Dr. Konstantinidis MD, PhD, FACS - General Surgeon & Director of Bariatric, Laparoscopic & Robotic Surgery of Athens Medical Center.
Often the underlying cause of infertility, endometriosis in addition to being painful can be an obstacle to a woman’s desire to have children.
The most effective method of treating endometriosis is minimally invasive surgery, which guarantees a combination of optimal medical and cosmetic results, without the hassle and large incisions of open surgery and with really minimal tissue injury.
What is Endometriosis?
Endometriosis is the growth of tissue that is usually found on the lining of the uterus (endometrium) at a location outside the uterine cavity. It can appear in the ovaries, on the surface of the uterus, in the intestine, in the abdominal wall or in other organs.
With hormone levels changing during the menstrual cycle, tissue can grow and / or break, leading to pain and eventually scarring.
How common is Endometriosis?
The prevalence of endometriosis in women cannot be determined precisely, as the diagnosis is usually made only by direct examination of the endometrial tissue (which requires a surgical procedure, typically laparoscopy).
It is estimated, however, that about 6 to 10% of all women suffer from endometriosis.
The percentage of women who have endometriosis is higher among those who are infertile (25 to 50%) and women who have pelvic pain (75 to 80%).
The median age at diagnosis is 27, but endometriosis can also develop in adolescence.
What are the causes of Endometriosis?
The causes of endometriosis are unclear, but there are many theories:
- Small pieces of the endometrium that are discarded during menstruation may flow back through the fallopian tubes to the ovaries and abdominal cavity, instead of flowing through the vagina and out of the body during menstruation.
- Cells from the endometrium can be transported through the blood or lymphatic vessels to another location.
- Cells outside the uterus can be transformed into endometrial cells.
Endometriosis is sometimes hereditary and more common in first-degree relatives (mothers, sisters and daughters) of women with endometriosis.
What are the risk factors for Endometriosis?
Endometriosis is more likely to occur in women with the following characteristics:
- they had their first baby after the age of 30
- they never had children
- menstruation started earlier or stopped later than normal
- they have short menstrual cycles (less than 27 days) and heavy periods lasting more than 8 days
- they have structural abnormalities in the uterus
In contrast, endometriosis is less common in women with the following characteristics:
- multiple pregnancies
- menstruation starts later than usual
- breastfeed for a long time
- use low-dose contraceptives
- exercise regularly
What are the symptoms of Endometriosis?
The most common symptom of endometriosis is pain that occurs before, during or after menstruation.
The pain may occur during sexual intercourse, urination or during bowel movements.
Some women experience severe pain that can pin them down.
Endometriosis sometimes causes chronic pain in the back or pelvis.
However, many women have mild or no symptoms at all.
How is infertility related to Endometriosis?
Infertility can be the first sign of endometriosis in many women.
It is estimated that approximately 30% to 40% of patients with endometriosis have difficulty conceiving.
How is Endometriosis diagnosed?
The diagnosis of endometriosis begins with a detailed history and clinical examination of the patient’s pelvis.
If endometriosis is suspected, then a laparoscopic examination is decided.
The doctor examines the abdominal cavity with a special instrument, the laparoscope, to check for endometrial tissue.
The laparoscope is inserted into the abdominal cavity through a small incision that is most often made just above or below the navel.
If it is not clear whether the tissue found is normal or endometrial, a tissue sample is taken for biopsy.
Depending on the location of the tissue, a biopsy sample may be taken endoscopically through the anus (sigmoidoscopy) or the bladder (cystoscopy).
Ultrasonography may be applied to determine the extent of endometriosis, but its usefulness in diagnosis is quite limited.
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Laparoscopic Endometriosis Repair
Laparoscopic Endometriosis Repair
How is endometriosis treated?
Endometriosis treatment depends on a woman’s symptoms, her plans for childbearing and age, as well as the stage of endometriosis.
Usually, non-steroidal anti-inflammatory drugs are used to relieve pain. It may be all that is needed if the symptoms are mild and patients do not intend to have children.
Medication can be used to suppress the activity of the ovaries and therefore slow down the growth of the endometrial tissue that has grown in the wrong position and as a result reduce bleeding and pain.
For most women with moderate to severe endometriosis, the most effective treatment is the surgical removal or destruction of the endometrial tissue.
In the past, endometriosis was treated with open surgery, which involved a large incision.
Today, however, endometriosis is more commonly treated with laparoscopy or, with its evolution, robotic surgery, in order to achieve the optimal medical outcome with the least possible tissue injury.
What is Laparoscopic Endometriosis Repair?
Laparoscopic endometriosis repair is a minimally invasive procedure that involves not a large incision, as in conventional, open surgeries, but 3 – 4 small holes in the patient’s abdomen through which laparoscopic instruments are inserted.
Among them is the laparoscope, which includes a camera that offers the surgeon an extremely clear view allowing him to investigate all foci of endometriosis, minimizing injury to neighboring tissues and organs.
What is Robotic Repair of Endometriosis?
Robotic repair of endometriosis is an evolution of laparoscopy and is also performed through 3 – 4 small holes in the abdomen.
The surgeon is seated on a special console enjoying 3D imaging and digital magnification of the surgical field as if he were inside the patient’s body!
From the console, the surgeon navigates with incomparable precision and stability the robotic arms and the special robotic tools, while being able to intervene in parts of the body that are inaccessible to the human hand.
In this way, the risk of injury to neighboring tissues and therefore complications from the operation is significantly minimized and the ectopic endometrial tissue is removed optimally.
Thus, the chances for a future relapse and new surgery are significantly reduced, while at the same time the postoperative pain, the duration of the hospitalization as well as the recovery of the patient is minimized, who quickly returns to her daily life and family.
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Why Dr. Konstantinidis?
The Robotic Surgery Team of Athens Medical Center, under the direction of Dr. Konstantinidis, with the participation of experienced gynecologists has performed a great number of robotic endometriosis repair procedures with high success rates and patient satisfaction.
Combining the latest developments in medical technology and science with respect and sensitivity to each woman, Dr. Konstantinidis and his Surgical Team offer internationally acclaimed and innovative treatments.