International Medical Conference Endometriosis 2025:
Endometriosis 2025: Your Mother Should Know, Your Doctor Should Know Better!
Discussion: Bridging the Mind and Pelvis
Speaker 1:
Do we have any questions from our audience? Very nice talks. Now on the shoe wave. I assume you've been using that instead of the strain elastography.
Speaker 2:
This one is actually string.
Speaker 1:
All right.
Speaker 2:
That's, that's why I didn't shoot the stiffness of the endometrial because actually fluctuate quite a bit. First of all, it's actually highly operated dependent and also it's actually has a reference which is usually using the self endometrial is a reference. So that's why the only, the lesions very consistent for junction zone, fairly consistent. But if you use a she wave elastography, that will be actually even better because first of all, it gives the absolute value for stiffness.
Speaker 1:
Also, elastography has been used for the last 15 years to differentiate cancer from inflammatory disease in many organ systems. Have you tried this on endometrial or cervical cancer?
Speaker 2:
Well, I don't do cervical cancer, but I think that we did use it to try to help diagnose deep mitosis and we actually have a paper that essentially says yes, it actually increased the accuracy in diagnosing deep mitosis. Yes.
Speaker 1:
Thank you.
Speaker 2:
Yeah,
Speaker 3:
More than comment. Thank you very much. It was great presentations. Horace, for the sake of other surgeons, looking at your procedure with robot, do you see with respect to during recovery, I mean I see that you're coagulating, you're liberally coagulating a lot. So one of the things I may differ from that European way of doing things and Mario also just goes on and on. I couldn't escape Harry's way of doing things. We irrigate a lot and go after little by little. It takes longer. But do you find different type of recovery or is any compared to your old laparoscopy approaches, when you coagulate M do you see any difference? Most likely you don't, but I mean how do you feel about it? I mean I think there's a lot of energy I see here, there when you control bleeding in the end you use clip for example. That was beautiful. How would you change or was there any accidents with accidental touch to an earth and things like that? The burning, you cannot get it back when you
Speaker 4:
Yes, so if I look at my movies, I see that my technique is very different depending on the laparoscopy or robotic approach, meaning that in laparoscopy I use a lot. The ultrasound and plasma, I irrigate a lot, so I have all the time, almost all the time, the irrigator, the suction in a hand. While in robotic surgery as I do not have the irrigation, the irrigation is very limited and I use almost exclusively the monopolar and bilar current. In laproscopy, I do not use the monopolar. So it's very different. But the overall outcomes are very, very similar. And maybe it may be a tendency to maybe to less pain into the shoulder with the robot because maybe the insufflation is less because the arms suspend the abdominal wall. So we use a lot of maybe a lower pressure of the peritoneum. But the difficulty to promote the robot is that in terms of outcomes, you compare something which is supposed to be better to something, which is very good because outcomes in laparoscopy are very good. It's very difficult to show you do even better. That's why for me, the differences or in term of ity, intraoperative ity and for sure the nerves, the small nerves, the inferior gastric plexus, I think you can do it better if the robot, because you have the flexibility versus straight instruments.
Speaker 3:
Thank you. I just want to make comment to Dr. Wilson's participation. I want to tell the audience how much I appreciate his being part of my practice. And for those who does use psychologist contribution to their care and surgical patient, I have to tell you how my conviction is so strong on this. When I see a patient who does use strong pain medication or heavy use of marijuana or other reasons that they're seeing psychologists, those are the patients very difficult postoperatively. And I tell the patients, I'm not as professional psychologist, but I'll know them. Better professionals should talk to them. Let me tell you something. These patients, as much as I think they're difficult as they have this type of approach, first of all, maybe one or two out of 400, I sent them over a decade. Now one or two patients refused to go and they were psychologists, they were themselves psychologists or they refuse to get a consult.
