What Is Endometriosis
Tissue that forms the lining of the uterus (endometrium) is sometimes present in other places in some women. These sites can be ovaries, fallopian tubes, cul-de-sac (behind uterus), intestines, rectum, urinary bladder. Endometrial tissue outside the uterus also responds to changes in hormones. It also breaks down and bleeds like the lining of the uterus during the menstrual cycle every month. However the bleeding inside the uterus has a passage to come out as menstrual bleeding through vagina, the bleeding in endometriotic site accumulates and forms cysts (chocolate cysts) or adhesions. This can cause pain, especially before and during period. One third of cases of infertility is due to endometriosis.
Who Is Commonly Affected
- Young women in the reproductive age group (20-40years)
- Endometriosis commonly presents as infertility
- Women with uterine defects like septum or bicornuate uterus(double uterus)
- It can run in the family
What Are the Symptoms
- Pelvic pain (pain in lower abdomen and back). Such pain may occur with sex, during bowel movements or urination, or just before or during menstrual cycle.
- Heavy Bleeding during menstrual cycle.
- Pain during sex.
- Feeling of bloating & Fullness in abdomen around the periods.
- Some women with endometriosis may have no symptoms.
How Do We Diagnose
- Pelvic examination
- LAPAROSCOPY- is the gold standard in diagnosing endometriosis
What are the treatment options?
Treatment for endometriosis depends on the extent of the disease, presenting symptoms, and whether one wants to have children. It may be treated with medication, surgery, or both. Although treatments may relieve pain and infertility temporarily, it is a = problem and conservative treatment (medical or surgical) cannot provide permanent cure.
Medications– is used both to relieve pain and to keep the disease under control. Painkillers like paracetamol or mefenemic acid relieves the pain up to great extent. Hormones like progesterones or combined pills not only relieve the pain but also help to control the disease process. Hormonal injections or Mirena (a intrauterine contraceptive device with progesterone) are also used in some situations. These medications cannot be used for long as women are not able to tolerate the side effects that these medications. Medications do not provide permanent cure.
Surgery – is done to remove endometriosis and the scarred tissue around it. In severe cases surgery is the best choice for treatment. Surgery is done almost always by LAPAROSCOPY. During laparoscopy, endometriosis can be removed or burned away. Extent of surgery depends on the patient’s needs. If infertility is the issue then conservative approach and trying to save the normal tissues is attempted followed by active treatment for infertility. If the woman does not desire any more children the complete removal of uterus along with both ovaries and all endometriotic tissue is done. Sometimes severe endometriosis cannot be handled with laparoscopy and a procedure called laparotomy may be needed.
Robotic surgery is the latest addition in approach to management of endometriosis. Da Vinci ® surgical intervention is a new category of minimally invasive surgery that combines the best of open and laparoscopic surgery. With the assistance of Robotic ARMS (controlled by the surgeon of course!), we can perform surgeries through small incisions with unmatched precision and control. Robot-assisted surgery allows superior 3D visualization of the surgical field with 10 times magnification with human wrist like manueuverability. Advantages of Robotic surgeries are-
Minimal scarring. Due to precise movement, tissue trauma is less.
Less blood loss. Better dissection in the right planes and the ability to suture more quickly, there is significantly less intra-operative blood loss
Less post-operative pain.
Faster recovery. Most patients are able to resume normal activities within 2 weeks, compared to 6 weeks for open surgery. Additionally, patients can go home the same day of the procedure
Excellent suturing The excellent precision and visualization offered by the da Vinci Si system enhances the surgeon’s ability to suture the uterus appropriately.
Endometriosis is a progressive disease. The source of the problem is the hormonal changes associated with menstrual cycles and presence of endometrial tissue at abnormal places. After conservative surgery the disease can recur. Patients who are treated with both surgery and medications have extended symptom-free period.