Zaraq Khan, M.B.B.S. , and Tatnai L. Burnett, M.D. , discuss endometriosis, its prevalence and the types of personalized treatments available to patients. They highlight the collaborative nature of treatment for better patient outcomes.
Endometriosis is a fairly common condition impacting about 10% of women, where the lining of the uterus or endometrium like tissue starts growing outside of the uterine cavity. It causes inflammation and it's the body's immune response that actually causes most of the symptoms because inflammation causes pain and that's really what. Sort of unmasks the disease um in in in women. Pain is almost you have to think of it like a cancer. It brings friends. So while someone may start out as having endometriosis pain with their periods when they're a teenager, as they get older and that pain continues over time. It often brings on other organ systems into the pain process. It turns out it can be very hard to tease those individual pieces apart, and as a result, what we try to do really is treat all possible causes of pain. Typically when we see patients with endometriosis, there's a subset of patients that are seeking pain relief, and then another subset of patients that are really truly seeking fertility, and that's their top priority. Approaching endometriosis surgically really takes a specialized team. The goal always is, it usually is when it's when we're dealing with pain at least to remove all disease completely, even if that includes removal of the uterus sometimes, whereas people that are seeking fertility were trying to preserve as much ovarian tissue. As possible rather than removing the ovaries we're actually removing cysts from the ovaries. The endometriosis surgeon has the skills to attack the complex endometriosis where everything's stuck together and you need to open planes. It's not part of regular training and our endometriosis specialists here at Mayo Clinic have that training. We have a minimally invasive approach to surgery. Even with complex disease, the minimally invasive approach is superior. It's what all of our Mayo Clinic endometriosis experts are trained to do, and it's what we offer our patients because of those benefits. We do both straight stick laparoscopy and robotic surgery. And uh we have state of the art robotic surgeries. We, for example, work together with colorectal surgeons, GYN oncologists, urologists, plastic surgeons, um, hepatobili and pancreatic surgeons, as well as thoracic surgeons. For our cases with endometriosis. When we do some complex cases here at Mayo Clinic that might involve 2 or even 3 different surgeons when bowel and ureter and other things are involved, it's a team effort and bringing that team to bear for the benefit of the patient. We work very closely with radiology because now imaging is becoming a diagnostic tool for endometriosis. We have the ability to use imaging to preoperatively counsel patients, preoperatively plan. So that when we go in to do surgery, we can do one surgery and remove and treat all of the disease with the full knowledge of the patient and their decision making involved prior to going to that operating room. These are endometriosis, radiologic experts that all they see day in day out is endometriosis only. And there's a team of 5 of them that that sit with us, the surgeons, to give us a roadmap and explain to us where the disease is. Here at Mayo Clinic we do team sport well and endometriosis tends to be a big team sport. That's some of the reasons why we can really take care of a patient no matter how complex and serious that condition would be. We have a robust. research program whether it's clinical or translation or basic sciences research we're looking at the pathophysiology or the basic sciences of the molecular sort of way of how this disease forms then we're looking at disease detection and the interface with radiology. We're then looking at the clinical outcomes and how surgery or fertility treatments are impacted in these patients. It's not a simple disease. It's not, not one that we understand very well. It takes complex treatment, it takes complex surgery, um, and being able to centralize that care in places where we have all of the tools and resources and expertise to deal with it, we get better outcomes for patients. We are happy to take care of those complex patients, those patients that might keep you up at night. That's what we specialize in doing here at Mayo Clinic. When I see patients back like today, the patients I operated on 6 or 8 weeks ago. And they tell me that they have their life back, that the pain is gone, that they can lift their child, that they can run, that they can. Eat things that they couldn't eat before. That's the reason I do this, OK? We can help patients feel better. More than that, we can help patients get their lives back. If it wasn't for that, I wouldn't do this. It's not worth it, um, but for the patients to feel better, that's why we all do this. That's the whole reason we've developed this central program at Mayo Clinic multidisciplinary program is because we can help patients feel better and function better.
