Tag Archives: Minimally Invasive Surgery

Endometriosis

What Is Endometriosis?

Endometriosis is a uterine condition that affects as many as 1 in every 10 women during their childbearing years, or about 175 million women worldwide. Women with endometriosis experience a wide range of symptoms, and it’s crucial to understand this condition’s effects on a woman’s body and identify its existence as soon as possible.

Left unchecked, endometriosis can cause chronic, daily, and even debilitating pain for women and girls who experience it. Prolonged, unidentified endometriosis can even cause infertility; in fact, about 30 to 40 percent of women with endometriosis will experience infertility because of the condition. In addition, some of the symptoms of endometriosis can masquerade as other, common uterine and hormone-related conditions, lengthening the time to diagnosis and increasing infertility risks.

For that reason, early identification and treatment is crucial. Some women with endometriosis can manage the symptoms with simple treatments like hormone therapy or birth control, while others may require surgery. Building a wealth of knowledge about the condition can help you identify it, seek treatment, and make more informed decisions regarding the treatment process.

How Does Endometriosis Occur?

Endometriosis Diagram

As you may have suspected, endometriosis involves the uterus as well as potentially other reproductive organs within the woman’s body. The endometrium is the tissue that lines the walls of the uterus, and endometriosis is a condition that affects these tissues. During a normal menstrual cycle, the endometrium builds up in anticipation of pregnancy, where it is needed to help sustain a growing embryo or fetus; when pregnancy does not occur, the endometrium breaks down and is shed via menstruation.

A woman with endometriosis will start accumulating endometrial tissue outside the uterus, usually inside the abdominal cavity. Unfortunately, the tissues outside the uterus still respond to the menstrual cycle the same as the tissues inside the uterus. Once a period begins, these tissues will break apart and bleed. While the endometrium tissues inside the uterus can exit through the cervix, the tissues outside the uterus have nowhere to go.

How Does Endometriosis Affect Women?

The endometrium tissues that dissolve and bleed in the abdominal cavity will aggravate the other tissues around the uterus and cause inflammation, swelling and severe cramping pains. Doctors refer to the tissues scarred by endometrial tissues as nodules, implants, growths or lesions. This scarred, misplaced tissue is what causes the pain or discomfort common to endometriosis and can lead to the infertility so common to the condition. However, the exact symptoms experienced often depend on the location of the endometrium outside the uterus.

Most commonly, endometriosis affects:

  • Ovaries
  • Fallopian tubes
  • Ligaments supporting the uterus
  • The area between the uterus and the rectum
  • The outside of the uterus
  • The lining of the pelvic cavity

In rare cases, endometrium tissues can accumulate in the intestines, anus, bladder, cervix, vagina or vulva, including previous abdominal surgery scars. In extremely rare cases, doctors have located endometrial tissues in patients’ thighs, arms and lungs.

Endometriosis is a progressive condition that may not manifest noticeable symptoms until many years after menstrual periods begin. Each cycle causes more endometrium accumulation. Over the years, the endometrium implants grow and affect more tissues. Menopause generally causes the symptoms of endometriosis to subside and the implants to deteriorate.

What Causes Endometriosis?

While researchers have made many discoveries regarding what happens to the tissues affected by endometriosis, the exact endometriosis causes remain unknown. Currently, the only endometriosis cases that can be linked to a definitive cause are those where direct transplantation – the transferal of endometrial tissue onto the abdominal wall after a caesarean section or other uterine surgery – has occurred.

Popular, evidence-based theories include:

  • Travel theories, in which researchers posit that endometrial tissues may travel via the blood and lymphatic systems and implant elsewhere in the body.
  • Reverse menstruation, in which some menstrual tissue reverses direction within the fallopian tubes and into the abdomen, where it implants.
  • Transformation, in which researchers suggest that other types of cells in any location may transform spontaneously into endometrial cells.

While research is ongoing, in an attempt to determine the root cause of endometriosis, researchers agree there may be a genetic component as well. Some women, due to genetic family history, may be predisposed to endometriosis.

