Taking Time for My Patients
Treating endometriosis with a combination of in-depth discussion and the latest technologies
By John F. Dulemba, MD, FACOG
Gynecologist specializing in minimally invasive robotic surgery
The Women’s Centre, Denton, Texas
All I do in my practice is treat endometriosis and adhesions (scar tissue that causes pain) to improve patients’ health and quality of life. To date, I have performed well over 2,000 minimally invasive endometriosis robotic procedures (almost 4,000 cases laparoscopically), yet my approach is all about quality over quantity. Seeing fewer patients may not be possible for most surgeons, but at this stage of my career, I choose the luxury of time to devote to my patients.
From a personal perspective, I want to spend time with patients before we plan their surgery. Endometriosis often has such a deep effect on people’s lives, and they may have already been through various treatments. I think it’s important to focus on each person and hear all the details. It helps me get the best understanding of their disease, so I can ensure I deliver the best care to each individual patient.
To spend an average of 2 hours with each new patient, I limit the number of office visits each day. I am also available for free phone consultations at night, which is particularly helpful for patients traveling long distances to see me. On operating room days, I limit myself to two procedures per day. This way, I never rush, and I can spend time with patients before and after surgery.
From a technological perspective, I choose to use a surgical robot and Lumenis CO2 laser with advanced pulse technology, which is the best way to outline and remove the target tissues in my opinion. The robot lets me access every part of the abdomen very easily with 3-dimensional vision and 10-times magnification. The CO2 laser causes less bleeding than other methods such as cold scissors, as well as less of the painful scarring we’re trying to avoid.1 The 3-dimensional vision allows me to see and remove more of the endometriosis cells than I could with a standard endoscope.2
Finally, from a procedural perspective, my support staff and I follow the same standardized steps in sequence every time. This ensures that surgery is very safe and accurate. If we encounter anything unexpected, we’re prepared to deal with it calmly and efficiently.
Once we inflate the abdomen, before manipulating any tissue, I carefully identify and document where endometriosis and adhesions are located. Then I begin removing tissue in lower areas and work my way up, from the cul de sac and rectum to the uterus, ovaries, fallopian tubes, sidewall, and bladder, looking at the bowel as I go. Next, I remove tissue adjacent to the ascending colon, appendix, liver and diaphragm. Finally, I remove the endoscope, close the small incisions, and move the patient to the recovery area.
Many excellent surgeons have their own effective approaches to CO2 laser excision of endometriosis and adhesions. This is wonderful – we need to have many dedicated doctors working to alleviate this common condition. I will continue an approach that’s a bit slower because I enjoy it and it produces excellent results for my patients.
- Dulemba JF, Pelzel C, Hubert HB. Retrospective analysis of robot-assisted versus standard laparoscopy in the treatment of pelvic pain indicative of endometriosis. J Robot Surg. 2013 Jun;7(2):163-9.
- Mosbrucker C, Somani A, Dulemba J. Visualization of endometriosis: comparative study of 3-dimensional robotic and 2-dimensional laparoscopic endoscopes. J Robot Surg. 2018 Mar;12(1):59-66.
* Participants are unpaid, non-solicited volunteers of information.
CO2 lasers (10.6 μm wavelength) are intended solely for use by trained physicians. Incorrect treatment settings or misuse of the technology can present risk of serious injury to patient and operating personnel. The use of Lumenis CO2 laser is contraindicated where a clinical procedure is limited by anesthesia requirements, site access, or other general operative considerations. Risks may include excessive thermal injury and infection. Read and understand the CO2 systems and accessories operator manuals for a complete list of intended use, contraindications and risks.