Level 7: The two types of surgeries – definition and what to look for in that expert surgeon
Full Layout for Level 7
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Types of surgeries to treat Endometriosis
Surgery for endometriosis is either excision or ablation.
Excision surgery is the golden standard treatment for endometriosis. Excision surgery involves physically cutting out endometriosis lesions at the root and not leaving any of the disease behind.
Ablation is burning or vaporising endometriosis at the surface with a laser or heat source of some kind, leaving roots and other scar tissue behind, causing quick recurrence of the illness.
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Excision surgery is better than ablation surgery
If excision is done by a trained endometriosis excision specialist and at the earliest stage of diagnosis, then this can be a game changer for the life of the patient. This is because there is a greater chance of the disease not coming back or taking longer to come back.
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Why you need a trained Endometriosis excision specialist
Endometriosis can look very different from person to person. It can be found on the surface of organs, deep in tissues, or as cysts called endometriomas.
Because it looks different in colour and shape, it takes a very experienced surgeon who does these surgeries often to find it all.
They also need to know where to look, including places many doctors are not trained to check, like behind the liver or on the diaphragm. Doing only a few surgeries a month is not enough to build this level of skill.
A few surgeries per month are simply not frequent enough to become proficient.
There are no great Endometriosis surgeons who still practice Obstetrics, either — they are simply too busy doing Endometriosis surgeries.
The best endometriosis care is done by a multidisciplinary team that may include thoracic surgeons, colorectal surgeons, and nerve specialists to treat disease outside the pelvis and more complex cases such as deeply infiltrating bowel disease.
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What to look out for
There are very rarely locations/situations where Endometriosis cannot be excised.
If the surgeon simply believes they can cauterise (ablate) Endometriosis, this is a serious red flag.
Even if they try to convince you that some regions are too dangerous to excise or that superficial Endometriosis doesn’t need to be excised.
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If you're told you don't need surgery
Exceptional surgeons will NOT tell you that the disease can be treated with hormone suppression that completely shuts down the ovaries, such as Lupron/Orilissa.
These surgeons will NOT perform an ultrasound/MRI and decide that if deeply infiltrating Endometriosis is not found, you won’t need surgery, meaning, if your imaging comes back normal, an expert won’t say surgery isn’t needed.
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What type of Edometriosis excision surgeon to look for
Look for a surgeon who is operating on complex Endometriosis cases each week with a team of other surgeons, including a colorectal surgeon and a cardiothoracic surgeon.
These surgeons won’t tell you that extra-pelvic Endometriosis is rare; instead, they will investigate whether you may have Endometriosis on your bowels, diaphragm, bladder, lungs, and more.
These surgeons will work with you and inform you of all of your options before surgery.