Endometriosis Symptoms

Signs and Symptoms of Endometriosis

As mentioned earlier, identifying endometriosis symptoms early can allow for earlier treatment of the condition, perhaps reducing the chances women will experience infertility as a result. The early symptoms of endometriosis typically include more significant:

  • Menstrual cramping
  • Abdominal pain
  • Lower back pain
  • Pain or discomfort during sexual intercourse
  • Pain or discomfort during urination and bowel movements
  • Heavier periods
  • Clotting during periods
  • Spotting during periods
  • Irregular periods
  • Fatigue and disrupted sleep
  • Depression

If endometriosis is allowed to progress, symptoms can spread beyond the reproductive system itself and into the other abdominal systems it affects. Endometrium implants can cause irritation that can progress into infections, abscesses or areas of the body that are tender to the touch. If endometriosis affects the tissues of the intestines or bladder, it can cause urinary or intestinal pains as well.

Endometriosis and PCOS Fertility

Although endometriosis is a fairly well-known and well-documented condition that causes infertility, it’s often confused with another common reproductive disorder known as polycystic ovary syndrome, or PCOS. Both conditions can cause infertility but distinguishing between the two is important, since treatment regimens differ. So, what is PCOS and how is it different?

Simply put, while endometriosis involves the transferal and growth of the endometrium outside of the uterus, PCOS involves the ovaries. With PCOS, the ovaries don’t ovulate as they should, causing egg follicles to become stuck inside. While, on the surface, endometriosis and PCOS can feel like depression, “period pain” or “abdominal pain”, their primary symptoms and the method of diagnosis differ greatly.

Diagnosing Endometriosis Cases

A doctor will need to review a patient’s entire gynecological history to properly diagnose endometriosis. The doctor must also perform a full physical examination and a pelvic examination. In some cases where doctors have reason to believe endometrial tissue may have spread to other, specific areas within the pelvis, doctors may perform an ultrasound, CT scan or MRI to provide images of the organs in question.

Endometriosis Symptoms

However, a positive diagnosis is only confirmed with a laparoscopic procedure. During this procedure, the patient is typically subject to general anesthesia, and the abdomen inflated with air via a small needle; this allows the doctor to have a better view of all components of the abdominal cavity. Then, the doctor will insert a lighted laparoscopic surgical instrument through a small abdominal incision to view the internal organs and locate endometrial implants. Overall, the procedure takes approximately 30 to 45 minutes.

Based on the findings during the laparoscopy, the doctor will be able to confirm the presence of endometriosis. However, doctors rarely eliminate the possibility of endometriosis, since endometrial growths may be tiny, or hidden by other tissues. Next, the doctor will rate the severity of the endometriosis present.

Determining Endometriosis Severity

The American Society of Reproductive Medicine has established a classification system for endometriosis, which is as follows:

  • Stage 1 – Minimal presence of endometriosis
  • Stage 2 – Mild presence of endometriosis
  • Stage 3 – Moderate presence of endometriosis
  • Stage 4 – Severe presence of endometriosis

To determine which stage each case of endometriosis falls under, doctors must first consider a number of factors, including:

  • The amount of tissue accumulation
  • The location of those tissues
  • The amount of scar tissue involved
  • The spread of the scar tissue within the abdominal cavity
  • Whether pelvic structures like the pelvic cavity or the pelvic floor are involved
  • Fallopian tube blockage
  • The presence of pelvic adhesions
  • The severity of the patient’s symptoms

Small, isolated endometrial implants are usually considered mild endometriosis, while more significant lesions would be moderate to severe endometriosis. More severe cases of endometriosis will also create more scar tissue, potentially involving the structural components of the pelvis, causing blockage of the Fallopian tubes and other organs.

