Endometriosis

Lead: Mr Ertan Saridogan

The UCLH endometriosis centre consists of a multidisciplinary team that is able to assess and treat women with all grades of endometriosis ranging from mild disease to the most severe form involving the bladder and bowel. There is an alternate week clinic consisting of three consultant gynaecologists (Naaila Aslam, Alfred Cutner and Ertan Saridogan), two clinical nurse specialists, a subspecialty trainee in fertility and a minimal access fellow. Expertise includes scanning and medical and laparoscopic management of pain and sub-fertility issues. The nurse specialists run additional clinics on a weekly basis.

The patients attend for an initial assessment at the nurse led clinic where all the options for treatment are discussed. Investigations are arranged and the patients are given a booklet with regards treatment options. At the next visit results are reviewed with one of the medical staff and the patient is able to ask questions and make a decision about preferred treatment options. Should the patient have mild or moderate endometriosis and require surgery then she would undergo surgery on one of the consultant’s routine laparoscopic lists. If the patient is thought to have severe endometriosis involving the recto-vaginal space or rectum then they would make arrangement to have surgery on either Alfred Cutner’s or Ertan Saridogan’s Tuesday list. These lists are chosen as Richard Cohen and Al Windsor (colorectal surgeons) are available should the patient require laparoscopic resection of a disc of bowel or laparoscopic segmental resection. Thus this combined approach enables complete surgery to be carried out in a safe manner with efficient use of consultant time. The expertise in ultrasound offered by Naaila Aslam greatly helps in the triaging of patients.

On occasions there may be ureteric involvement and even the need for laparoscopic nephrectomy. Hiten Patel (urologist) carries out joint laparoscopic surgery where required. Sometimes due to the chronic nature of endometriosis, the pain does not fully resolve even after the condition has been fully excised and Andrew Baranowski and Brigitta Brandner offer an excellent pain management service.

Due to the complexity of this type of laparoscopic surgery a high level of technical support is required. We are fortunate to be able to carry out our laparoscopic surgery in one of two state of the art voice activated theatres. The operating environment that this affords enables a more relaxed atmosphere that is condusive to complex surgery. Times have moved on from the buzzing of dots of endometriosis, and although excisional surgery takes longer and requires expensive disposables, it results in a more complete treatment and better long term results. In the longer run the total treatment cost is less as the patient has less chance of multiple surgery. This level of laparoscopic surgery can only be performed in a multidisciplinary setting.

Thus we offer an integrated service that starts with an assessment by the nurse specialist, followed by a gynaecologist appointment and a decision about treatment choices. Where the condition is severe, joint surgery is carried out with appropriate laparoscopic surgeons. At follow up residual pain is treated within the pain management service. There is a long term nurse led follow up clinic to enable long term outcomes to be assessed.

Accreditation

The British Society of Gynaecological Endoscopy is about to set up accredited endometriosis centres. The requirements include sufficient throughput and integrated care. There will also be a requirement to submit data on patient outcome to a national database. This should with time improve the care that women with this condition receive. We have signed up to be one of these centres. In line with these requirements we run a nurse led follow up service to audit and assess our outcomes of surgery.

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