But the rest had an incredible feedback. Actually, they want to use him, but he doesn't accept them. He does other things. But I think for a long-term there was a question, how do you take care of patients postoperatively? I think that was a beautiful question. You asked that question. I think if you cannot format that trust between you and patient and that trust is not dependent on transparency and giving time, convincing her that you really care about her post-op care is zero, trust me. And surgery is not difficult at all. Surgery is part, the patient sleeps. You do the surgery, you close the skin, but then she starts complaining. A, B, C, D. Thank you so much, Sadar. Beautiful presentation again. Thank you. I think everybody should know that endometriomas are for me as something a time bomb that's going to explode one day because one of the most difficult things to deal with, ruptured endometrioma and chronic closure of the cul-de-sac and sustained pain, all the diaphragm implants, most of them have diaphragm implants. Even though they don't have symptoms, if they know diaphragm implants, they come back, Hey, I have this type of pain later. So I don't think we should be very vigilant. Following are, as we know, so many patients end up in emergency rooms and operated or develop abscesses. We take care of. It's very difficult. So that's one thing. And for Elastography, I think it's interesting area livers surgeons use this extensively. It's a great field. Hopefully it'll open something.
Speaker 2:
Breast disease and also thyroid.
Speaker 3:
That's right. Thyroid.
Speaker 2:
And also there's a elastic based on magnetic MI essentially is on the horizon. Thank you.
Speaker 3:
Any questions go on after this?
Speaker 5:
I just wanted to add on respect to robotic surgery. I think all the points made were very good. I've been operating just over 30 years at this point. In the first, I would say 17 years were laparoscopic and the last years robotic. Initially I thought it was a doy, but then once you get deep into it, the approach very different because with laparoscopy, our perception of depth is in our hands and where robotic is a hundred percent visual. So once you get past that, I'll tell you the main effect that I have is my posture. I don't stand in this cookie bending over. The patient twisted for hours and hours, and I typically do eight, 10 surgeries in a day. So it is so much easier on my back. And secondly, the ability not to rely so much on my assistant. Since I can easily move my visual and I have control of my right and my left arm, I'm working a lot faster. So I will say that in my surgical center, my hospital, the timing to set up a robotics or laparoscopy is equivalent. And I think it depends just a lot of the experience of the center.
Speaker 4:
So of course what I did not mention, I think that to be at ease with the robot and you had to have a short operative time, you have to do at least one robotic day a week exclusively robotics. So the team should be trained to change, to prepare everything. The role of the assistant in the robot is very, very important because you do not control the change of the instruments. So you just ask them. So it is important to have the same assistant all the time. And I am lucky to be now in a private system. I have a company and we have two employees, me and my operative assistant. So she works for me all the time, and she knows me by heart and the surgery is very, very fluent. Thanks to her, to Milan. As regards the poster, I agree with you. You have less pain into the back me, in my case, I have more pain on my eyes at the end of the robotic surgery because maybe I need to have a convergence or maybe I do not close the eyes enough frequently when I do the robotic surgery. But it is not rare that I finish that robotic day with a lot of unpleasant sensation of dry eyes. But for the back it is better for sure. So there are advantages and advantages, but the main advantage in robotic surgery is what I identified in this six localizations of the disease where I think the robot is better than the laparoscopy.
Speaker 6:
Thank you. We'll take the last question. Hi. Thank you everybody. I just wanted to say very, very informative sessions. My question is mostly for Dr. Wilson, but also for all the researchers and doctors. He had mentioned that stress is a really huge component post pre and post surgeries. But I wanted to find out if anybody had ever tackled the issues of micronutrient deficiencies as far as the depletion of B vitamins or patients having methylation issues. Or for example, like amino acids, like serotonin issues related to tryptophan depletion as well as zinc deficiencies have been associated with rheumatoid arthritis or autoimmunity issues. So I'm not sure if anybody has ever come across any of those things in relation to endometriosis.
Speaker 7:
I think that there's probably an enormous correlation between various autoimmune diseases and endometriosis. Most of the people who I see have 'em in terms of the different supplements that you mentioned, many of the patients that I've seen have taken them and swear by them, and I don't question that. I'm not aware of any systematic studies that have been done.
Speaker 2:
Speaker 8:
Does anyone, anyone in the whole audience have much experience with checking the patient in the recovery room after a big surgery to see if they have any pain? We used to do that on a routine basis after excising nodules, and most of the time the patient can describe it's gone. That's the ideal result, of course. But anyone else have experience with that?
Speaker 2:
