Endometriosis — an inflammatory disease in which tissue similar to the uterine lining (endometrial glands and stroma) is found elsewhere in the body — can be very debilitating for women who must live with its painful symptoms. While not all cases of endometriosis are symptomatic, the condition is often characterized by chronic pelvic pain, severe menstrual bleeding, abdominal bloating, painful intercourse, and issues with fertility. Symptoms are frequently related to the location of the lesions as well as the presence of “adhesions,” or scar tissue.
The exact cause of endometriosis is uncertain and likely multifactorial, often including both genetic and environmental factors. Potential explanations for why endometrial tissue may be found elsewhere include genetic predisposition and Mullerian cells with endometrial implants placed outside of the uterus during fetal development. Risk factors for endometriosis include one’s family history, as well as an early age of menarche (first menstrual cycle).
Conservative treatments for endometriosis, such as medication and balancing hormones, may be able to mitigate symptoms in certain cases; however, while the medications will help treat symptoms, they will not remove the underlying disease. Surgery is necessary to conclusively diagnose endometriosis and remove endometrial lesions from the reproductive organs or other locations in the abdomen and pelvis. Research has shown that complete surgical excision of severe endometriosis is superior to incomplete resection combined with post-operative hormone therapy. Fortunately, board-certified gynecologist Rachael Haverland, MD, MS, FACOG can help eliminate painful symptoms with robotic-assisted endometrial resection—a cutting-edge procedure considered the least invasive method of endometriosis surgery.
- What is Endometriosis Resection?
- Endometriosis Surgery Candidates
- Endometriosis Diagnosis
- Robotic Surgery vs. Traditional Surgery
- Endometriosis Surgery Procedure
- Endometriosis Surgery Recovery
- Endometriosis Surgery Cost
- Endometriosis Surgery Scars
What is Endometriosis Resection?
Endometriosis resection is a procedure that can surgically remove endometrial plaques from the fallopian tubes, ovaries, bladder, intestines, and peritoneum. Also known as “endometrial excision,” this technique can often help significantly reduce painful symptoms and may improve fertility issues catalyzed by endometriosis. During surgery, endometrial lesions and scar tissue are removed with the assistance of a laparoscope, or a thin tube equipped with a tiny light and camera. The laparoscope is inserted through tiny incisions, allowing Dr. Haverland to precisely remove endometrial tissue using the state-of-the-art da Vinci® system.
Dr. Haverland has extensive fellowship training in minimally invasive gynecologic surgery, making her uniquely qualified to perform laparoscopic and robotic-assisted endometrial resection. Having trained under Dr. Javier F. Magrina and Dr. Megan Wasson at the renowned Mayo Clinic, Dr. Haverland has the skills and experience to alleviate your pelvic pain with smaller incisions, as well as a faster and smoother recovery period, than a traditional endometrial resection procedure.
Who is a Candidate for Endometriosis Resection?
Endometriosis resection may be recommended for patients whose symptoms have not responded to more conservative treatments like medication and hormone therapy. In general, surgery can benefit patients who:
- Routinely experience abdominal and pelvic pain suspected to be caused by endometriosis
- Have recurring symptoms even after hormone therapy
- Believe they’re having trouble getting pregnant due to their endometriosis
- Are experiencing bladder or bowel-related issues that may be due to endometriosis
- Have an ovarian endometrioma, or a dark cyst-like mass found deep in the ovaries
If your symptoms are negatively impacting your daily life and you would like to potentially become pregnant in the future, endometriosis resection can be an optimal treatment choice. Dr. Haverland can discuss your symptoms and concerns in a consultation to determine whether this procedure is an ideal solution, or if another treatment option may be better-suited to your needs.
How is Endometriosis Diagnosed?
When diagnosing endometriosis, an ultrasound and/or pelvic exam may first be performed to give Dr. Haverland an initial idea of what may be causing your symptoms. While physical exams may provide Dr. Haverland with a greater understanding of your condition, the presence of endometrial patches cannot be definitively confirmed until a laparoscopy and biopsy are performed.
- For many patients, a minor surgical procedure called a laparoscopy can allow your doctor to observe whether endometrial lesions are present and, if so, shed light on the size, location, and extent of the growths. This involves a thin, lighted telescope (laparoscope) being inserted into your abdomen through a small incision. Through the laparoscope, Dr. Haverland can observe your internal organs and check for any suspicious tissue.
- With high suspicion for endometriosis, typically the peritoneum — the thin saran wrap layer of the pelvis — is removed. This is called a “peritonectomy,” and is typically completed without removing pelvic organs. The tissue that is removed will be evaluated by a pathologist under a microscope to confirm endometriosis.
