Iris Kerin Orbuch, M.D. | Advanced Robotic & Laparoscopic Surgery
Robotic Excision Of Endometriosis
The da Vinci system with its 3-D High Definition Camera allows for precise excision of endometriosis. Excision of endometriosis is the gold standard treatment for endometriosis. Ideally all endometrial lesions should be excised. Unfortunately most gynecologists are not trained in advanced endometriosis cases. Others approach endometriosis with cautery or a laser, two modalities shown to be far inferior to excision using scissors, the method performed by Dr. Orbuch. With scissors, the endometrial implants are removed, but with cautery or a laser the lesion remains and continues to cause pain necessitating more surgery. A doctor utilizing laser may vaporize the surface of the lesion, but still leaves active endometrial tissue below. Deep fibrotic endometriosis usually does not respond well to hormonal suppressive therapy. Adequate surgical excision of endometrial implants provides the best symptomatic relief and long term results. In addition, surgical excision has been shown to improve fertility rates in women. Drug therapy can suppress endometriosis, not eradicate endometriosis. The definitive treatment of endometriosis is NOT hysterectomy or removal of both ovaries; rather it is complete excision of endometrial lesions.
Excisional surgery makes sense if one understands what endometriosis is. Normally during a monthly cycle, a woman's' endometrium, or uterine lining builds up then is shed as her monthly flow of menses. The endometriosis areas growing outside the uterus go through a similar cycle but because the build up cannot leave the body, the implants get deeper and deeper. Additionally, endometriosis lesions can irritate nearby tissue causing adhesions, scarring, and pain. Over time, endometriosis can grow into nodules causing scaring to nearby organs. Excision of endometriosis is the only therapy to objectively cure disease and thus improve quality of life. Dr. Orbuch excises endometriosis using Wolf blunt scissors, a technique initially performed by Harry Reich, M.D., a leader in advanced gynecological endoscopic surgery. This technique, along with other advanced laparoscopic techniques, was learned during her advanced laparoscopic fellowship with Dr. Harry Reich and Dr. C.Y. Liu.