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Excision surgery is where the endometriosis lesions are removed in totality and sent to Pathology for biopsy by cutting into the affected tissues deeply. Once they are removed, even where they form deep lesions, they can no longer cause pain, and when biopsied can be identified as endometriosis. Traditional laser and cautery just burn the top off the lesions but LEAVES THE DISEASE BEHIND, causing more pain and adhesions. Lesions can look suggestive and yet not be endometriosis. As opposed to destructive techniques such as cautery or laser, excision gives a pathology specimen and thus avoids potential misdiagnosis.
Excision vs. Laser
So many women say that after laser surgery their pain was worse. Then they have excision surgery and their pain level was virtually gone. What is the difference between excision surgery and laser surgery for endometriosis?
In the words of Dr. Redwine:
"Laser surgery has never been studied with respect to how well it eradicates endometriosis. Many times it simply burns too shallowly. Excision allows the surgeon to remove all of disease in any location, regardless of whether it is superficial or deep. Because laser does not always eradicate endometriosis, it can be like trying to run on a sprained ankle. The endometriosis is still there, but it's been irritated by the heat of the laser and can hurt worse for that reason. Also, laser can leave carbon behind, and the carbon can result in a foreign body giant cell reaction, which can be a cause of pain."
In the words of Dr. Robbins:
"Studies have been done on how deep the endometriosis disease invades and how far the different treatments penetrate. The carbon dioxide laser is basically a drill and can go as deep as the surgeon wants to go. But the reality is that most often these energies are used superficially. Superficial application of laser (Carbon dioxide, KTP), Argon Beam, or bipolar electrical energy are relatively safe but coagulate to no more than 2 mm. The problem is that endometriosis lesions penetrate more than 2 mm in 61% of cases and more than 5 mm is 25% of cases. The depth that endometriosis invades can vary within a single lesion. Therefore, it is essential when destroying a lesion to not miss areas and treat all the deeper areas, to avoid residual endometriosis and persistent pain. The only way to be sure to get all the lesions is to stay in adjacent normal tissue and go completely around and underneath the lesions."
"The only way to have a chance off long-term pain relief and avoid multiple surgeries is complete excision."