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)
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..