Treatment Options for Endometriosis

Women diagnosed with endometriosis have a number of treatment options available, based on many factors such as overall health, the severity of the condition, tolerance for certain treatments, and the expected outcome of treatment. Endometriosis treatment may include:

  • Rest and relaxation. Avoiding stress, heat therapy, taking warm baths, and other relaxation techniques can help relieve minor symptoms of endometriosis and dyspareunia.
  • Diet changes. For minor cases, doctors may suggest a diet for endometriosis and fertility. Typically, this includes avoiding caffeine, alcohol, red meat and processed foods, as well as increasing consumption of fruits, vegetables, Omega 3s and soy.
  • OTC medications. Doctors suggest simple pain medications such as ibuprofen for mild cases of endometriosis or other over the counter treatments like CBD endometriosis pain relievers.
  • Hormone therapy. Hormone treatment is very effective for small, isolated endometrial implants. Oral contraceptives that contain estrogen and progestin or synthetic progestin pills can provide relief in some cases.
  • Hormone blocking. Other women may require more robust treatments with synthetic pituitary blockers or gonadotropin-releasing hormone agonists. These medications block hormones from the pituitary gland that contribute to the menstrual cycle. While these monthly injections are effective for some women, they also cause bone mineral loss.

Female hormone therapy

For women who want to become pregnant after treatment of endometriosis, the first three options are often considered the most conducive to a healthy pregnancy in the future. Some women opt for temporary hormone suppression therapy, so they can attempt to conceive afterward. For other patients, hormone suppressants can be an effective solution with the added benefit of preventing pregnancy, if desired. Still others require surgery to treat the cause of endometriosis pain.

Surgical Options

Some women with severe endometriosis will require surgery for relief. In these cases, surgeons will try to remove as much of the endometrium implants as possible without risking damage to the surrounding tissues. Primarily, endometriosis surgery is limited to three distinct options:

  • Laparoscopy. Some surgeons opt for laparoscopic laser removal, which begins with the same process used to diagnose endometriosis. Once endometrial tissue is found, the surgeon will cauterize and vaporize sections of endometrial tissue. Laparoscopic procedures are minimally invasive and have shorter recovery times than typical abdominal surgeries.
  • Laparotomy. For advanced cases, more drastic surgical options may be the only solution. A laparotomy uses a much larger incision into the abdominal cavity to expose more of the interior to the surgeon. Then, a similar procedure is used to excise the endometrial tissue. With a larger incision comes a more extended recovery period post-surgery.
  • Hysterectomy. For the most severe or advanced cases, a hysterectomy may be required to stop the symptoms of endometriosis. During this procedure, a surgeon removes the uterus altogether, either laparoscopically, through a large incision, or even through the vagina. In some cases, the ovaries are removed as well to inhibit tissue growth. After hysterectomy, future pregnancy is not possible.

Endometriosis Surgery

While conservative surgery is a safe and effective way to treat endometriosis, it’s important to treat as early as possible. In fact, as many as 40% of advanced endometriosis patients experience symptoms within five years as the result of tissue regrowth. More drastic surgeries such as hysterectomy with ovary removal do a better job of eliminating existing tissue and the hormone swings that cause it to grow, but regrowth and infertility is still possible. Thus, it’s vital for any woman considering any level of surgery to discuss the issue at length with her doctor.

Take Control of Your Uterine Health with Endometriosis Specialists in Arizona

Keeping close tabs on your menstrual cycles and uterine health are important at any age. Every endometriosis case is different, but your case can be manageable with early detection, symptom management and careful screening. The providers who work with Arizona Gynecology Consultants can handle any aspect of gynecological care, so contact us today if you would like more information about endometriosis or treatment options.

What Women Should Know About Minimally Invasive Surgery - AZ Gyn

What Women Should Know About Minimally Invasive Surgery

For women who are in need of gynecological surgery, the idea of “going under the knife” or “getting cut open” (especially “down there”) can be enough to scare off even the bravest and most confident of us.

But thanks to advances in surgical procedures, women today have many minimally invasive surgical options. In fact, it’s never been safer to get the surgery you need.

What Is Minimally Invasive Surgery?

To understand what minimally invasive surgery is, let’s look at what it’s not.

Traditional, or “open,” surgery involves making an abdominal incision large enough for the surgeon to see the area well and navigate the site with surgical tools. Although surgeons do their best to make the surgical incision as small as possible, there are practical limitations with this type of surgery.

Minimally invasive surgery (MIS), meanwhile, utilizes modern advances in technology that allow a surgeon to perform procedures using very small incisions, or in some cases, no incision at all.

