Endometriosis: Finishing the Job

By Camran Nezhat, MD, FACOG, FACS

As surgeons, updating skills so that we can completely, thoroughly remove endometriosis is a necessary part of our education and skill update. For example, it is critical that surgeons have the advanced skills and instruments needed to be able to safely and thoroughly remove endometriosis when it has invaded delicate structures such as blood vessels. Because some are not able to remove endometriosis from these sites, they have no choice but to leave it behind, where it will continue to cause pain and other potentially severe symptoms.

Where science is making progress we need more training. The diagnosis of thoracic endometriosis has improved substantially over the past two decades because of advances in endoscopic techniques (video-assisted thoracoscopic surgery [VATS] as well as laparoscopy), coupled with a higher level of clinical suspicion. Its etiology and pathogenesis, however, are still not well understood. Hence, optimal management of thoracic endometriosis remains to be elucidated, with medical, surgical, or combined approaches being reported in medical literature.

However, implicit in narratives and over the net is the flawed assumption that endometriosis returns as a result of an incomplete and/or inadequate method of treatment (ie, ablation/excision) from a previous surgery. While it’s certainly true that inexperienced surgeons might treat endometriosis inadequately, what’s equally true, if not more so, is the fact that endometriosis can recur despite the most thorough treatment possible. In other words, all the medical interventions in the world, by all the world’s greatest practitioners, cannot prevent endometriosis from returning in certain cases.

We have created a new fellowship program that will address this need for training through SLS. See this at: http://sls.org/sls-fellowship-programs/fellowship-in-specialized-minimally-invasive-surgery

Camran Nezhat, M.D., F.A.C.O.G., F.A.C.S. is the Director of the Center for Special Minimally Invasive and Robotic Surgery in Palo Alto, California.