Robotic Surgery for Endometriosis

Endometriosis is a medical condition where the endometrial tissue and stroma grow outside the normal uterine cavity, usually on the posterior surface of the uterus, fallopian tubes, ovaries and in the pelvis. 25-50% of infertile women have endometriosis and 30-80% of patients presenting with pelvic pain have endometriosis. Unfortunately, endometriosis is 6-8 times more common in infertile women and it reduces their fecundity from the normal 20% chance of pregnancy per month to as low as 2% chance of pregnancy per month.

There are different ways by which endometriosis causes infertility. They include, but are not limited to, pelvic adhesions, tubal damage, destruction of the ovaries resulting in poor ovarian reserve and follicle recruitment, abnormal production of prostaglandins, interlukins (IL1, IL6) TNF, etc. and abnormal endometrial receptivity to embryos. Endometriosis also increases the risk of miscarriage.

Diagnostic laparoscopy is a gold standard diagnostic tool for endometriosis. Surgery to remove the endometriotic lesions has shown to increase the pregnancy rate. In young patients, laparoscopic surgery with excision of endometriosis may be followed with anticipation for natural pregnancy for 6 months or controlled ovarian stimulation with or without IUI is advised. In advanced stage disease or in older patients, surgery followed by treatment with IUI or IVF is recommended.

Recently, robotic assisted laparoscopic surgery has been shown to improve the end results of surgery and associated improvement in pregnancy rate. The treatments are based on the patient’s age, ovarian reserve after surgery (low day 3 FSH and normal AMH), patency of the tubes and patient desire.

At the Center for Reproductive Medicine and Robotic Surgery, Dr. Jacob and team have specialized in robotic assisted resection of advanced stage complex endometriosis. Please click the link below to watch videos of robotic surgeries performed by Dr. Jacob for advanced stage endometriosis.

Commonly Asked Questions

I have severe pain, pain with sex and am unable to conceive. What should I do?

You may have endometriosis. Please call and make an appointment for evaluation for endometriosis. You may be asked to check your hormone levels, ultrasound and surgery based on the findings. If you are young and have only mild disease you may wait to conceive naturally. If you have advanced stage III or IV disease, the best option is to undergo treatment within 6 months of surgery.

My doctor told me I have endometriosis and had multiple laparoscopies. I still have pain. What are my options?

Most likely your disease has returned. The best treatment option is robotic assisted laparoscopic resection of endometriosis. This will give you significant pain relief. In addition, you may consider pre-sacral neurectomy, a procedure where the nerve supplying the pelvis is cut, thus reducing pain sensation. These procedures may be followed by long term continuous contraceptive pills or Lupron therapy upto 6 months.

I have completed my family but still have severe pain. What are my options?

The best treatment option is to undergo surgery and remove the ovaries which will eliminate estrogen production in your body. Estrogen is the fuel for endometriosis and its growth. Most patients with endometriosis usually undergo a hysterectomy with oophorectomy to get cured from the disease. This commonly happens in their 40’s after completion of their families.