Types of Minimally Invasive Surgery

Any type of surgery that isn’t open surgery and that involves minimal incisions can be considered minimally invasive surgery. However, there are two main types that we will explore here. Both use technology inserted through small incisions or natural orifices to perform the operation. Which one is used depends on the specific protocol of a particular surgery.

Endoscopic Surgery

Benefits of Minimally Invasive Surgery Bulleted List - Arizona Gynecology Consultants

Endoscopic surgery involves making small incisions – often less than an inch each – and inserting a small tube equipped with a tiny camera, and other tubes with microsurgery tools as appropriate. The tube can also be inserted through a natural orifice, such as the mouth or cervix, depending on the location to be operated on and the type of surgery.

The camera allows the surgeon to see an enlarged view of the surgical area for clear viewing. The small surgical tools give the surgeon the ability to make very precise cuts and sutures.

Other terms you might hear used for this type of surgery include:

  • Laparoscopy
  • Hysteroscopy
  • Keyhole surgery

Robotic-Assisted Surgery

Like with endoscopic surgery, microscopic cameras and tools are inserted through small incisions. However, during robotic-assisted surgery, the surgeon operates from a console with controllers and a high-definition screen. When the surgeon makes a movement with the controllers, the computer makes the movement more precise.

Robotic-assisted surgery is appropriate for delicate surgeries that benefit from the computer’s ability to perform movements that are more precise than what the human hand is capable of.

With both types of MIS, the surgeon is still very much in control of the operation, regardless of the technology used.

Like all surgeries, minimally invasive surgeries require a professional surgery center and well-trained medical staff with experience performing these types of procedures. Anesthesia needs vary; your doctor will discuss your options with you.

Benefits of Minimally Invasive Surgery

MIS is generally considered safer and more effective than traditional open surgery. Benefits include:

  • Smaller incisions
  • Lower risk of infection
  • Reduced blood loss
  • Less pain
  • Minimized scarring
  • Shorter hospital stay
  • Faster recovery time

The smaller incision means less healing time for the patient, and it reduces the chance of infection. This, in turn, leads to a shorter hospital stay and reduced expenses for the patient.

Professional women, in particular, enjoy the benefit of being able to rehabilitate to full capacity as quickly as possible, while still taking enough time for a full recovery after surgery.

How to Know If Minimally Invasive Surgery Is Right for You

Gynecological conditions that improve after minimally invasive surgery include:

  • Uterine fibroids
  • Endometriosis
  • Ovarian cysts
  • Pelvic organ prolapse
  • Cervical incompetence
  • Abnormal uterine bleeding
  • Pelvic pain

Minimally Invasive Gynecological Surgery in Phoenix, Arizona

Our experienced surgeons at Arizona Gynecology Consultants are well-practiced in advanced surgery techniques like minimally invasive surgery. Dr. Kelly Roy is our in-house specialist in gynecology and advanced endoscopy.

If you’ve been putting off a surgery or aren’t sure if your situation warrants surgery, make an appointment today to meet with one of our gynecological specialists. We have offices in multiple locations in the Phoenix area.

Whatever your surgical or reproductive needs, we’ll help you feel safe and well-cared for when you join the Arizona Gynecology Consultants family!

What Are Uterine Fibroids - Arizona Gynecology Consultants

What Are Uterine Fibroids?

Uterine fibroids are small, benign tumors that grow in the uterus. They are made of the same type of cells found in the walls and connective tissues of the uterus.

In some cases, they embed in the walls of the uterus, but some fibroids will project from the outer surface of the uterus into the abdominal cavity. Others can cluster inside the uterus and project into the interior space of the uterus.

The cause of uterine fibroids is not known, but some women are at higher risk of developing them than others. Black women receive uterine fibroid diagnoses 2 to 3 times as often as other women, and uterine fibroids only rarely appear in young women who have not started menstruating.

Uterine fibroids will stop growing and dissolve over time after menopause.

What Does My Uterine Fibroid Diagnosis Mean?

Uterine fibroid diagnoses are incredibly common, and about 70 to 80 percent of women will receive a uterine fibroid diagnosis before age 50. If your doctor recently diagnosed you as having uterine fibroids, don’t be alarmed: Uterine fibroids are not cancerous, and the worst symptoms they cause are manageable.

