Undergoing Robotic Surgery for Endometriosis? Here’s what to expect!

Hi, my name is Dr. Rich, and I’m passionate about empowering every woman with practical knowledge about the world of women’s health. In my last video, we talked about painful period cramps, and whether or not that’s a sign of endometriosis. If you have severe endometriosis, here’s what you need to know about robotic surgical resection of endometriosis.

Don’t have time to read this blog post? Watch it here instead!

Robotic surgical resection of endometriosis, that’s a mouthful. So what does that actually mean? Endometriosis is a disease process in women where there’s scarring that occurs inside the pelvis, that results in really painful periods. Now to catch up on that, you can look at our last video that we did here. When women have this disease and they’ve failed medical treatment options, then we’re looking at surgery. So the surgery involves little tiny incisions, as opposed to a big open incision, and the robotic technology essentially enhances the surgeons’ dexterity, their vision, and really improves the quality of the surgical resection.

So resection is one option. The other option is called ablation. And it’s important for you to ask your provider which of these two types of treatments are done. So resection differs from the other treatment option known as ablation, in that it’s a more complete removal, and we can expect patients to get a much greater improvement and relief of their disease and their symptoms. Ablation, if we think about weeds in a yard, ablation would be just cutting them off right to the ground, okay, but we’re leaving those roots in there. Resection would not only be removing the weeds, but going down and into the ground and removing the deep roots that infiltrate into the ground in this case, or with the disease process, endometriosis, the roots that go down into the tissue.

So with ablation, essentially what doctors do is they burn the disease, but you can only do that on tissues that aren’t vital structures or highly sensitive.

So if the disease is on the back part of the uterus, on the ligaments, that’s amenable to an ablation type procedure. If however, the disease is on the ureter, on the bowel, on the bladder, or some other vital structure, the ablation technique will leave all that disease behind. So the resection allows a surgeon to remove the entire disease burden, all the macroscopic or visible disease, at the time of the surgery. We’ve seen results in trials that have shown benefit for advanced-stage disease. And even for early disease, we have benefits specifically is it relates to pain scores and cyclic cramping. So it’s very important for you to ask your provider if they do resection, or if they do ablation.

For the most part, surgeons would need to do advanced training or have this be a large part of their practice, or have a mentor, a fellowship, to be able to get the skill level to be able to do the resection. And so I think it’s important, as the patient, to advocate for yourself and make sure that the treatment that you’re going to get is going to be the best treatment for you.

Now, I realize this may have prompted a lot of questions. Go ahead and feel free to drop those in the comment section below.

So how is this different from non-robotic surgery? Well, fortunately, the vast majority of providers do either laparoscopic or robotic. There are very few providers that are going to do an open incision, and that’s a good thing because open incisions, like a C-section, or an up and down incision, would end up getting you two months of recovery, whereas if we can do it laparoscopic or robotic, we’re actually looking at a week to get back on your feet, pretty much get back to normal, go to work. So whether they’re doing it one way or the other, that’s the best, as opposed to having some type of an open incision.

Those of us who do a lot of this type of surgery have gravitated towards robotics because it’s specifically engineered and designed for meticulous, difficult surgery, which endometriosis qualifies as that type of surgical procedure. And using the what’s called an EndoWrist, or the ability to move the instrument tips as if your own hands were inside operating, 3D visualization with true depth perception. These are all things that are common sense additions that we feel, most of the robotic providers feel, that this is ideally suited for resection of endometriosis.

So who is surgery, and specifically robotic surgery, right for? Well, for those of us that do high volume robotic surgery, we would say that everybody would be a candidate for robotic surgery that’s already a candidate for surgery. So who would be a candidate for surgery? Well, as you saw in our last video, many times painful periods and endometriosis can be managed with medical treatment options, with what’s called an NSAID or your Motrin or you ibuprofen, hormonal therapies. But for a lot of patients, they get to the point where it’s just not cutting it and they need something for the pain control. So anybody who’s at that point where they is interrupting their quality of life. I’ve had certainly patients that have not been able to leave their bed for two days every month, because of the severity of the cramps. But anybody who feels that this is affecting their quality of life, you’re a candidate for surgical resection.

