Choosing your surgeon

How to Choose the Right Surgeon for Excision Surgery

Deciding to undergo excision surgery is a significant step, but an even bigger decision is selecting the right surgeon. While you may already know that a typical OB/GYN isn’t ideal for this specialized procedure, navigating the list of recommended surgeons can feel overwhelming. Here’s a guide to help you choose the surgeon who’s best suited for your needs.

Key Factors to Consider

1. Training

• Seek a surgeon who is certified in MIGS or FMIGS (Minimally Invasive Gynecologic Surgery and Fellowship-trained). These programs provide advanced training in endoscopic gynecologic surgery beyond standard OB/GYN residency.
• Ensure your surgeon is Board-certified, as this signifies a high standard of training and competence.

2. Experience

• Ask about the number of surgeries they have performed, including laparoscopies and cases of Stage III-IV endometriosis.
• Inquire about their complication rates, how they manage unexpected situations during surgery, and their use of imaging (e.g., MRI or ultrasound) for surgical planning.
• A seasoned surgeon will have a track record of successfully managing complex cases and adapting to challenges.

3. Surgical Team

• Find out who will handle specific tasks, such as addressing bowel, bladder, or diaphragmatic involvement if needed.
• Confirm if the surgery will be completed in one procedure and clarify the roles of fellows or other team members during the operation.

4. Obstetrics Practice

• Experienced excision surgeons often no longer practice obstetrics. Delivering babies is time-intensive, leaving less opportunity to refine skills in advanced endometriosis surgery.

5. Excision vs. Ablation

• Ask about the surgeon’s approach to excision and whether they use ablation (e.g., fulguration or cauterization). Excision is the gold standard for treating endometriosis, though some surgeons may use ablation for small areas. Ensure their methods align with your preferences.

6. Medication Use

• Ask if the surgeon routinely prescribes suppressive medications before or after surgery. If they do, request a detailed explanation of the purpose and duration of such treatments.

7. Costs and Fees

• Don’t hesitate to discuss costs. Ask if they accept insurance, are in-network, or assist with out-of-network claims.
• Understand their payment policies, including up-front fees, installment plans, and charges for consultations or follow-up visits. Transparency here prevents financial surprises.

8. Personal Fit

• Ensure you feel comfortable with your surgeon’s communication style. Are they approachable and thorough in answering your questions? You need a provider you trust and feel at ease with.

What Doesn’t Matter

1. Gender

• The gender of your surgeon has no bearing on their ability to perform excision surgery. While personal preference is valid, focus on their skills and expertise.

2. Tools

• The tools a surgeon uses—be it lasers, robots, or traditional instruments—don’t matter as much as their proficiency with those tools.

3. Bowel Prep

• Some surgeons prefer bowel prep before surgery to reduce infection risk; others don’t. Both approaches are acceptable and depend on surgeon preference, with no significant difference in outcomes.

Factors That Might Matter

1. Reputation

• Reputation can be helpful but isn’t the sole indicator of expertise. Some surgeons may be well-known due to media coverage or excellent bedside manner but lack technical expertise. Research carefully and ask questions to understand their true skill level.

2. Office Operations

• A well-run office can make your experience smoother, while a poorly managed one can cause frustration. Decide how much this matters to you, weighing it against the surgeon’s expertise.

3. Location

• Consider whether you’re willing to travel for care, as top surgeons may not be local. Factor in costs for travel, lodging, and other logistics.

4. Timing

• Some surgeons have long waiting lists. Consider how urgently you need the surgery and whether waiting aligns with your personal timeline.

iCareBetter has a list of video-vetted surgeons. These surgeons are approved by their peers after reviewing their surgical videos. Please go to this link to review the doctors: Video-Vetted Endometriosis Excision Surgeons

What Matters Most

The most common feedback from patients about their surgeons is that they listen. Your surgeon should:

• Pay attention to your concerns and respect your knowledge about your condition.
• Be open to having consultations recorded or attended by a support person.
• Treat you as an active partner in your care, making you feel heard and valued.

Ask all your questions, listen carefully to the answers, and give yourself time to reflect. Trust your instincts. Once you’ve made an informed decision, commit to it and focus on the future with hope and optimism for a better quality of life.