Surgical Treatment for Endometriosis - Yale Medicine Explains

Transcript

• 00:05Endometriosis is a chronic inflammatory disease.
• 00:09We define it by having endometrial cells,
• 00:11so cells that are typically in the lining of the uterus
• 00:13when they're growing outside of the uterus,
• 00:15and when they implant to different places
• 00:17and cause inflammation and pain and downstream effects because of that.
• 00:21It can be very difficult to diagnose endometriosis,
• 00:23in large part because if those cells are implanted
• 00:26on different organ systems like the bowel or the bladder,
• 00:29it may manifest as bowel symptoms or bladder symptoms, for example.
• 00:31We don't quite understand why the disease happens,
• 00:35which makes it even harder to treat.
• 00:37For most patients. typically, they will respond
• 00:41to our first line treatments, like hormonal therapy.
• 00:43For those patients, though, who are refractory to those treatments alone.
• 00:46It typically does require a multimodal strategy,
• 00:49meaning tackling the symptoms through different agents
• 00:51beyond just the typical first line hormonal treatments,
• 00:53and sometimes that involves getting into other specialists if they need it.
• 00:58The gold standard diagnosis historically for endometriosis
• 01:01has been a surgical diagnosis, meaning we don't have great ways to diagnose it.
• 01:05Otherwise, 85% of patients with endometriosis don't have lesions
• 01:09large enough to be seen on imaging.
• 01:10So to actually diagnose a patient,
• 01:13if we're not doing it based off of symptoms alone,
• 01:15which we are now advocating to do so.
• 01:16In the past, the way that you can confirm a diagnosis is with a surgery,
• 01:19so many people will have a diagnostic surgery to take a look inside the abdomen.
• 01:24Some type of laparoscopic or robotic assisted laparoscopic surgery
• 01:28is preferred for endometriosis from the ability to be able to see much more closely and in detail
• 01:34to the tissue that you're looking at compared to something like open surgery, for example.
• 01:37We can bring a camera and really zoom in and see all of the tissue
• 01:41and look closely at it to find
• 01:43any potential lesions of endometriosis to resect it
• 01:46and get a pathologic diagnosis, meaning we send that tissue to our pathologist
• 01:49and they look under the microscope and they see are there endometrial cells,
• 01:54The resection of those lesions
• 01:56and the benefit in terms of pain is variable.
• 01:59So it's not well predicted to say a patient will have
• 02:02this much duration of time with pain relief after excision.
• 02:05But we do know that when you pair surgical excision with medication management,
• 02:10specifically hormonal management after the surgery,
• 02:12you have longer durations of pain relief compared to surgery alone.
• 02:15So it's a tool and it is not curative.
• 02:17When someone wants fertility sparing, then we'll use excision procedures like that.
• 02:21If someone is done with fertility and they're interested in surgery,
• 02:25that may have a longer lasting impact
• 02:27in terms of reducing their need for medicine and surgery in the future.
• 02:30That's when we consider surgeries like hysterectomy,
• 02:33which is removing the uterus and the cervix,
• 02:34and typically the fallopian tubes at the same time,
• 02:36and in rare circumstances, we would consider removing the ovaries as well,
• 02:39depending on the patient's health and risk factors.
• 02:42Those surgeries are still not curative.
• 02:43So it's important to know that surgery,
• 02:45while it can have good results for pain relief for many people,
• 02:48is not the end all be all in terms of treatment
• 02:50for patients who have particularly refractory endometriosis.
• 02:55I think what makes Yale probably a standout is honestly our research,
• 02:58in terms of leading the research on endometriosis
• 03:01and understanding the newer concepts that are coming out with the management
• 03:04and clinical diagnosis and thought processes around how we think about endometriosis,
• 03:09I think patients often want to feel empowered by the fact that there are options.
• 03:13When it feels like there are no options available,
• 03:15it can be a really isolating and scary experience
• 03:17and hearing someone say, we have all these other agents that we can try
• 03:21or other techniques that we can do can be something that patients find
• 03:26is a new experience for them, and that they're hopeful again,
• 03:28that there may be something that can help them
• 03:30when they were only told, all you have are birth control.