The other consideration is that of infertility. So endometriosis comprises 15, 20% of the cause of female infertility. And usually the woman will be symptomatic. The patient will complain of painful periods. And the only true way to have an absolute diagnosis is through surgery, to remove the disease, look at it in the microscope and confirm. Now that process, the surgical process of going in, viewing and removing, is diagnostic. So we know in fact that the endometriosis is affecting certainly their pain symptoms, but also fertility at that point. And we can remove it at the same time, thus improving their fertility.

So, now that we’ve decided to have surgery, what should we expect? What is the expense? What’s the time off of work? What’s the recovery like? So we’ve touched on these issues, but briefly, if you decide with your surgeon that this is the optimal treatment for you, that your provider is able to offer a resection of the disease, and they have a high volume experience, that you know that they’re going to be able to resect the disease completely, then in the OR, you’re going to expect somewhere around a one to three hour procedure, depending on the extent of the disease, you’ll go to the recovery room and you’ll be able to go home the same day.

How long is it going to take for you to get back to normal activities? I’d give it a week. The first day to two days, you’re going to really just want to rest, but by three to four or five days, you’re going to be off of pain meds, you’ll be able to drive the car, go to the store. By seven days, you’ll probably about 90%, and you’ll be able to go back to work.

Expense-wise really in medicine, healthcare, with the hospital, there’s not really a monetary value that can be placed, because every insurer has different benefits and every insured has different levels of coverage, deductibles, coinsurance. So that’s something that you’re definitely going to want to talk to your insurance or talk to your provider’s front office about getting that estimate for you. There are some providers that will see patients that don’t have insurance, and there are certainly cost considerations in there that involve the surgeon, the anesthesiologist, the pathologist, the hospital staff, the use of the robot. So the estimates are usually anywhere from eight to $12,000, depending on time. And that seems like a very large amount of money, and in truth is, but there are some patients that just have to go through a process where maybe they see a provider that doesn’t give them the extent of the treatment that they need. And that is an option that they’re provided with, and I would say that most patients that go down that route end up being very happy when they find a provider that’s able to resolve the condition that they’ve been suffering for years.

So how do I prepare for my robotic surgical resection? And this is going to vary slightly by provider, and they’ll give you specific instructions, but in general, you’re going to come in for what’s called a preop visit the day before your surgery, or a couple of days before. And you’re going to go over your consents, where the surgeon talks to you about all of the risks that can happen with the surgery, what to expect, the benefits, the recovery specific to your surgery. That night, you’re going to probably have a light dinner, and then you’re going to fast after midnight. So nothing to drink, nothing to eat when you wake up in the morning, no coffee, tea, water, nothing.

So on the day of surgery, you’ll come in, usually early. Most of my patients are going to come in around 5:30 in the morning, they’ll get prepped and ready. I will personally see them in the preop holding. We’ll go back, we’ll do the surgery. And then we will have already called in the postoperative pain medicines, so you’ll have that ready and available. So as soon as you get home, you have to worry about that.

What does the recovery process look like? That’s a challenge because everybody recovers differently. Okay? So all aspects of health, or really anything, exists on a bell curve. So when you look at a population, 80% of people are going to be in the middle and you’ll have 10% of super healers and 10% of delayed healers.

So if you have had an average recovery from prior surgeries, you’re probably going to take about a week to recover. If, however, you maybe had another laparoscopic surgery a tubal ligation, a gallbladder, and it was done laparoscopically, and it took you six to eight weeks to recover, history repeats itself. You’ll probably take that long to recover from this surgery as well, even though the average person’s not going to take quite that long.

On the other hand, there are certain patients that, two days after a C-section, they’re back at work, super healers, and for those patients, you’ll probably have a similar recovery process.

Now I would urge, if you’re in that group, if you’re in that cohort, that’s going to just want to jump out of bed and get back to work, don’t overdo it. Because there tends to be a process where maybe you pull on some stitches, or you just get yourself overtired, and then your actual recovery will end up being longer than the one week, if you do too much too early. So give yourself a break, give yourself that week to recover, and you should be pretty much back to most activities within that seven-day timeframe.

Well, that’s all the time we have for today. Thanks for tuning in. As always, we’re providing general healthcare information, not individualized healthcare instruction. So feel free to leave your comments in the section below, or reach out to your local OB-GYN or other healthcare provider. Thanks for tuning in. As always, we’re here to listen and to help.