The gold standard for diagnosis of endometriosis is through laparoscopic surgery. The knowledge and skill of the surgeon can affect the ability to accurately identify endometriosis- in order to not only diagnose it but to also successfully remove all disease (Jose, Fausto, & Antonio, 2018; Fischer et al., 2013). In addition to the appearance of endometriosis, the numerous locations, including lesions not confined to the pelvis, can make surgery more complicated (endometriosis can involve areas such as ureters, bowel, or diaphragm that require a higher level of care).
Leibetseder et al. (2022) reports that “in over 60% of diagnosed cases, endometriosis treatment requires multiple surgeries due to unidentified (missed) lesions.” Fattah et al. (2017) also echoes this, pointing out that “the numerical importance of atypical, subtle, non-hemorrhagic disease has recently been shown: at least two-thirds of patients have a visual appearance of disease that many clinicians have not been trained to recognize…” Fischer et al. (2013) states that “although excisional biopsy and resection offers a higher success rate in treating the disease, surgical excision also requires a higher level of surgical skill. As a result, many patients receive incomplete treatment, which in turn may lead to persistent symptoms and recurrent disease.” Rolla (2019) remarks that “the treatment of endometriosis requires a delicate and experienced surgeon and, if it is the case, an interdisciplinary team, including gastrointestinal surgeons or urologists (or both), in selected patients.”
Achieving expertise in endometriosis surgery requires a lot of time and dedication. Some surgeons devote a large portion or all their practice to the surgical treatment of endometriosis- meaning more practice and skill in identifying and removing endometriosis. Some also have a multidisciplinary team that they work with in order to treat endometriosis in more complicated areas (such as ureters, bowel, thoracic). While endometriosis is reported by the World Health Organization (2021) to affect 190 million worldwide, the availability of endometriosis specialty care is not in keeping with the number of those who suffer with endometriosis. As-Sanie et al. (2019) states that “despite its high prevalence and cost, endometriosis remains underfunded and under researched” and indicates that this is “due in part to the societal normalization of women’s pain and stigma around menstrual issues, there is also a lack of disease awareness among patients, health care providers, and the public.” Endometriosis awareness month is next month- time to help raise awareness about this often debilitating disease that affects so many.
References
As-Sanie, S., Black, R., Giudice, L. C., Valbrun, T. G., Gupta, J., Jones, B., … & Nebel, R. A. (2019). Assessing research gaps and unmet needs in endometriosis. American journal of obstetrics and gynecology, 221(2), 86-94. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0002937819303850
Fattah, H. A., Helal, S. M. F., Hosny, T. A., & Basuni, S. M. A. (2017). Reliability of Visual Diagnosis of Peritoneal Endometriosis. Red, 23, 27-06. Retreived from https://www.researchgate.net/profile/Tamer-Hosny/publication/324706887_Reliability_of_Visual_Diagnosis_of_Peritoneal_Endometriosis/links/5c60543c45851582c3dd583f/Reliability-of-Visual-Diagnosis-of-Peritoneal-Endometriosis.pdf
Fischer, J., Giudice, L. C., Milad, M., Mosbrucker, C., & Sinervo, K. R. (2013). Diagnosis & management of endometriosis: pathophysiology to practice. APGO Educational Series on Women’s Health Issues. Retrieved from https://www.ed.ac.uk/files/atoms/files/diagnosis_and_management_of_endometriosis_booklet.pdf
Jose, C., Fausto, A., & Antonio, L. (2018). Laparoscopic Enhanced Imaging Modalities for the Identification of Endometriosis Implants a Review of the Current Status. MOJ Womens Health, 7(1), 00160. DOI: 10.15406/mojwh.2018.07.00160
Leibetseder, A., Schoeffmann, K., Keckstein, J., & Keckstein, S. (2022). Endometriosis detection and localization in laparoscopic gynecology. Multimedia Tools and Applications, 1-25. Retrieved from https://link.springer.com/article/10.1007/s11042-021-11730-1
Rolla, E. (2019). Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. F1000Research, 8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480968/
World Health Organization. (2021). Endometriosis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Endometriosis%20affects%20roughly%2010%25%20(190,and%20girls%20globally%20(2).