Almost 10 million American women of childbearing age are affected by chronic pelvic pain, gastrointestinal and urinary tract difficulties and infertility due to endometriosis, a strange condition, in which cells normally forming the lining of the uterus (endometrium) start colonizing other organs and tissues beyond the uterus. This year’s annual meeting of gynecologic laparoscopic surgeons explores endometriosis from both the patient’s and the physician’s perspective in a Keynote session (8:00 to 10:00 AM Tuesday, November 8) at the 40th AAGL Global Congress of Minimally Invasive Gynecology that takes place from November 6 to 11, at the Westin Diplomat in Hollywood, FL.
Keynote speaker and women’s health advocate Padma Lakshmi, an international supermodel and TV show host, who co-founded the Endometriosis Foundation of America to encourage research to help other women to avoid her ordeal, declares: “Endometriosis is one of the most treatable, but least treated of women’s health problems. Like me, many women suffer debilitating pain and other symptoms for as long as a decade before receiving an accurate diagnosis and proper treatment.”
Many women suffer silently or use painkillers, sometimes for years. Because pelvic pain can have many different causes, including appendicitis, bowel obstruction, ovarian cysts, pelvic inflammatory disease, diverticulitis, ectopic pregnancy, fibroids, IBS and many others, correct treatment can often be delayed further, as endometriosis is sometimes not immediately diagnosed.
For example, in women with endometriosis on the intestines, symptoms may prompt a physician to suggest GI tests, which will not reveal the true problem.
Lakshmi continues saying: “If a woman wants to have children, it’s critical to get an accurate diagnosis and treatment as soon as possible. Endometriosis is one of the top three causes of infertility. Many women are delaying childbearing into their 30s and even 40s these days, but if you have had untreated endometriosis for many years, it may be too late. And that is a real tragedy.”
The currently most effective treatment is laparoscopic excision surgery as alternative medical therapies for endometriosis are extremely limited.
Although the cause of endometriosis is unknown, researchers suspect a strong genetic component, as daughters of women suffering from the condition have a seven times higher risk of developing the disease themselves. During the AAGL meeting, members will present research on abnormal expression of Homeobox (HOX) genes (2:45 PM, Tuesday, November 8) in both the uterine lining and in the lesions of women with endometriosis. Homeobox genes play a major part in cancer and infertility. A better understanding of these genes could explain how and why endometriosis develops.
According to Linda G. Griffith, PhD, Director of the Center for Gynepathology Research at the Massachusetts Institute of Technology, who attempts to replicate human tissue as a research model for endometriosis in her lab, the disease probably has many causes, just as it has many manifestations. Dr. Griffith aims to initiate a discussion between surgeons and basic scientists in her keynote address (8:30 AM, Tuesday, November 8) that will reveal new research questions about the factors involved in endometriosis.
Griffiths comments: “Endometriosis is non-malignant, but it is far from benign. It can have devastating health consequences for a woman, such as losing a kidney or a section of bowel or becoming infertile. There is a continuum from benign to malignant, and our understanding of endometriosis at the molecular level may open opportunities to help us understand metastatic cancer, and vice versa.”
Cancer and endometriosis are very similar, both have endometrial cells that are able to migrate, vascularize and invade other tissues, some quite far away from the uterus. Griffiths explains: “Through cell and tissue engineering we can begin to understand the behavior of these cells, such as the pathways they follow and why. That will help us develop therapies targeted precisely at the sub-cellular factors that lead cells astray.”
Griffith and her team are developing research models that allow scientists to manipulate constellations of the factors involved in endometriosis, such as cytokines of the immune system, whilst observing their roles in the disease process.
Endometriosis can affect any pelvic or extra-pelvic organ and when it occurs beyond the reproductive organs it generally affects the bowel or bladder but it has also been discovered in atypical sites (Virtual Poster 414), like the lungs (Virtual Posters 406 and 418).
Excising deep and invasive endometriosis whilst preserving the health and functionality of surrounding organs can be extremely challenging, as can be seen by keynote speaker Grace M. Janik, M.C. Director of Reproductive Endocrinology and Infertility at St. Mary’s Hospital in Milwaukee, during her live telesurgery of a laparoscopic peritoneal resection of extensive endometriosis (9:00 AM, Tuesday, November 8). Dr. Janik will lead surgeons through the surgery and as the full extent of the disease reveals itself, she will discuss what steps have to be observed along the way, including a potential treatment of the bowel and urinary tract.
The sessions at the AAGL meeting provide training for the best strategies to eliminate endometriotic lesions with conservative methods. As part of a CME course a video will be shown, “Endometriosis Bowel Resection vs. Shaving,” (12:05 PM, Tuesday, November 8) where surgeons are challenged to judge whether to treat endometriosis that has infiltrated the bowel by removing the diseased portion of the bowel itself (resection) or with a more conservative technique that attempts to remove only the endometriotic cells (shaving).
The AAGL Special Interest Group on Endometriosis has designed a new classification system to accommodate the advances in understanding of the etiology, diagnosis and treatment of endometriosis.
Keynote speaker Mauricio S. Abrão, MD will introduce the new system (9:50 AM, Tuesday, November 8) and address the need for an improved classification system, which includes deep infiltrating endometriosis and pelvic pain for improving patient prognoses. He will also lead a specialized course, “Deep Endometriosis: Surgical Approach and Future Perspectives” (8:00 AM, Monday, November 7) that reviews contemporary approaches for deep endometriosis from diagnosis to treatment and explain the relationship between endometriosis and cancer.
By focusing on endometriosis, the 40th AAGL Global Congress aims to raise awareness about this ‘silent’ disease but also provides laprascopic surgeons with the opportunity to further enhance their skills in minimally invasive treatments.
The keynote session will be from 8:00 to 10:00 AM Tuesday, November 8, 2011, and offers the latest surgical insights in dozens of oral presentations, educational videos, surgical tutorials and poster sessions at the 40th AAGL Global Congress of Minimally Invasive Gynecology, November 6-11, 2011 at the Westin Diplomat in Hollywood, FL.
Written by: Petra Rattue