Dr. Iris Orbuch - Laparoscopic SurgeonAbout Endometriosis
(printable version)

What is Endometriosis?
Endometriosis is a disease in which the tissue that normally lines the inside of the uterus (endometrium) grows outside the uterus. More specifically, it occurs when endometrial glands and stroma are found in locations other than the lining of the uterus.

What are the symptoms of Endometriosis?

  1. Pelvic pain during menses and/or anytime during the month
  2. Painful intercourse
  3. Infertility
  4. Right and Left sided pelvic and abdominal pain
  5. Constipation
  6. Diarrhea
  7. Painful bowel movements
  8. Urinary symptoms (frequency, urgency, painful voiding)
  9. Fatigue
  10. Bloating
  11. Malaise
  12. Lower back pain
  13. Heavy or irregular periods

The symptoms of endometriosis are related to the areas where endometriosis invades. Endometriosis of the uterosacral ligaments/cul-de-sac leads to painful intercourse, constipation, diarrhea and painful defecation. Endometriosis on the ovary can lead to left sided or right sided pain. Bladder endometriosis may lead to urinary frequency or urgency. You may have only one of the above symptoms or many. Even one symptom can be suggestive of Endometriosis.

How is Endometriosis diagnosed?
Laparoscopy is both diagnostic and therapeutic. The diagnosis of endometriosis can only be made by laparoscopic excision of tissue with pathological confirmation. Ultrasounds are frequently normal in women with endometriosis. Dr. Orbuch will take and extensive history and perform a thorough physical exam before deciding whether surgical therapy is beneficial. Surgery is day surgery, meaning on most occasions you go home on the same day as surgery.

Treatment of Endometriosis
Laparoscopic surgery is the definitive method to diagnose and treat endometriosis. Excision of Endometriosis is the gold standard treatment for endometriosis. Ideally all endometrial lesions should be excised. Unfortunately most gynecologists are not trained in advanced endometriosis cases. Others approach endometriosis with cautery or a laser or burning, two modalities shown to be far inferior to excision using scissors, the method performed by Dr. Orbuch. With scissors, the endometrial implants are removed, but with cautery or a laser or the lesion remains and continues to cause pain necessitating more surgery. A doctor utilizing laser may vaporize the surface of the lesion, but still leaves active endometrial tissue below. Deep fibrotic endometriosis usually does not respond well to hormonal suppressive therapy. Adequate surgical excision of endometrial implants provides the best symptomatic relief and long term results. In addition, surgical excision has been shown to improve fertility rates in women. Drug therapy can suppress endometriosis, not eradicate endometriosis. The definitive treatment of endometriosis is NOT hysterectomy or removal of both ovaries; rather it is complete excision of endometrial lesions.

Excisional surgery makes sense if one understands what endometriosis is. Normally during a monthly cycle, a woman’s’ endometrium, or uterine lining builds up then is shed as her monthly flow of menses. The endometriosis areas growing outside the uterus go through a similar cycle but because the build up cannot leave the body, the implants get deeper and deeper. Additionally, endometriosis lesions can irritate nearby tissue causing adhesions, scarring, and pain. Over time, endometriosis can grow into nodules causing scaring to nearby organs. Excision of endometriosis is the only therapy to objectively cure disease and thus improve quality of life. Dr. Orbuch excises endometriosis using Wolf blunt scissors, a technique initially performed by Harry Reich, M.D., a leader in advanced gynecological endoscopic surgery. This technique, along with other advanced laparoscopic techniques, was learned during her advanced laparoscopic fellowship with Dr. Harry Reich and Dr. C.Y. Liu.

Dr Orbuch specializes in Excision of Endometriosis via traditional laparoscopy as well as Robotic Surgery.  The da Vinci system with its 3-D High Definition Camera allows for precise excision of endometriosis. Excision of endometriosis is the gold standard treatment for endometriosis. Robotic Surgery is a form of Minimally Invasive Surgery. Minimally Invasive Surgery, which includes laparoscopic surgery, uses small incisions instead of large incisions to perform surgery thus reducing the damage to human tissue. The da Vinci System is a sophisticated robotic platform designed to expand a surgeons capabilities. With da Vinci, small incisions are used to introduce miniaturized wristed instruments and a high-definition 3D camera. This allows Dr. Orbuch to view a magnified, high-resolution 3D image of the surgical site allowing for superior visual clarity of anatomy with up to 10x magnification. At the same time, state of the art robotic and computer technology converts Dr. Orbuchs' hand movements into precise small movements resulting in extreme dexterity. The robotic 'wrists' rotate a full 360 degrees that enable Dr. Orbuch to control the miniature surgical instruments with unprecedented accuracy with a wide range of motion. These technological advancements allow Dr. Orbuch to perform complex surgery with precision, dexterity and control. The da Vinci System enables Dr. Orbuch to perform more precise, advanced techniques and enhances her capability to perform complex minimally invasive surgery.

How the da Vinci Robot Works:
The patient cart is positioned over the patient during surgery and contains the robotic four arms, three which hold different instruments, and one that holds the 3-D camera. These arms are controlled by a computer that replicates Dr. Orbuchs' movements.

The surgeon console is where Dr. Orbuch sits and operates the robotic controls while looking into a stereoscopic monitor which provides her with a 3-D, high definition view of the surgical anatomy.

Robotic Surgery Patient Benefits
The da Vinci offers important benefits:
Less pain
Less blood loss
Shorter recovery time
Less trauma on the body
Less scarring
Fewer complications
Quicker recovery and return to normal activities

Hear Dr. Iris Orbuch in a live radio interview

More endometriosis resources
The Endometriosis Association