Endometriosis Excision Surgery

What is endometriosis?
Endometriosis is a common gynecological condition where tissue resembling the lining of the womb (endometrium) is found outside the uterus, involving the pelvic structures (e.g., the lining of the pelvis, the ovaries, tubes, bowel, and bladder). This aberrant tissue can cause pain, inflammation, and infertility. Women with the condition may suffer from painful periods, pain with sexual intercourse, pain with bowel movements, and chronic pelvic pain. Infertility is also commonly associated with endometriosis, especially if the disease is severe and affects the ovaries.

The condition presents in many forms from mild to severe. In mild cases, the abnormal tissue only involves the thin lining of the pelvic cavity (the peritoneum) but in more severe cases, deep disease involves the structures beneath this lining, including the bowel, ureters, and bladder. In advanced disease, the disease often results in scarring and bands of fibrous adhesions that can stick structures together and distort the normal pelvic anatomy. This can affect the way the pelvic and abdominal organs function. Regardless of how severe the condition is, it can be extremely debilitating to a woman’s life.
What is endometriosis excision surgery?
Endometriosis excision surgery is a specialized advanced minimally invasive laparoscopic procedure that carefully removes all endometriosis and scar tissue from the body while preserving and restoring normal pelvic anatomy and function. Due to the severe nature of endometriosis in some cases, this complex surgery can involve work on multiple organ systems including the genitourinary and intestinal tracts.
When is endometriosis excision surgery indicated?
Endometriosis excision surgery is indicated if a patient is strongly suspected of having symptomatic endometriosis and/or endometriosis-associated infertility.  A diagnostic work-up consists of a careful evaluation of her medical history, a pelvic examination, and a transvaginal ultrasound. Excision surgery can help resolve symptoms caused by the disease and can help restore fertility and improve fertility outcomes whether by natural conception or via artificial conception (IUI and IVF).
How does endometriosis excision surgery differ from other surgical treatments for endometriosis?
Most surgeries performed to treat endometriosis involve directing thermal energy at the areas of abnormal tissue to attempt to destroy (burn or vaporize) them. The problem with this approach is that the areas of abnormal tissue are often only partially eradicated with some disease left behind. If deep disease and disease overlying delicate structures are present, these areas are often left untreated because the surgeon does not have sufficient expertise or surgical privileging to operate outside the pelvic cavity. Due to thermal spread, burning is not an ideal method when treating disease that is close to delicate structures as it may result in unintended and undetected damage to these areas and serious complications. Another common issue is lack of familiarity with the subtle appearances of endometriosis and therefore missing areas of disease. If the disease is only partially treated and disease is missed, a patient is more likely to experience ongoing or recurrent symptoms associated with the condition and will need to undergo further treatment to address these symptoms. Excision surgery performed by a surgeon who specializes in this procedure can fully remove disease in any location in the body without compromising delicate structures. As an excision specialist, Dr. Koh and his team are highly experienced in performing surgery on all areas involved by the disease and have successfully treated thousands of cases, including some of the most challenging presentations of the disease.

In the case of infertility associated with endometriosis, removal of all disease is key in order to provide the best chance of natural conception. Excision of all disease helps to avoid a need for costly and invasive fertility treatments, such as IVF, and if IVF is ultimately required, excision of all endometriosis prior to fertility treatment has been found to improve IVF outcomes.
What is the prognosis following endometriosis excision surgery?
Women who undergo successful endometriosis excision surgery with a specialized surgeon can expect relief of symptoms associated with endometriosis and a very low risk of ever requiring further surgery for endometriosis. Even in severe cases of the disease, most patients who are trying to conceive will conceive naturally following meticulous excision and careful restoration of the pelvic anatomy.

The careful selection and counseling of patients for excision surgery is important. If the patient has a complex pain syndrome and other pelvic pain conditions besides endometriosis, they will need to be carefully counseled on their options and offered a multidisciplinary approach to their care. Endometriosis excision surgery is a highly effective treatment for endometriosis-related pain and infertility but does not directly address pain and infertility due to other conditions. Patients with complex pain conditions may require multiple treatment modalities for optimal relief and restoration of quality of life.

‘After 2 unsuccessful surgeries in the UK for stage 4 endometriosis, I finally had the excision surgery that I needed with Dr. Koh. Words cannot express the gratitude that I have for him and his assistant surgeon Dr Lien, for finally bringing my pain and misery to an end. Thank you!’ Read Emma’s Story