How to Choose an Endometriosis Specialist

By Dr Donald Angstetra, Gold Coast Private Hospital

Why is endometriosis hard to diagnose?

Every woman suffers from endometriosis symptoms differently. Mild endometriosis can cause severe pain, while severe endometriosis may be asymptomatic. The lack of consistency creates barriers for many gynaecologists to effectively diagnose and treat endometriosis. Some cases are discovered as part of investigation for infertility.

Why is endometriosis hard to treat?

Diagnosis of endometriosis can only be done through a laparoscopic procedure. Complete surgical removal of endometriosis, endometrioma (ovarian cysts due to endometriosis) and scar tissue requires extensive skill and experience to minimise the risk of relapse and to ensure the best chance for recovery.

Why Should I See a Specialist In Endometriosis Surgery?

While endometriosis is a common disease, affecting 176 million women worldwide, it is not a simple disease to treat surgically. Endometriosis requires specialist treatment. Choosing the right gynaecologists can often be difficult. Though endometriosis is a common gynaecological condition that most gynaecologists treat, but there is no formal accreditation of surgical training in treating endometriosis.

How important are the experience and training of a surgeon?

Experience and training of a surgeon is essential to treat endometriosis. The gynaecologist should be devoted to gynaecological surgery and specialise in minimally invasive endometriosis excision (removal of endometriosis lesions), ability to restore normal anatomy and removing scar tissue. Endometriosis can cause frozen pelvis where delicate pelvic structures stuck together. Additional surgeon (Colorectal surgeon/urologist) may need to do repairs on the surrounding organs (bowel/bladder/ureter) in severe condition.

What makes endometriosis surgery so demanding?

  • Endometriosis can be difficult to identify due to varying visual presentations, some very subtle and can be found in multiple locations throughout the pelvis.

  • Endometriosis can cause severe adhesions that fuse pelvic organs together distorting pelvic anatomy and careful dissection is needed without causing damage.

  • While laparoscopy offers optimal visualisation and greater magnification of the pelvis, it does require a high level of surgical skills and experiences.

  • Endometriosis may affect the bladder, ureter, fallopian tubes, ovaries, bowels, major blood vessels, and even diaphragm. The gynaecologist needs to be comfortable working in all these areas and has multidisciplinary team (general, colorectal, urology and thoracic surgeon) to assist to completely remove the disease while minimising complications.

  • Effective removal of endometriosis can be achieved by excising (cutting out) the affected areas. Using burn (diathermy/ablation) technique may only treat superficial disease but do not destroy the underlying disease. It is not suitable if near or involving bowel and ureter.

What is the difference between surgery offered by a non-specialist versus endometriosis specialist gynaecologist?

Non-specialist Gynaecologist

  • Low volume of endometriosis patients

  • Limited experience in recognising and treating endometriosis.

  • Due to extent of practice, reserves limited time for surgical procedures.

  • Has no or minimal training in laparoscopy.

  • Relies on techniques to burn the endometriosis, leaving untreated or partially treated.

  • Higher complication rate if complex surgery is attempted

Advanced Laparoscopic specialist

  • Focuses on seeing patients with complex gynaecological conditions.  High volume of endometriosis patients

  • Extensive experience in recognising and treating endometriosis

  • Spends hours performing surgery each week, providing ample experience to refine and maintain skill set.

  • Has completed further training in laparoscopic surgery to develop advanced skills.

  • Confident performing wide-excision to remove all disease and uses ablation in limited situation.

  • Low complication rate with complex surgery.

What do women with endometriosis need to know about choosing a specialist?

Women should educate themselves. It is not simply a keyhole version of an open surgery. There are few gynaecologists who are true specialists in laparoscopy and have also mastered the additional techniques required to ensure a safe procedure.

About The Author 

Dr Angstetra is a consultant O&G staff specialist at Gold Coast University and Robina Hospitals and also a conjoint senior lecturer with Griffith University. He has a keen interest in developing and applying minimally invasive surgery for all benign diseases of the female reproductive tract and his passion for advanced gynaecological laparoscopic surgery see him fit the role as the training-site director of Australian Gynaecological Endoscopy Society (AGES) and as O&G training supervisor for RANZCOG training program. He has published multiple articles in peer reviewed journals and presented multiple papers at local, national and international meetings.Dr Angstetra offers a range of gynaecological services including office gynaecology, endometriosis, laparoscopic adnexa surgery, laparoscopic hysterectomy, laparoscopic pelvic floor repair, prolapse, infertility, contraception, fibroid, abnormal Pap smear and chronic pelvic pain. 

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