Robotic Endometriosis Excision Surgery


Robotic Endometriosis Excision Surgery

When hormonal suppression or other methods of eliminating endometriosis fail, surgery becomes the treatment of choice. With endometriosis causing pain, bowel and bladder dysfunction, prohibitively painful sex, and infertility, the surgery option can become the final solution in a long, frustrating journey for a woman suffering from it. This surgery, however, is fraught with the danger of damaging the anatomy involved with the endometriosis, requiring the highest expertise in knowledge, technique, and respect for tissue.

Two-way street.

The endometrium is one of the layers of your uterus (womb). It is hormonally reactive and controlled by the menstrual cycle. Glandular in nature, it forms an adherent relationship to whatever it is attached, which in your uterus is the main muscular layer, called the myometrium. Being hormonally responsive, it is designed to thicken, mature its cells, and then fall away as debris during that hormonally deficient time of the cycle called your “period.”

Your uterus is a complex organ, allowing sperm to enter and travel up to its top openings into the tubes, or your eggs to travel down the tubes to your uterus: a two-way street. The ends of your tubes are not attached to the ovaries, but near enough such that a released egg will attract finger-like extensions of the tube (called “fimbria”) to enclose around it and herd it the right way back down the tube toward your uterus. There is a gap, anatomically, between the “catching” part of the tube and that part of your ovary that releases an egg (“ovulation”). It is this gap which many feel causes most cases of endometriosis.

Endometriosis: menstrual hygiene defeated.

There are several theories regarding what causes endometriosis. The most cited one is that of “retrograde menstruation.” This is a process by which some of your endometrium, when detached from the uterine wall, finds its way upward toward your tubal openings instead of downward through your cervix (then to vagina, then to a tampon or sanitary napkin for discarding).

There is a reason menstrual tissue is best discarded: it doesn’t play well with other tissues.

If this theory is correct, when retrograde (“backwards”) menstruation occurs, this hormonally reactive tissue eventually spills though the gap between your tube’s fimbria and your ovary to land on and attach to it or—worse—to your bowel, bladder, other organs, or anatomical spaces meant to remain spaces. Wherever it lands, it attaches, and because it hasn’t joined the rest of the menstrual debris into the outside world, it remains in your body, re-stimulated cyclically each month. Any woman recognizes her period as a bloody network of disorganized tissue. With the right hormonal stimulation, however, attached to other tissue it can invade into it, inflame it, and initiate the body’s immune response against it. Trouble brewing.

Taking root.

When endometrial-like tissue, that is, endometriosis, is on other tissue—bowel, ovary, bladder, etc.—its tendency to invade that tissue makes it not easily separable from it. When hormonal suppression or other non-surgical methods fail in treating endometriosis, the dense attachment it makes with your other tissue makes surgical removal difficult without injuring or sacrificing the tissue to which it is attached.

When a space is no longer a space.

Besides the destructive attachment to other organs’ tissues, the inflammation endometriosis provokes will attract free-floating organs such as bowel and bowel fat to migrate toward it and stick to it in an attempt to wall it off. This is one of the inherent talents of our immune system. For example, in an infection of your skin or a foreign body reaction around a splinter, your body does the same thing—walls it off, which you see as an abscess. This pocket of unwelcome infection and debris is designed to swell toward the exterior, rupture, and expel into the same outside world you discard your tampons. On the inside, however, things stick and then they stay stuck.

Your bladder lies over your uterus/tubes/ovaries, and these lie over your rectum. They are all separate, but if endometriosis tissue lands there and does all of its dirty tricks, this space, called the “cul de sac,” can become a solid block of adhered bladder-uterus-rectum-small bowel. This is called a “frozen pelvis,” and the solidity of this space—no longer a space at all—remains even if the endometriosis eventually fades away. Therefore, the physiological dysfunction such solid entanglement creates will remain until surgically corrected.

Home of the brave.

Surgically treating endometriosis is easy when there is a spot of it on your pelvic floor where it can merely be cut away or burned with a cautery. Such ideal approaches are not always there, with disease involving organs that won’t like extra holes in them or if the endometriosis overlies a portion of pelvic floor with blood vessels or parts of the urinary tract running under, unseen. This is where technology like the da Vinci robot far exceeds what is able to be done with the other minimally invasive GYN surgery techniques, such as general laparoscopy, which can be woefully inadequate in addressing advanced cases. Without the proper expertise, tools, experience, and talents, such surgery would be foolhardy. Thankfully, these traits are well at home at NYCEndometriosis and its robotic surgeon, Dr. Bozdogan.

Making spectacular use of stereoscopic visualization, from almost any angle—over, under, or around—of any organ involved with endometriosis, and using the two-hand dexterity that the robotic surgeon is able to wield, the delicacy required to strip away endometriosis from other tissue has revolutionized the treatment that has changed so many women’s lives. Even better, the da Vinci allows for magnification views, giving surgeons like NYCEndometriosis’ “Dr. Boz” access to microscopic surgery of sorts, pioneered by the reproductive surgeons in the past but perfected under the instruments of robotic surgery, all through cosmetically small incisions.

…where no endometriosis has been excised before!

This all makes possible removal of this abnormal tissue from normal tissue and leaving the normal tissue intact, functional, and uncompromised. It also makes possible the “thawing” of a frozen pelvis via intricate surgery that will allow the return of your urinary tract, reproductive organs, and intestinal structures to their former anatomical (and free!) glory.

With his expertise and experience (thousands of robotic surgeries), Dr. Boz fears no underlying structures: this is not an empty boast, but a necessary expertise for you to expect if you want a comprehensive solution to endometriosis and its successful and complete excision

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