Endometriosis: diagnostics and techniques of surgical treatment
dr n. med. Tomasz Songin
  1. What is endometriosis?

Endometriosis is a chronic disease based on the ectopic occurrence of the uterine mucosa. The term seems to be super-professional, but basically… endometriosis can be compared to a cancer that attacks a woman’s body by creating metastases from the cells of the uterine mucosa beyond it – in the uterine muscle, in the fallopian tubes, in the ovaries, the abdominal cavity and other distant organs. This disease accompanies the woman until the end of menstruation causing a significant reduction in the comfort of everyday life, infertility, pain during sexual intercourse, painful passing of stool and urine and many other ailments. There are many theories looking for the causes of this disease, but none of them has finally been accepted by the medical community. We know that the abnormally functioning immune system of our body is involved in its formation. That is why often other autoimmune diseases coexist with endometriosis.


A low level of awareness of the existence of this disease in society as well as among doctors, causes a lack of understanding for the suffering of women affected by it. One often hears that this is just specific feature that menstruation must be painful or that all these ailments will miraculously disappear with the puberty period or pregnancy and delivery. This leads to the rejection of women in relationships due to their infertility and cessation of intercourse, problems at work due to absenteeism, frequent visits to hospital admission rooms. All this causes that this disease also has a different dimension beyond the suffering of the woman herself – it is a socio-economic dimension that cannot be ignored.


  1. As the research shows, the diagnosis of endometriosis can last on average from 8 up to 10 years.

Can you presumably diagnose endometriosis based only on the patient’s interview and the gynecological examination with the use of ultrasound?


In medicine there is always a group of patients in whom the symptoms of the disease as well as the tests carried out obviously guide us towards the correct diagnosis. These are women with severe pain, heavy bleeding, with endometrial cysts revealed during the examination. These patients are quickly qualified for treatment, mainly surgical as well as pharmacological, and do not constitute the diagnostic problem, in contrast to patients with nonspecific symptoms. Making a diagnosis in this case is sometimes not obvious. Already during the conversation with the patient, we must pay attention to details that are often neglected by the patients. Properly performed gynecological examination with an ultrasound, helps us to make the correct diagnosis. And “correct” in this case means not only searching for a cyst, but first and foremost, paying attention to the mobility of the ovaries, uterus, suspected presence of intestinal adhesions with the posterior uterine wall, altered myometrium structure in search for adenomyosis and many other details. If we can establish a good relationship with the patient and get answers to the questions that are often considered embarrassing and then carry out a thorough examination, in the majority of cases we can make the preliminary diagnosis of endometriosis.


  1. Is gynecological laparoscopy the only 100% sure way to diagnose the disease and when should it be prescribed?


Why preliminary? This is due to the characteristics of the disease. In the initial stage, the ailments are caused by small, superficial outbreaks which are not visible in any imaging examination (neither resonance nor tomography) or nor possible to sense in the palpation. Then all available methods of surgical diagnostics turn out to be useful. Thanks to these procedures, which allow us to take fragments of tissues and examine them under a microscope, we are able to make a 100% sure diagnosis. Although nowadays availability and security of such operations is very large, we do not carry out such procedures only to confirm our assumptions. Usually, we want to get some additional benefits (e.g. infertility diagnosis, treatment of pain syndrome, etc.). Each case should be considered separately, and sometimes potentially similar cases require different recommendations for both diagnosis and treatment.


  1. You conduct surgeries in Miracolo Clinic, where great group of doctors specializes in diagnosing and treatment of endometriosis. What are the most beneficial tools and techniques used for diagnosis and removal of endometriosis and cysts and adhesions?


In every case of endometriosis diagnostic, we would like to minimize interfering with the woman’s body and at the same time obtain the maximum number of information. Such criteria are met by transvaginal laparoscopy in the water environment, which can even be performed under local anesthesia. It allows to identify even the smallest outbreaks, which in most cases of classical laparoscopy are omitted.


In turn, during the surgical treatment it is important to determine the purpose of each surgery. The scope of surgery would be different for a 45 year-year-old patient, who is not planning pregnancy and different for a 30-year-old woman, who is under infertility treatment. What undoubtedly connects these cases is our care to preserve as much ovarian reserve as possible and to minimally damage healthy neighboring tissues. Such a possibility gives us, for example, a plasma knife and a laser.


  1. The great thing is that the Miracolo Clinic not only professes the principle that in undertaking surgery makes every effort to remove all visible outbreaks of endometriosis and any changes resulting from this disease, but also has dietitians in its team who arrange nutrition therapy for individual needs patients with endometriosis. Does holistic approach to the treatment of endometriosis give women any chance of complete elimination of the disease?


Holistic approach to the patient always brings benefits, especially in the case of endometriosis, causes of which are rooted in many places in our body as well as in the environment. Multidirectional and professional care of the patient is desirable, but we cannot forget about the key principle that we, doctors, must follow – practicing medicine, which is based on facts. Scientific evidence allows us to reliably assess the risk and present proven therapeutic options to the patient. Unfortunately, not all of the treatment methods meet such criteria. Including a specific diet in the healing process gives us the opportunity to partially eliminate harmful environmental effects on body. According to some organizations, not only doctors, it is believed that this may help to relieve the discomfort associated with this disease, which is often observed. Unfortunately, we cannot guarantee it and that is the reason why a diet is recommended as a supplementation of the treatment process and not as its basis. We would like to believe that thanks to all these actions combined together, we could entirely overcome endometriosis, but for the time being it remains only in terms of hope.