Techniques of endometriosis removal

There are three techni­ques for surgical removal of endometriosis:

  1. electrocoagulation - with the use of coagulating electrodes (electric current),
  2. cutting - with scissors or a scalpel,
  3. vaporization - with the use of plasma knife or a laser with appropriate properties.

1. Electrocoagulation (current coagulation, fulguration)

Proce­dure performed using mono- or bi-polar electro­des. It is the simplest method, which does not require specia­lized tools, there­fore it is most commonly used. Warning! Studies have shown that in the charred tissue there are still active endome­trial glands that lead to recur­rence of the disease even in the first months after the surgery. Another disadvan­tage of electro­co­agu­la­tion is the signi­fi­cant damage to the tissue lying under­neath the endome­triotic lesions, reaching up to 1 cm! It is parti­cu­larly impor­tant during ovarian coagu­la­tion resul­ting in a signi­fi­cant reduc­tion in ovarian reserve and thus reduc­tion of fertility.

At Miracolo Clinic we do not perform electrical coagu­la­tion of endome­triosis lesions!

Jan Olek, gynecologist, Miracolo Clinic
Electrocoagulation

Advantages

  • check quick use
  • check low price
Electrocoagulation

Disadvantages

  • closefrequent relapses
  • closetissue damage
  • closereduced ovarian reserve
  • closeno possibility to remove lesions from delicate areas (eg. gut)

Fig. Electrocoagulation of endometriotic lesions (source: atlasofpelvicsurgery.com)

2. Excision of endometriotic lesions

This technique requires more effort and dexte­rity from the opera­tor. It allows to remove disease lesions effec­ti­vely. Unfor­tu­na­tely, it results in more exten­sive "wounds" that can form larger adhesions during the process of healing . Endome­triosis excision is mainly used for perito­neal foci. It is diffi­cult and very mutila­ting, especially when it concerns the surface of the ovary, uterus or in case of super­fi­cial, small changes on the intestine, ureter, liver or diaph­ragm. However, this is the only technique possible to use in deep infil­tra­ting endome­triosis (eg. in the recto­-va­ginal area).

Excision of endometriotic lesions

Advantages

  • check less risk of recurrence
  • checkthe technique of choice for deep infiltrating endometriosis
Excision of endometriotic lesions

Disadvantages

  • closetime-consuming
  • closegreater bleeding
  • closewounds of greater range
  • closegreater risk of adhesions
  • closelimited possibility of use in endometriosis on the surface of the ovary, uterus, intestine, bladder, liver and diaphragm.

At Miracolo we use the excision techni­ques to remove foci in case of deep infil­tra­ting endome­trio­sis, in order to obtain histo­pa­tho­lo­gical speci­mens, and to minimize costs of the surgery in women with mild severity of the disease in perito­neal area.

Jan Olek, gynecologist, Miracolo Clinic

3. Vaporization with the use of plasma knife or a laser

Vapori­sa­tion involves the evapo­ra­tion of tissue with the use of a new genera­tion plasma knife or laser. It allows to preci­sely remove the endome­triotic foci without any unneces­sary margin. An additional benefit of vapori­za­tion is the effect of super­fi­cial coagu­la­tion (to the depth of 0.2 mm). The tissue under­neath remains intact. We use a plasma knife to remove endome­triosis from the surfaces of ovaries, uterus, intestine, liver, diaph­ragm. In this way the maximum ovarian reserve is mainta­ined. This technique result in minimal blood loss during the proce­dure, a very fast regenera­tion of the patient and lower risk of adhesions.

Vaporization of endometriotic lesions

Advantages

  • check saving technique for the tissues lying underneath the endometriotic lesions
  • checksafety
  • checkthe risk of relapse is comparatively low (similar to the use of excision techniques)
  • checkno bleeding
  • checklower risk of adhesions
  • checksaving of ovarian reserve
Vaporization of endometriotic lesions

Disadvantages

  • closeprice

Treatment technique of endometrial cyst (endometrioma)

Endome­trial cyst can be:

  1. enucleated or
  2. open, drained, vaporized,

Until recen­tly, endome­trial cysts were mainly enucle­ated, which guaran­teed complete removal of the endome­trial tissue in the bottom of the cyst. Endome­trioma is not a simple cyst. An endome­trial cyst bag is nothing else but ovarian bag! Under­neath it there are numerous vessels and follicles with egg cells. In the bottom of such a cyst, and there­fore on the surface of the ovarian bag, there are lesions of endome­triosis that grow and bleed during menstru­ation. The blood is collected in the walle­d-off ovary and incre­ases its volume month by month. However, the ovarian bag itself is not the focus of endome­triosis. There are only super­fi­cial foci on the ovarian bag, exactly the same as it happens on the perito­neum. There­fore, if the cyst is opened and the foci on the ovarian bag and vapori­zed, the ovarian reserve can be saved in a great extent! If the bag is removed it unveils bleeding ovarian stroma. Bleeding is inhibited with electro­co­agu­la­tion which destroys ca. 1 cm of healthy ovarian tissue with follic­les, which reduces ovarian reserve as well as the chance of concep­tion. We often observe the ovaries after 2 or 3 removals of endome­trio­mas. The ovary turns into a set of fibrous tissue; a spe­cific type of keloid. There­fore, in our clinic, we are more and more inclined to the use of vapori­za­tion techni­ques of endome­trial cysts.

Exemplary surgery of advanced endometriosis with the use of plasma knife

Watch an example surgery of an advanced endome­triosis carried out by our operator using plasma knife:

See our offer of endome­triosis surgical treatment.

Wondering if you also have endometriosis?

The sooner you diagnose this disease, the more likely you are to cure it completely. It means not only a better quality of life due to the lack of menstrual ailments, but also a restoration of your natural fertility.