Bowel Endometriosis 4 Ways - Society of Robotic Surgery 2020 Meeting
Endometriosis of the bowel is relatively rare, but can be common in a medical practice focused on advanced endometriosis such as ours. This video demonstrates 4 different techniques for resection of bowel endometriosis - shave procedure, sutured disc excision, stapled disc excision, and segmental resection with end to end reanastamosis. Depending on clinical characteristics, any one of these techniques may be used for resection of endometriosis of the bowel. Dr. Fogelson offers consultative and surgical services through Northwest Endometriosis and Pelvic Surgery in Portland, OR. Call 503-715-1377 for consultation.
Dissection of Rectovaginal Endometriosis with Linear Stapled Nodulectomy of Multifocal Bowel Disease
This video demonstrates technique for mobilizing the rectum off of the vagina in stage IV endometriosis with obliterated cul-de-sac, resection of vaginal endometriosis, dissection of rectal wall endometriosis, and the use of a GIA stapler to perform a linear nodulectomy of the anterior rectal and sigmoid wall. This video is directed primarily to other surgeons, but may be of interest to other parties interested in the disease state. For clinical consultation with Dr Fogelson, call Northwest Endometriosis and Pelvic Surgery in Portland, OR at 503-715-1377
Robotic Hysterectomy in Uterine Didelphys
This video demonstrates technique for removal of a uterine didelphys, or "double uterus". Uterine didelphys is a condition where a woman is born with two uteruses rather than one. In the normal process of embryogenesis, two halves of the reproductive and urinary tracts fuse in the center to form complete organs. When this fusion fails, mullerian defects occur. Uterine didelphys is a complete failure of fusion, resulting in two complete uteri, each with its own cervix. In some cases there can also be a septum in the vagina, leading to a double vagina as well. This particular didelphys shows complete failure of central fusion, with very widely spaced uteri. Hysterectomy in this condition requires an expert understanding of pelvic anatomy, as many of the typical landmarks one would use in laparoscopic hysterectomy are distorted. We also have to modify the way we use the uterine manipulator, as there are two cervices instead of one. This particular patient was experiencing uterine pain with her menstrual cycle that was not responsive to medical therapy, necessitating hysterectomy. She came to Dr Fogelson and NWEPS because of our reputation in surgical excellence particularly in complex cases. For clinical consultation, please call us at 503-715-1377.
Liver Mobilization for Diaphragm Surgery - AAGL 2020
This video is a demonstration of technique required for mobilization of the right diaphragm to allow access for severe diaphragm endometriosis surgery. This surgery is directed towards surgeons perfoming these types of surgeries, with significant technical explanation, though it may be of interest to patients with diaphragmatic endometriosis as well. Submitted for review for the AAGL 2020 Meeting, November 2020. Dr. Fogelson is a gynecologic surgeon in practice at Northwest Endometriosis and Pelvic Surgery in Portland, OR. We offer high level care for all types of endometriosis, including severe cases involving bowel, diaphragm, thoracic cavity, and abdominal wall disease. Please call 503-715-1377 for clinical consultation.
Rectovaginal Endometriosis Dissection with EEA Stapled Discoid Resection of Rectal Endometriosis
This video demonstrates technique for dissection of rectovaginal endometriosis, including a description of what I call the "Reverse Horseshoe" technique for separating the rectum and sigmoid from adherent cervix/vagina in cases of high grade bowel endometriosis. We also demonstrate the use of an EEA stapler to do an anterior disc resection of the rectal / sigmoid wall. This video is created with the intention of demonstrating these techniques to other surgeons, but will also be of of interest to women with high grade endometriosis who seek to better understand the surgical techniques that are involved in removing such disease. -------- Dr Fogelson is a Physician in practice at Northwest Endometriosis and Pelvic Surgery in Portland, OR. For clinical consultation please call 503-715-1377, and visit us at http://www.nwendometriosis.com
AAGL 2019 Rectus Muscle Endo
This video demonstrates laparoscopic excision of rectus muscle endometriosis, a relatively rare variant of abdominal wall endometriosis. Most abdominal wall cases have to be removed through an abdominal incision, but when the disease is entirely within the rectus muscle, a laparoscopic approach is feasible and preferred. Performed by Dr. Nicholas Fogelson of Northwest Endometriosis and Pelvic Surgery in Portland, OR. Call 503-715-1377 for clinical consultation. To be presented at AAGL annual meeting, Vancouver, BC, 2019.
