscopic surgery which include: 

1) laser vaporization
2) electrical cautery/fulguration
3) ultrasonic coagulation, or the most effective
4) laparoscopically excising the endometriosis by means of going around, underneath, and completely removing the endometriosis and fibrosis entirely. 

This last option, laparoscopic excision of endometriosis, is Dr. Lucas’ approach.  As head surgeon of the New England Center for Endometriosis, Dr. Lucas is dedicated to the safe and thorough removal of endometriosis lesions throughout the abdomen.

Why does Dr. Lucas use robotic/laparoscopic excision of endometriosis for surgically removing the endometriosis?

Endometriosis starts out superficial in the lining of the body cavity. Over time, with menstrual cycling of estrogen, it will invade progressively deeper into the tissues. When endometriosis invades deeper than superficial application of laser or electrical energy penetrate, these modalities may not be sufficient to treat these deep lesions.   There is also some concerns that the burning may leave more tissue damage that now just overlies the endometriosis that was unable to be treated. These may cause recurring pain for the patient, resulting in surgery after surgery. Almost all centers that specialize in endometriosis, in and out of the USA, perform laparoscopic excisional surgery for endometriosis.

What are endometriotic lesions and how can robotic/laparoscopic surgery help?

As endometriosis invades progressively deeper into the tissues, the endometriotic lesions will bleed into themselves, creating a blood-filled cyst, or endometrioma (“endometri” refers to endometriosis, and “oma” means new growth). Ovarian endometriomas do not occur as isolated findings, and there is usually endometriosis involving the pelvic sidewalls and ligaments that needs to be excised. It is necessary for the surgeon to excise the cyst wall from the ovary, and repair the ovary, to have the best chance of saving the ovary and avoiding recurrence of the endometrioma. 

What are "adhesions" in endometriosis?

The most common surgical finding of endometriosis is fibrosis and scarring (“adhesions”) it leaves behind. If adhesions are felt to be due to previous surgery, then the adhesions can be just divided. If adhesions are felt to be related to endometriosis, then it is necessary for the surgeon to come around both sides of adhesions and remove the scarring/adhesions.

If you’re ready to get started, or if you have any questions, please call the office at (207) 200-7671 or send us a message, we’d love to hear from you.

Will excisional surgery for endometriosis help with infertility?

Our Endometriosis center focuses on thorough excision of Endometriosis and associated fibrosis, with the restoration of normal anatomy. We do everything possible to help each patient get long-term pain relief and minimize repeat surgeries. While our focus is on the excision of endometriosis for pain relief, many go on to have successful pregnancies.

Ready to take the first step towards personalized pelvic health care? Fill out our simple form below to schedule a consultation with Dr. Romeo Lucas, and embark on your journey to relief and well-being.


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