Dr. David Rosen

Endometriosis Specialist

Gynecologic Laparoscopic Surgeon

Address

Kogarah, NSW, Australia

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Specialties
  • Endometriosis Excision Surgery
  • Pelvic Endometriosis
  • Fertility and Endometriosis
Profile Description

Dr. David Rosen, M.B., B.S., Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon

City: Kogarah, NSW, Australia

Philosophy: The cause of endometriosis is unknown – deep infiltrating disease arising from the uterosacral ligaments and incorporating the ovaries and bowel shows a very different natural history to peritoneal gunpowder or vesicular deposits yet both can cause severe symptoms in women. Accordingly, each patient is approached individually however the overarching philosophy is extensional surgery to remove all deposits (versus “diathermy to endometriosis” which can often leave deep deposits of endometriosis especially in the Pouch of Douglas)

Medication:

OCP, Progesterone IUD (Mirena), Long acting oral Progestagens (Visanne), GnRH analogs (Zoladex / Synarel) and analgesia for chronic pain.
Endometriosis requires a visual diagnosis in all but the most severe cases (when a DIE scan or ultrasound demonstrating endometriotic cysts of the ovary can make the diagnosis pre-operatively). Depending on severity of symptoms, age and physical examination, patients who present with a possible history of endometriosis will undergo laparoscopy or be initially tried on medical therapy (OCP, Mirena IUD). Laparoscopy is never diagnostic alone : if there is endometriosis present it will be excised. Furthermore, if medical therapy is trialled and pain persists then laparoscopy is the next step.
Stronger medications, such as Visanne or Zoladex, are utilized to manage recurrent or chronic pain prior to more definitive measures, or to determine if the chronic pain is indeed gynaecological in origin.
Analgaesic medication is used in conjunction with my pelvic floor physiotherapy colleagues and Pelvic pain team.

Approach to Persistent Pain After Surgery: Endometriosis represents a chronic disease and I believe that pain pathways are laid down over years, like a highway of stimuli from the source in the pelvis, to the sensory cortex and back to the pelvis. As such, it is not unusual to experience recureent symptoms in the same areas as the initial presentation, even if the stimulus is minor. Whilst all physicians hope that their patients experience rapid and permanent relief from excising disease, I am aware of the concept of visceral sensitization and the strategies needed to reduce chronic pain symptoms for this group of women. Accordingly all endometriosis patients are reviewed annually until they feel they no longer need to be seen, offered hormonal therapy following surgery if fertility is not immediately desired and then work as a team to strategize the best plan for chronic pain sufferers, often involving clinicians listed below..

Additional Info
Gender:

Male

Hospital Affiliations:
Insurance:

All

Waiting Time:

15 days

In Practice Since Year:

1995

Fellowship & Certificates:

1996-7: Fellowship - Sydney Women's Endosurgery Centre, Sydney , Australia (Ethicon Fellow in Minimally Invasive Surgery)

Residency:

1995, MRACOG Melbourne

Medical School:

1988: Bachelor of Medicine, Bachelor of Surgery, Sydney University, Sydney, Australia

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