One size does not fit all
Excision is step one, and not all pain is resolved in one step.
By Nancy Petersen
One size does not fit all: by that I mean excision surgery will address endometriosis, assuming the surgeon is truly trained in disease recognition, distribution, and removal (not many gynecologists are in fact trained for this level of surgery). That is one aspect of pelvic pain, and it has to be expertly addressed to eliminate endometriosis as a cause. Other pelvic pain generators need to be addressed when pain persists after EXPERT excision. It is common for the disease to be missed by general gynecology at surgery, or for the disease to be intentionally left when the surgeon does not have the skills or training or when they believe they can “clean up” endo with medication (medication/hormonal treatments may seek to alleviate symptoms but do NOT stop the progression of the disease).
Other pelvic pain generators need to be identified, and a treatment plan devised for each. You cannot remove endometriosis and expect pelvic floor dysfunction to fully resolve. Nor does the removal of endometriosis address a painful uterus with adenomyosis, nor does excision resolve ovarian cysts which can return by pushing up from the body of the ovary with cycles. Bladder issues, such as interstitial cystitis, will also need its own treatment plan if present. Wellness is a journey, while some will feel well with endometriosis excised, others will have other issues that need attention.
Likewise, having been in chronic pain for years, you may need some emotional support to get past the impact of treatment failures, anger at the system (which did not fail you on purpose, rather did not know what it did not know, so did what they thought would help). It can be useful to seek help, even after resolution of symptoms, in learning to let go of the anger and victimization one can sometimes feel from being chronically ill and losing out on many aspects of life for many years. The nature of relationships also changes after the disease is resolved. Family members roles will change as you become healthier, and your role will as well. This can cause conflict and counseling can help. There is a sense of victimization patients can feel when the system fails them, but you can get past it rather than continue in that mode. It’s a decision you make.
The skill of the surgeon can affect the ability to accurately identify endometriosis in order to diagnose as well as to remove all disease (Jose, Fausto, & Antonio, 2018; Fischer et al., 2013). Also, endometriosis is not confined to the pelvis and can involve areas such as ureters, bowel, or diaphragm that require a higher level of care.
Endometriosis lesions can have many different appearances and varying locations. It used to be taught that the lesions had “black, powder burn” appearance; however, we know now that they can vary widely in appearance and can be clear, yellow, tan, red, or black.
The average time from symptom onset to diagnosis is 7-12 years. You cannot un-do this in a few hours of surgery. This does not mean individuals with endometriosis and pelvic pain cannot get well. They absolutely can but it is not like appendicitis where you have acute pain, surgery, surgical recovery and back to normal in a few weeks.
Just as endometriosis treatment is not one size fits all, recovery will be different for every individual as well. The extent of the disease removed, length of surgery, how your own body heals, and many other factors will come into play.
Endometriosis is a common disease whose treatment consumes a substantial amount of health care resources. As healthcare spending grows as a proportion of GDP, there is more pressure for cost-containment and wiser use of funds.
Carbon left behind by laser vaporization is more problematic than just the question of being mistaken for recurrent disease. Carbon can stimulate a foreign body giant cell reaction which can be its own cause of pain and lymphadenopathy.
I think it is time to explain the Davinci robot from the viewpoint of someone that actually uses the device. There are many people that may disagree with some of the things I will mention, or describe, but this is based on my published data, my experience, and my opinion.
Paracetamol or acetaminophen as it is also known is a very safe and effective painkiller when taken in regular intervals. It has been used to reduce the levels of narcotics that patients have to use to control their pain. I would always recommend that a patient suffering chronic pain should be on regular paracetamol.