While this condition can cause some unpleasant symptoms, many women with uterine fibroids do not have any symptoms at all, and the condition is not medically threatening.

Possible Symptoms of Uterine Fibroids

Most uterine fibroids do not cause any noticeable symptoms. If a doctor discovers uterine fibroids that are asymptomatic during a routine gynecological exam, he or she will likely suggest a wait-and-see approach for monitoring the fibroids in the future. The doctor may wish to confirm the uterine fibroid diagnosis with imaging scans like an ultrasound or pelvic MRI.

Women who experience negative symptoms from uterine fibroids typically report painful or excessive bleeding during periods, or bleeding between periods. Uterine fibroids may also cause abdominal swelling or a feeling of fullness.

If fibroids compress the bladder, the woman may experience a frequent need to urinate or may have difficulty urinating. Uterine fibroids can also cause lower back pain and pain during sexual intercourse.

Excessive bleeding during periods is a common issue, and some women develop anemia from the blood loss and can suffer other medical complications as well. If these symptoms are severe enough, the woman’s doctor may recommend one of several possible treatment options.

What Are Uterine Fibroids: Treatment Options

A doctor will only treat a case of uterine fibroids if they are causing the patient significant discomfort. The type of symptoms the patient displays, and the severity of those symptoms, typically determines the best course of treatment.

Women who experience only mild pelvic pain may benefit from over-the-counter anti-inflammatory and painkiller medications like ibuprofen. If the pain is too severe for these drugs to handle, the woman’s doctor can prescribe a stronger medication.

Hormone Treatment

While doctors have yet to pinpoint the causes of uterine fibroids, they do believe that uterine fibroids have an easier time developing in an estrogen-rich system. Some doctors may wish to treat uterine fibroids with hormonal medication to limit estrogen production, but it’s important that women understand the effects of hormonal medications.

While a birth control pill may contain hormones that reduce excessive bleeding and decrease a woman’s pain during menstruation, birth control pills that contain estrogen can cause uterine fibroids to grow. This treatment would effectively only manage the symptoms while making the cause of those symptoms worse.

Uterine Fibroids and Pregnancy

Some women may wonder if uterine fibroids interfere with pregnancy. Since estrogen encourages fibroid growth, a woman’s existing uterine fibroids may enlarge during the first trimester when estrogen levels are highest. However, the tumors will later shrink after birth.

Surgical Options

Advanced cases of uterine fibroids that cause significant pain and discomfort may require surgery. The two types of surgery that can solve a uterine fibroid problem are:

  • Hysterectomy
  • Myomectomy

If a woman undergoes a hysterectomy during her childbearing years, she will no longer be able to have children. Some women may not wish to have children, or any more children, and find this acceptable if it stops the unpleasant symptoms of the fibroids.

Women who wish to remove their uterine fibroids but still want to be able to bear children may opt for a myomectomy instead. A myomectomy procedure removes the uterine fibroid tumors while leaving the uterus intact.

Doctors perform myomectomies in three different ways:

  • Laparotomy: The doctor enters the uterus through a small incision in the abdomen to remove the uterine fibroids.
  • Laparoscopic myomectomy: The doctor uses a small, thin telescopic instrument through a small incision in the navel to reach the uterine fibroids.
  • Hysteroscopic myomectomy: A procedure which involves inserting a hysteroscope through the cervix to extract the uterine fibroids through the vaginal opening.

Finally, if a woman does not wish to undergo surgery and wants to keep her fertility intact, she can opt for a fibroid embolization procedure. This is a minimally invasive outpatient procedure during which an interventional radiologist shrinks the uterine fibroids by cutting off their blood supply. The patient will often be able to go home the same day as the procedure after a short recovery period.

Know Your Options

Uterine fibroids can be unpleasant and cause a host of problematic symptoms, so women should always refer to their gynecologists for their recommendations for treatment and handling symptoms. Arizona Gynecology Consultants works with a large network of trusted medical providers, so reach out to us if you have questions about managing your uterine fibroids.