For many women, it’s not uncommon to feel a sense of relief, just from simply receiving a diagnosis for the symptoms they’ve been experiencing. Methods of diagnosing endometriosis will vary based on each patient’s concerns, but may include additional techniques like an ultrasound or MRI. Our team is committed to supporting you throughout the process of diagnosing your condition and helping you manage your symptoms.
Robotic Surgery for Endometriosis vs. Traditional Surgery
At Highland Gynecology, Dr. Haverland takes pride in offering women long-term endometriosis treatment through the most minimally invasive means of surgery: a robotic gynecologic procedure. Robotic surgery with the da Vinci® system can allow gynecologists to remove endometrial tissue while lessening the physical burden placed on patients. Whereas traditional endometriosis resection requires one long incision, robotic endometriosis surgery can be performed with a laparoscope and a few tiny incisions. In turn, patients are often able to experience benefits such as:
- Less pain during the recovery process
- Less downtime compared to open surgery, resulting in a faster recovery
- A lower risk of complications and infections
- Less extensive scarring after surgery
- Greater precision during surgery
- Reduced blood loss
Robotic surgery can be utilized in a range of other gynecologic procedures besides endometriosis resection, such as a hysterectomy and a myomectomy. Dr. Haverland was fellowship-trained in minimally invasive techniques such as robotic-assisted surgery and has extensive experience achieving the best health outcomes for endometriosis patients.
How is Endometriosis Surgery Performed?
Endometriosis resection is performed while patients are under general anesthesia. Although cauterizing or burning the endometrium is a common approach to treat the symptoms of endometriosis, Dr. Haverland has found that excising endometrial patches outside of the uterus through laparoscopic and robotic-assisted techniques can provide the best overall health outcomes.
During the robotic-assisted procedure, Dr. Haverland uses the da Vinci® system to make extremely precise surgical movements via tiny, fully wristed instruments. Small incisions are made in the abdomen, which provide the entry points for the laparoscope. Magnified images from the tiny camera are then projected onto a chairside monitor, allowing Dr. Haverland to observe your reproductive organs for endometrial tissue. She can then meticulously excise endometrial lesions while operating at a chairside console, which translates her movements to the robotic surgical instruments in real time.
What Can I Expect From the Recovery Period After Endometriosis Surgery?
Recovery after robotic-assisted endometriosis surgery is usually much more comfortable and well-tolerated when compared to a traditional resection procedure, which utilizes a long incision that often takes longer to heal. Thanks to the smaller incisions and minimally invasive nature of surgery, patients are often up and walking within 24 hours of their procedure. While plenty of rest can help facilitate healing, Dr. Haverland encourages patients to walk around and practice light ambulation (sitting up, standing, etc.) as soon as they feel up to it. Any discomfort can typically be managed with over-the-counter or prescribed pain medications. Many patients feel well enough to return to work within two weeks; however, physically demanding work responsibilities and other strenuous activity should be avoided for at least six weeks.
How Much Does Endometriosis Surgery Cost?
Endometriosis surgery costs vary based on the details of each patient’s treatment plan, but expenses are often partially (if not fully) covered by health insurance. While the possibility of coverage depends on your policy, symptoms, and other individual factors, our team would be happy to help you navigate the insurance process and assist you in determining the full scope of your benefits. If you have any out-of-pocket costs, our office will fully inform you of gynecologic surgery financing options that may make paying for your treatment more manageable.
In general, the cost of endometriosis resection may depend on:
- The surgical technique utilized
- The type of procedure
- Your insurance (if applicable)
Because determining the cost of your treatment is impossible without an initial consultation, our office will be able to provide you with a personalized estimate after Dr. Haverland gains a better understanding of your condition. Please don’t hesitate to contact our Dallas practice if you would like to discuss our payment options, your financial responsibilities, or the cost of endometriosis surgery.
Will I Have Endometriosis Scars?
Any surgical procedure will leave scars to some extent; fortunately, the minimally invasive techniques often utilized during endometriosis resection can significantly reduce the amount of scarring after surgery. With a robotic or laparoscopic procedure, only a few small incisions are required instead of the long incision typical of traditional endometriosis surgery. If you and Dr. Haverland decide that a resection procedure is the best course of action, Dr. Haverland will show you the exact location of the incisions so you know where your post-surgical scars are likely to appear. In many cases, following Dr. Haverland’s wound care instructions after surgery can help scarring lighten and fade over time.
With minimally invasive endometrial resection, Dr. Rachael Haverland can help you enjoy life again without the pain of endometriosis symptoms. Please contact Highland Gynecology for additional information about our endometriosis treatment options, or to schedule a consultation with Dr. Haverland.