What percentage of your patients have endometriosis?
Do you practice obstetrics?
No
In 40 words or less, how do you treat endometriosis? How do you approach adhesions?
I believe in excision of all visible disease with negative margins around them and offer complete pelvic peritonectomy to patients. I believe adhesions should be lysed and any underlaying peritoneum removed to fully excise disease.
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?
I believe a minimal margin should be 1cm around any visible lesion, but I offer full pelvic peritonectomy with removal of the peritoneum on both pelvic sidewalls, behind the cervix overlaying the rectum and vagina and over the bladder to all patients who wish to have a peritonectomy.
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?
I think that medications are an excellent adjunct to surgical management, but do not replace it. I believe that there are cases where hysterectomy are indicated, but most patients will start with an excision of endometriosis, particularly with removal of peritoneal disease and lysis of adhesive (scar) disease rather than proceeding directly to hysterectomy.
What is your opinion on using Robotics (ie DaVinci) for the treatment of endometriosis? Do you use it?
I use robotics in most of my excision surgeries. I believe the robotic camera allows for better visualization of disease and the robot itself allows the surgeon to do most of the case themself with little reliance on the skill of assistants.
How do you approach the following: bowel cases, urinary cases, thoracic cases and any other extragenital cases?
I perform surgery in the pelvic sidewall myself, including freeing the ureters from surrounding endometriosis. If a ureter needs to be excised and reimplanted, I work with a Urologist to do this. While I perform bowel lysis of adhesions myself, I work with endometriosis-specific colorectal surgeons to perform bowel resections. Our center also has a thoracic surgeon who performs excision of diaphragmatic and thoracic endometriosis and we do these cases together. For abdominal wall endometriomas, I jointly operate with a plastic surgeon to allow for the use of mesh to strengthen and repair the wall, if needed.
Do you follow up with patients at regular intervals post-operatively? If so, what are your findings?
I work with a Gynecologist who specializes in medical management of endometriosis, who assumes care of our patients postoperatively if they do not have their own benign gynecologist who is comfortable with medical management of endometriosis. Then, if the patient's symptoms persist despite medical management, the Gynecologist and I review the case and they refer back to me. I have only had a few patients return for surgery in the past few years, and they were patients who had declined full excision, including bowel resection, at time of original surgery.
What percentage of your patients require re-surgery? How do you track this?
We do not track this. But, generally, they are fertility patients who do not desire full excision at time of initial surgery as they are focused on quick recovery and return to fertility treatments. They often return once they have completed childbearing.
Do you have any studies, talks, or publications you'd like to share?
No
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?
I love to read books (mostly fiction) and read 2-3 books per week as a way to unwind. I love being near the water, particularly the ocean, and one of my favorite activities is to read on the beach.