AAGL 2019 Intracorporeal Anastamosis Tutorial
This video is a tutorial for total intracorporeal colon resection and anastamosis with vaginal extraction of tissue, in 2 different cases of stage IV endometriosis. Surgeries with Nicholas Fogelson of Northwest Endometriosis and Pelvic Surgery in Portland, OR, along with general surgery colleagues Dr Avishai Meyer and Mark Whiteford. Call 503-715-1377 for clinical consultation. To be presented at AAGL annual meeting, Vancouver, BC, 2019.
AAGL 2019 Bladder Endo Video
This is a video demonstrating a case of invasive endometriosis of the bladder wall, managed with full thickness excision and closure. Resection of additional extensive pelvic endometriosis also performed (not shown in this video). Performed by Dr. Nicholas Fogelson of Northwest Endometriosis and Pelvic Surgery in Portland, OR. Call 503-715-1377 for clinical consultation. To be presented at AAGL annual meeting, Vancouver, BC, 2019.
Video Messages from Dr Fogelson
Video Messages from Dr Fogelson
Thoughts on the Effectiveness of Excision Surgery
A lot of women ask how effective excision surgery is in treating endometriosis. The truth in my opinion is that its very effective, but not perfect, and probably the rate of recurrence or persistence of disease is higher than is often reported. I intended to talk about this for 5 minutes and went for 20, as is usual :) For clinical consultation on endometriosis care or other complex pelvic conditions, call Northwest Endometriosis and Pelvic Surgery at 503-715-1377. http://www.nwendometriosis.com
Representativeness Error and Rare Conditions
Dr Fogelson discusses how misunderstandings about the rarity of conditions in specific populations can lead physicians to underestimate the likelihood a woman has "rare" presentations of endometriosis. For clinical consultation, contact Northwest Endometriosis and Pelvic Surgery at 503-715-1377.
Is Lupron Chemotherapy?
Dr. Fogelson addresses a common misconception about Lupron. Lupron is a drug that some doctors use to treat endometriosis symptoms, and it has a lot of side effects. Some of these side effects can be severe, and some women seem to have long term issues after only a few months on the drug. Lupron is also a drug that is used in some estrogen sensitive cancers as an anti-neoplastic agent. But Lupron is _NOT_ chemotherapy, in the sense that it is not a cytotoxic chemotherapy agent.
Doctor Fogelson Discusses Neuropelveology
Dr Nicholas Fogelson of Northwest Endometriosis and Pelvic Surgery discusses the field of Neuropelveology. Neuropelveology is the study of the pelvic nerves, how they function, how we diagnose their dysfunction, and the non-surgical and surgical techniques for addressing these issues. This video complements our page on Neuropelveology at https://www.nwendometriosis.com/neuropelveology NWEPS sees patients with advanced endometriosis and other pelvic pain conditions in our office in Portland, OR. We now offer evaluation for neuropelveologic type cases including sciatic or other directly nerve involved endometriosis, pudendal neuralgia, and other complex manifestations of pelvic pain and dysfunction. Please call 503-715-1377 for consultation if there is a need.
Thoughts in Surgical Fear
I had some thoughts about how surgical fear affects surgeons who are developing their skills at advanced endometriosis surgery. I was there in my past, glad to be past that point now. This is issue is part of why a patient with complex endometriosis issues should really seek out a very experienced surgeon who is well past the early part of their learning curve. Its not only about knowing how to do a surgery, but also having the courage to actually do it.