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Endometriosis behind the womb

Endometriosis is a very common condition and is often responsible for heavy, painful periods, pelvic pain, and pain on intercourse. In simple terms, and for reasons that are not entirely clear, some women develop a scattering of cells which are normally present in the womb lining. These cells “germinate” on the inside skin covering (peritoneum) of the pelvis (often behind the womb). They can also grow on the ovaries where, with time, they can grow into “chocolate cysts”. They can grow in the muscle layer (myometrium) of the womb where it is then called adenomyosis. This can cause cramping of the womb muscle during periods and hence intense pain. With time, this scattering of the womb lining cells causes scarring within the pelvis in some women. This can then cause distortions or kinking of the fallopian tube which, if totally or partially blocked, can cause infertility or ectopic pregnancies (pregnancy in the tubes).

chocolate cyst
Chocolate cyst

Not all women with endometriosis have symptoms! Once again, for reasons not entirely clear, there are women who are found to have severe endometriosis scarring in the pelvis at a laparoscopy done for other reasons who will claim to have “normal” periods. In contrast, there are other women who are crippled with abnormal periods with symptoms highly suggestive of endometriosis, and yet, when a laparoscopy is carried out to investigate it, very little is found!

Endometriosis plaques resected

In severe endometriosis, the scarring in the pelvis can affect the bowels, bladder and the ureter (pipe draining urine from the kidneys to the bladder). The surgery to relieve all this scarring can be delicate in order not to cause to much damage to these organs. Robotic surgery is especially useful in these circumstances because of the 3D vision that the surgeon gets and the precise control that he has of the instruments!


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