Endometriosis Surgery

Endometriosis Surgery- the Laser Vapor- excision™ alternative to Hysterectomy

Endometriosis (“endo” for short) is a common cause of pelvic pain, affecting millions of American women. It can occur at any stage during the reproductive age range (12-55+) and typically gets worse over time. Tissue growths can develop primarily in and around the pelvic area and sometimes even in far reaches of the body. These growths of cells act just like the lining inside of the uterus, growing and shedding in sync with the menstrual cycle. This causes pain and scarring and sometimes interferes with fertility and the function of other organs, such as the bladder and digestive tract. Common symptoms are painful periods, painful ovulation, sexual pain and infertility. Often there is pain or problems with bladder, digestive and bowel function.

A careful evaluation by a specialist will typically uncover tenderness, scarring or lumps on pelvic exam. Vaginal ultrasound, performed by a gyn expert, will sometimes “see” signs of “endo”. The diagnosis is most often made by laparoscopic surgery, using a small lighted scope to view the pelvic and abdominal organs and tissues. This is the perfect time to aggressively treat endometriosis by removing the “spots” and nodules of abnormal tissue.

Unfortunately, few surgeons are prepared or skilled in the removal or “excision” techniques that provide successful treatment. In other words, not all laparoscopies are equal. A simple “diagnostic” laparoscopy only “sees” what the problem is. An aggressive “operative” laparoscopy done by an advanced laparoscopic gyn surgeon combines quality treatment with making the correct diagnosis.

Endometriosis Viewed through Laparoscope

(the white, black and brown areas between uterus and right ovary)

Detecting and treating endometriosis is tricky and takes time and experience. Sometimes the growths or spots can be difficult to see. The most obvious endo tissue growths are the most advanced, late-stage black “powder burn” lesions. But in earlier stages they can also be clear, red, white, or brown in color. It can also “hide” inside the ovaries, ligaments and places like the appendix and the wall of the bladder or rectum. Small lesions can be very inflammatory and trigger major nerve pain. There can also be significant scarring and tissue damage from endo. When laparoscopic surgery is done, the goal should be to see and treat ALL lesions by removing them. Whenever possible, this should be done with the goal of preserving the important organs and reproductive function. Taking into consideration the wishes of the patient, only in the most extreme cases should complete hysterectomy be performed.

If the bladder, bowel or appendix is involved, then those areas should be aggressively treated as well. Completely excising all endometriosis growths provides an excellent chance of successful treatment and reduces the chance of future scarring or more surgery. For 25 years, I’ve called my surgical technique for this “laser vapor excision™”. I use a carbon dioxide laser to remove and vaporize endo from the surrounding normal tissues. If necessary, I will treat the bladder, rectum, bowel, deep pelvic areas and if necessary, remove an involved appendix. The laser minimizes thermal injury to healthy tissues and keeps scarring to a minimum.

I also use hydro-dissection technique, where saline is injected around lesions to provide a temporary protective cushion for normal tissues. When large areas are treated or the internal ovary is involved, repair work may be required to get the best results. Often specific “pain nerves” will be lasered for relief. These techniques are called LUNA (Laser Uterosacral Nerve Ablation) and PSN (PreSacral Neurectomy). Patients with retroverted or “tilted” uterus will often benefit with uterine suspension, where the uterus is “lifted” into a better position by tightening certain ligaments. Even when the surgery does involve hysterectomy, I use the same extra techniques to treat ALL involved areas and endo lesions. Since 2007, I have added robotic surgery technology for appropriate patients.

As Dr. Andrew Cook describes in his book, STOP ENDOMETRIOSIS AND PELVIC PAIN: WHAT EVERY WOMAN AND HER DOCTOR NEED TO KNOW, “The pervasive misunderstanding as to what constitutes good endometriosis surgery is a huge part of why so many women with endo continue to live lives of pain and suffering. Excision and Vaporization of Endometriosis is used by all of the top endo surgeons…. It is the most effective way of removing endometriosis from the body and deserves to be the surgery of choice for endo.”
As with any medical treatment, and especially surgical treatment, special expertise and experience really count when seeking optimal outcomes. As I say, just like with airline maintenance, there are no good shortcuts or discount deals. For the best results, see the best doctor and get the best care you can find.

Michael Swor, MD, founder of Swor Women’s Care and medical director of Physician Care Clinical Research in Sarasota, Florida, is a gynecologist and advanced gyn surgery specialist. He has over 25 years of experience treating women with complex health problems such as endometriosis. An assistant clinical professor at the University of South Florida in Tampa and Florida State University, he has provided women’s health lectures and training to thousands of professionals throughout the country. His special interests are advanced technologies, surgical safety and patient education programs.
Dr. Swor and his staff are known for their compassion, dedication, and holistic philosophy.