To excise or ablate, that is the question.
What is Endo excision & ablation?
Excision means to surgically cut out or remove all visible abnormal tissue. Ablation means to ‘destroy’ the tissue. This may be performed through diathermy (meaning the abnormal tissue is burned with an electrical current), a laser, or with carbon dioxide a CO2 laser.
Why?
Excision of tissue is a more complex procedure. It involves identifying margins of the abnormal tissue and where anatomy may be distorted, then removing the lesion in its entirety. Ablating tissue means destroying what can be seen without dissecting into the surrounding area.
Types of endometriosis?
Endometriosis may be superficial or ‘deeply infiltrating’. Superficial means it grows on the surface of the peritoneum. Peritoneum is the glad wrap-like substance covering the inside of the pelvis. The deeply infiltrating disease is a more severe disease. It grows inwards & deep, is more strongly attached, and can draw tissue towards it making it into a mass or a ‘nodule’. Imagine bubble gum stuck in hair – multiple strands of hair become attached, and to get the gum out you have to take the attached hair with it. Removing the hair from the gum is very difficult.
Ablation vs excision
The superficial disease can probably be completely destroyed with ablative techniques as the diseased layer is thin. With excisional surgery, the surgeon uses a combination of vision and ‘feel’. The dense nodular tissue behaves differently, and complete excision can be very difficult. An experienced surgeon will obtain better ‘margins’ than an inexperienced surgeon. The aim of all endometriosis surgery is to have none or minimal residual disease.
Summary
Expert opinion favours excisional surgery as the preferred mode of endometriosis treatment. Excision will lead to improved patient outcomes, less recurrence of pain, and less repeat surgery. It entails a ‘higher skill set’ than ablative surgery. Ablative techniques are still effective though. In some situations, ablative techniques may be preferable or advised, such as when the disease is in a location where it is unsafe to excise (eg. next to a major blood vessel).
The doctors at Central Gynaecology are all specially trained to perform excisional surgery and consider this the optimal technique. Please ask if you would like to discuss this concept further.
