One of our primary specialties is Advanced Laparoscopic Surgery for endometriosis. We follow the 30 year teachings of Dr. David Redwine and others regarding the aggressive EXCISION of ANY visible endometriosis lesions in the pelvic or abdominal area and beyond. The word ablation should not even be used with endometriosis treatment. KEY POINT HERE- ablation is for the endometrium not endometriosis. We advise minimally-invasive laparoscopic access as a common first-line approach in any woman of any age with a clinical presentation suggesting endometriosis. Once you have that access, the advanced gyn laparoscopic surgeon can carefully explore all areas in the abdomen and pelvis and excise/remove any suspected lesions with meticulous technique. Energy can be used as long as it has minimal surrounding tissue effect. The key is full excision or full depth treatment. Our common excision technique is CO2 laser “vaporexcision”. The new versions of helium-based plasma energies work well too. A careful clinical assessment including a detailed questionaire or gyn medical history with an experienced-hands on exam and a real-time, clinical transvaginal ultrasound help identify patients with suspected endometriosis. Some patients may qualify for a trial of birth control or other hormonal therapy, but any significant findings or symptoms, especially unresponsive to first treatments, should be advised to have laparoscopy. Endometriosis is commonly found (and treated) in or around the bowel, rectum, bladder, appendix, nerve-bearing ligaments, and other organs or tissues.
For patients with severe or recurrent endometriosis, we have targeted drug treatments as well. We also participate in clinical trials investigating new treatments not available to everyone and there are some new exciting advances in development.