Vesico Psoas-Hitch for treatment of severe Endometriosis

Article Conference CoverageFrom the 54th Annual Meeting of ASRM San Fransisco, California - 1998

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Roberta Speyer: "I'm Roberta Speyer, reporting from the 16th World Congress on Fertility and Sterility at the 54th annual meeting of the American Society of Reproductive Medicine in San Francisco. We're talking today with Dr. Camran Nezhat. Dr. Nezhat is Clinical Professor of Surgery and Gynecology at Stanford University and Director of the Stanford Endoscopy Center. Today we'd like to discuss endometriosis. Dr. Nezhat, could you tell us a little bit about endometriosis, first?"

Dr. Camran Nezhat: "Endometriosis is a benign condition that affects a large number of the population and can contribute to infertility, cause pain, and sometimes cause malfunction and dysfunction of some organs like the bowels, bladder, ureter, etc."

Roberta Speyer: "This is a very serious problem. About how much of the population is affected by this disease?"

Dr. Camran Nezhat: "The exact amount of endometriosis, or the incidence, is not very well known. We don't know exactly what the percentage is, but we can say that perhaps 10 to 15 million American women probably have endometriosis."

Roberta Speyer: "Is there a genetic cause for this disease?"

Dr. Camran Nezhat: "Endometriosis appears to be a multifactorial disease. It seems that in some families there could be a genetic link, and it could also be due to other things like environmental factors, dioxins, and autoimmune problems. All of that, to some degree, could be involved, so we don't know the exact cause of endometriosis, but a genetic factor is one of the factors."

Roberta Speyer: "Switching gears a little bit here, Dr. Nezhat, I know that you have a particular case of laparoscopic vesico psoas-hitch for severe endometriosis that you'd like to share with us."

Dr. Camran Nezhat: "Yes. Endometriosis can affect different organs. For example, it can involve the bowel, and when it involves the bowel, it can cause pain with bowel movements, constipation, diarrhea, or a significant amount of rectal bleeding. At the same time, endometriosis can involve the bladder or the ureter, and in that case, the woman has pain and also blood in her urine around the time of her menstruation. In the case of involvement with the ureter, if the endometriosis is very severe, the woman could lose a kidney because of the obstruction of the ureter and its involvement with endometriosis. For example, in the case that we are reporting, a woman had a history of extensive endometriosis involving her ovaries, bowel, bladder, and one of the ureters. One ureter was significantly more involved than the other one, and in this case, the involvement of the left ureter was almost completely obstructed and the amount of endometriosis was significant enough that it required removal of a good portion of the ureter, and of course, repairing it. Traditionally, this procedure has been done by opening up the abdomen, making a large incision, and repairing the ureter. In the past, we have reported and repaired it when there was a small portion of the ureter involved with endometriosis. We removed it, and we put the ureter back into the bladder without significant mobilization of the bladder. Now, more and more people have done this procedure when there is bad endometriosis involving the ureter. In this new case report, the amount of endometriosis was too severe and it did not work for her just to simply remove a small portion of the ureter and put it back into the bladder. A large-size portion of her ureter was involved. Thus, we had to remove a good portion of the ureter, and because the ureter was short, you couldn't easily put it back into the bladder. Thus, we had to also mobilize the bladder, stretch both of them, and then put them back together laparoscopically. This procedure has been done in the past, of course, and it is being done even now for multiple reasons, but you do it through a very large incision in the abdomen. What is interesting about this was that we were able to do it laparoscopically, so the patient didn't need to have a large incision, and she benefited from a speedier recovery with less pain. It has been close to two years now since we did this procedure, and the patient is doing quite well, the ureter is excellently open and all of that discomfort has disappeared."

Roberta Speyer: "That's wonderful. You are, of course, a very famous and highly-regarded surgeon with a great deal of skill. What are the opportunities for other physicians who want to be able to learn your procedure?"

Dr. Camran Nezhat: "You know when there is a marathon, and somebody is running at the very beginning of the race, and somebody is at the end, but everybody is running? Everybody is making progress, everybody is running, and nobody is stationary. This is the whole idea behind this technology. When we do an advanced case like this and we do it well and the patient benefits from it, the technique is standard - you're doing it by open abdominal surgery and there's nothing new about it. Instead of the same old things like cutting the abdomen open, we do it by laparoscope. This would stimulate other people to gradually try more and more easier procedures. There are going to be other spin-offs from this, and indeed, more and more surgeons, when they see things like this could be done successfully, will try easier cases more and try to do them endoscopically. In the long run, the winners in this process are the patients, and of course, when the patients win and they get back to their homes and their lives faster, everybody wins."

Roberta Speyer: "Thank you very much, Dr. Nezhat. I know that the physicians and women at the Endometriosis Pavilion will certainly appreciate hearing about the work that you've been doing."

Dr. Camran Nezhat: "You are very kind. Thank you very much."

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