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Which doc?  Gyn onc or endo specialist? Which doc? Gyn onc or endo specialist?

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Unread 05-01-2012, 04:52 PM
Which doc? Gyn onc or endo specialist?

I am having a hard time straightening this out in my head.

I am 39, and have had four surgeries for stage 4 endo. First was a laparotomy with a gyn onco. Third was with top, very well known endo specialist(traveled) who said my endo had a 20-25% of recurrance. That was almost five years ago. I have had one surgery since then, and have to have surgery again due to ovarian cysts and pain.

I am scheduled for a robot assisted total hysterectomy next week with the same gyn onc. who did my first sugery. My CA-125 is high again(is every time with cysts, but he does not suspect cancer), and bilateral cysts are large. He will do what he can to save one ovary. He will also remove endo and adhesions.

I am wondering if an experienced gyn onc with DaVinci is comparable to an endo specialist doing traditional lap. Like I said, I have already had excision with a top doc, but still had problems. I would likely end up with a hysterectomy and ovary removal with either doc, since specialist suspected adenomyosis during surgery, and recommended hysterectomy and left ovary and tube removal if additional surgery is needed. I am wondering, though, who might give me a better outcome regarding endo. DaVinci has a more magnified view, better access, and can remove deep implants. An endo specialist is a specialist, but is not foul proof. Any opinions?
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Unread 05-01-2012, 05:52 PM
Re: Which doc? Gyn onc or endo specialist?

I've never seen an endo specialist because I didn't know I had endo until my dvh but I think your odds are good with this surgery. My GYN showed me photos yesterday from my surgery it was such amazing resolution! She had several photos of the implants and said the da vinci enabled her to get everything. She spent 4 hours in there and said any other surgery type would have been even longer.

All of the stuff I had done is in my signature and it looks like alot but my ovaries were spared and I'm in great shape. I'm fairly lively and pain free ever since surgery thanks to getting that endometriosis removed!
Unread 05-01-2012, 08:17 PM
Re: Which doc? Gyn onc or endo specialist?

Thanks for your response, I appreciate it. That is very good reassuring to hear, and at this point, I need all of the reassurance that I can get!
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Unread 05-01-2012, 11:00 PM
Re: Which doc? Gyn onc or endo specialist?

There are a wide range of pros and cons for each choice, especially if you are specifically considering doctors who have performed surgery for you before. That means neither one was able to completely excise all of the endometriosis previously and neither may be able to so this time either.

Yes, the da Vinci robot definitely offers greater magnification during surgery. However, magnification is only one part of the issue. If the surgeon isn't going to be able to remove what s/he sees, the extra visualization isn't going to help you out much. On the other hand, a surgeon also can't remove what s/he does not see though some surgeons do assume there is microscopic endometriosis around what is visible and will excise accordingly.

The surgeon who is most familiar with recognizing and removing endometriosis is also the one most likely to be able to offer the most successful outcome endometriosis wise. That is their area of expertise and s/she should have the experience and skills to offer you the most optimal results. Experience only comes with time and practice, regardless of tools. You want someone with experience with endometriosis and which ever tools will be used.

The CO2 laser can't be used with the da Vinci robot which is one reason some endometriosis specialists are not switching to that option. However, there are some endometriosis specialists starting to use a combination of da Vinci and laparoscopy so they have the superior visualization for part of the surgery, then they can remove the robot and go with that traditional lap so the CO2 laser can be utilized.

There is no perfect answer and no promises for either choice. There are half a dozen reasons to choose the local gynecological oncologist, and half a dozen reasons to choose the endometriosis specialist. Realistically, finances, time, and travel do play a part in the decision process. Since you have had surgery with each, how well you liked each doctor and how well follow up care was handled could impact your decision.

Personally, before heading into OR with your local gynecological oncologist I would at least speak to the endometriosis specialist.

Also, has either doctor shared with you that active endometriosis can cause elevated CA-125 results?

I wish you all the best for which ever option you decide is right for you!

Unread 05-02-2012, 12:58 AM
Re: Which doc? Gyn onc or endo specialist?

Thanks so much for the reply. I am aware that CA-125 can be elevated with endo, that is how I ended up with the gyn onc for my first surgery. It has been high for all of my surgeries after that, last summer it was almost up to 300. Right now it is at 108, which is why my second opinion doc sent me to the gyn onc again. Also because the onc does DaVinci.

Do you have knowledge of what tool is actually used to excise when using DaVinci? I forgot to ask(totally not like me!), but will ask tomorrow. My second opinion doc has only been using DaVinci for three months, so sent me to onc since he has been doing it since 2008, and it is his standard unless dealing with ovarian cancer. I was happy to hear him tell me that a hysterectomy does not cure endo, and both second opinion doc and onc mentioned patients that where they have had to remove implants after patients have had a TH. I, frankly, just don't know if I want the hyterectomy, and wonder if an oopherectomy and cystectomy followed up with BCPs might get me a few more years down the road.

Thanks again!!

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