Dr. Jeffrey Arrington
Overview
Website
Phone Number
Email
Online Consult Available?
Yes
At a glance
Gender
Male
Education
Medical College of Wisconsin
Affiliations
I am contracted with Tricare for a limited number of appointments. I don’t contract with other insurers, but will work with them using out of network benefits or single case agreements.
I completed my Endometriosis Fellowship under ___________
C.Y. Liu, MD
Endometriosis Surgeon Questionnaire
What percentage of your patients have endometriosis?
99
Do you practice obstetrics?
No
In 40 words or less, how do you treat endometriosis? How do you approach adhesions?
I excise endometriosis from all areas that patients desire. I let the patients choose their priority for treatment and excise all endo that allows them to maintain that priority. Adhesions are released at surgery and the bed of the adhesions is typically excised as endo on they tissue may be the cause of the adhesions.
If you excise endometriosis, what is your goal for a sufficient margin size? If you use other methods of removing or destroying endometriosis, how do you approach this and under which circumstances?
My approach to margins is to just start in normal tissue and work toward the area involved. I use more blunt dissection to help separate tissue margins at their natural plane. The only times I use cautery is a cutting electrical current in small spots of ovarian superficial endo (this results in less damage to normal ovarian tissue for small disease). Also more widespread superficial uterine endo. I feel this is better treated and can safely be treated with cutting current. Shaving large areas off the uterus causes significant scarring and adhesion risk. My first approach is to excise endo. If a patient’s highest priority is maintaining fertility, I will be more conservative if I can’t separate endo from blood vessels.
On the scale of 1 (less experienced (I rarely treat/ mostly refer out)) to 5 (extremely experienced (the majority of my cases)) how would you rate your current experience level and comfort with stage 3/4 endometriosis and complex cases?
5
What is your opinion regarding GnRH agonists and antagonists? What is your opinion regarding hysterectomies?
GnRH modulators: they are one of many options for palliation of symptoms. That is their only known role. They don’t kill off or get rid of endo. For endometriosis they are alternative pathway pain modulators like all hormones. They have not been proven more effective at symptom control over less risky medications.
Hysterectomy: Hysterectomy only treats endo that is on the uterus. Although it can achieve a higher possibility of improvement in pain when done in conjunction. With endometriosis excision, hysterectomy does not treat endometriosis or prevent it from “coming back.”
Hysterectomy: Hysterectomy only treats endo that is on the uterus. Although it can achieve a higher possibility of improvement in pain when done in conjunction. With endometriosis excision, hysterectomy does not treat endometriosis or prevent it from “coming back.”
What is your opinion on using Robotics (ie DaVinci) for the treatment of endometriosis? Do you use it?
It is a method of laparoscopy. Benefits include a longer camera that can fully evaluate the diaphragm without an extra incision. It has 3-D visualization and 10 X magnification that some find helpful. It also allows the surgeon to control more instruments and rely less on assisting staff.
I have used robotics for 15 years. My version does not have direct haptic feedback, but over time, like so many sensory deficits, my eyes and mind have adjusted to be able to detect tissue densities based on the movement response and grasping action of the instruments. I have also moved toward the important of grabbing and picking lesions up to detect deeper disease. The brain is a remarkable adapter.
I have used robotics for 15 years. My version does not have direct haptic feedback, but over time, like so many sensory deficits, my eyes and mind have adjusted to be able to detect tissue densities based on the movement response and grasping action of the instruments. I have also moved toward the important of grabbing and picking lesions up to detect deeper disease. The brain is a remarkable adapter.
Do you work with and/or refer patients to other healthcare providers? If so, which types (e.g. physical therapists, nutritionists, etc.) ?
Physical therapy, complex pelvic pain center, fertility, NaPro fertility, functional medicine.
How do you approach the following: bowel cases, urinary cases, thoracic cases and any other extragenital cases?
I do most of my own bowel work. If a segmental resection is needed, I have a general surgery or colorectal colleague perform this. Urinary cases: I do my own bladder done excisions and ureteral dissections. Ureteral preimplantation and bladder trigone excision is done by a urologist. : superficial and partial thickness diaphragm and smaller areas of full thickness are done by me. Larger, central tendon excisions I feel are best treated by a thoracic surgeon who can then identify the phrenic nerve.
Do you follow up with patients at regular intervals post-operatively? If so, what are your findings?
Only as needed and requested by the patients.
What percentage of your patients require re-surgery? How do you track this?
11 year review showed just over 10% required an additional surgery, 1.1% required two additional surgeries, 7% went on to have a hysterectomy after an initial excision. This was tracked through hospital system data gathering.
What are some fun facts about you? Hobbies, interests, family life, languages, etc. that you would like to share to help patients get to know you as a person?
First I enjoy my family. They is my time priority. I also enjoy fly fishing and fly tying as well as currently learning golf to play with my son. I speak English, Spanish, and Portuguese.
Location
11762 S. State St. #350, Draper, UT 84020