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Women's Health

Endometriosis

If you have endometriosis, tissue normally located in the lining of the uterus grows outside the uterus. It can be found on the ovaries, fallopian tubes, bowel and possibly other places in the pelvic cavity. Sometimes it can even grow outside the pelvis.

This extra tissue may be referred to as “implants.” During your period, the extra tissue swells with blood along with the normal tissue in your uterus. This swelling and blood can irritate nearby tissues, which can cause pain or cramps. Constant irritation may cause scar tissue known as “adhesions” to form. These adhesions can bind organs together and cause additional pain or discomfort. Adhesions may also make it difficult to get pregnant or maintain a pregnancy. In other words, adhesions caused by endometriosis can cause infertility.

 

Endometriosis is one of the most common health problems for women.¹ Symptoms are usually experienced by women in their 30s and 40s, but can occur in anyone who has menstrual periods. The exact cause of endometriosis is unknown, although there are many theories. Unfortunately, there is no cure for endometriosis but there are several treatments for the pain and infertility it may cause.

Common Symptoms of Endometriosis

If you have endometriosis, you may have one or more of these symptoms:

• Cramps and menstrual pain
• Pelvic pain
• Pain during sexual intercourse
• Infertility - trouble getting pregnant(endometriosis)

Stages of Endometriosis

The stages of endometriosis are ranked as follows: minimal (I), mild (II), moderate (III), or severe (IV). Staging of this condition depends on the number, size, and site of the implants. The stage also depends on the extent of the adhesions and whether other pelvic organs are involved. The severity of your disease may not match the pain you feel. Even mild endometriosis can cause severe pain.

Endometriosis Treatment Options

Your doctor may recommend endometriosis be treated with over-the counter pain medications, hormone therapy, surgery, or a combination of treatments. If your pain is severe and on-going, your doctor may recommend either endometriosis resection or a hysterectomy as a cure, depending on whether you want to preserve your uterus. Talk to your doctor to find out the benefits and risks of each treatment and which one may be best for you.

Hormone Therapy

Hormone therapy regulates or blocks the hormones that control your menstrual cycle. Certain hormones can limit the swelling of your endometrium and extra endometrial tissue (implants). This treatment may be used before, instead of, or after surgery. The following are different types of hormone therapies:

• GnRH Agonists and FSH and LH Inhibitors. This medication is used to stop or lower the production of estrogen and progesterone hormones.
• Birth control pills. This medication contain estrogen and progesterone. Birth control pills help to regulate the estrogen and progesterone in your body.
• Progestins. Progestins are a form of progesterone and help to keep estrogen levels low.
• Danazol. This hormone stops or lowers the production of estrogen and progesterone.

Surgery

When the symptoms of endometriosis are severe or affect a woman’s quality of life, surgery is often recommended. There are two surgical options for treating endometriosis:

• Endometriosis resection. This involves removal of endometrial tissue implants while leaving the uterus in place. Endometriosis resection is usually recommended for women who want to become pregnant in the future.
• Hysterectomy. This procedure involves removing the uterus and other organs affected by endometriosis, such as the ovaries or fallopian tubes. Hysterectomy is often recommended for patients who do not desire a future pregnancy.

Endometriosis resection and hysterectomy can be performed with minimally invasive surgery known as laparoscopy or traditional open surgery known as laparotomy.

• Laparoscopy. This is a minimally invasive procedure in which surgical instruments are inserted through small abdominal incisions to remove the implants or organ(s). One of the instruments is a laparoscope – a thin, lighted tube with a tiny camera at the end. Laparoscopy requires the use of long-handled, rigid instruments which can present limitations during complex and delicate operations that require greater precision or dexterity.
• Laparotomy. Laparotomy is traditional open surgery performed using a long abdominal incision and typically requires a long recovery. Laparotomy may be used to remove large implants that cannot be reached with a laparoscope. Laparotomy may also be recommended when pelvic organs such as your bowel are involved.

Fortunately, there is a minimally invasive option for treating endometriosis designed to overcome the limits of traditional open and laparoscopic surgery – da Vinci Surgery.

da Vinci Surgery

If your doctor recommends surgery to treat endometriosis, you may be a candidate for da Vinci Surgery. Using state-of-the-art technology, da Vinci® Surgery requires only a few tiny incisions, so you can get back to your life faster. The da Vinci System enables your doctor to operate with enhanced vision, precision, dexterity and control. da Vinci’s 3D, high-definition vision system allows surgeons to see key anatomy with immense depth and clarity– critical to removing deep endometrial tissue implants.

da Vinci Endometriosis Resection

This procedure offers women with moderate to severe endometriosis a definitive treatment that preserves the uterus. It also offers patients the potential benefits of minimally invasive surgery. Unlike conventional open and laparoscopic surgery, da Vinci Endometriosis Resectionoffers the added benefit of computer- and robotic-assisted technology to help your doctor perform a very precise operation, with the goal of minimizing the risk of endometriosis recurring.

da Vinci Hysterectomy for Endometriosis

If you have decided to have a hysterectomy after discussing treatment options with your doctor, you may be a candidate for da Vinci Hysterectomy – a definitive treatment for endometriosis. Potential benefits of da Vinci Hysterectomy compared to traditional open and laparoscopic surgery include:

• Less pain¹
• Fewer complications²
• Less blood loss^3,4
• Shorter hospital stay⁴
• Low risk of wound infection⁵
• Quicker recovery and return to normal activities⁶

The da Vinci System is a state-of-the-art surgical platform with 3D, high-definition vision and miniaturized, wristed surgical instruments designed to help doctors take surgery beyond the limits of the human hand. By helping doctors to overcome the challenges of traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for women around the world.

If you have been putting off treatment for endometriosis, it's time to ask your doctor about da Vinci Surgery.

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As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you to make the best decision for your situation.

While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for you.

1. “Endometriosis”. WomensHealth.gov; The Federal Government Source for Women’s Health Information. Available from: http://womenshealth.gov/faq/endometriosis.cfm#j

1. Ko EM, Muto MG, Berkowitz RS, Feltmate CM.Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol. 2008 Dec;111(3):425-30. Epub 2008 Oct 16.
   
2. Piquion-Joseph JM, Navar A, Ghazaryan A, Papanna R, Klimek W, Laroia R. Robot-assisted gynecological surgery in a community setting. Journal of Robotic Surgery, 2009:1-4.
   
3. DeNardis SA, Holloway RW, Bigsby GE, Pikaart DP, Ahmad S, and Finkler NJ. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecologic Oncology 2008;111:412-417.
   
4. Payne, T. N. and F. R. Dauterive. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol, 2008;15(3): 286-291.
   
5. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008 Oct;199(4):360.e1-9.
6. Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol. 2008 Dec;111(3):407-11. Epub 2008 Oct 1.

Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com

PN 874293 Rev A 12/10 U6-30-2011

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