Endometriosis is the second most common Gynaecological condition for women in the UK, and Liverpool Women’s Hospital is providing better treatments and experiences for women with the help of robotic surgery.
Endometriosis is a chronic condition affecting a significant number of women of reproductive age (1 in 10) and develops by forming growths of endometrial tissue (lining of the womb) in areas such as the ovaries, fallopian tubes, pelvic walls, bowel, ureters and/or bladder.
Michelle, 43 from Liverpool first started to experience symptoms of endometriosis in 2016. The severe bowel issues that she was experiencing at the time meant that she was often taking time off from her busy job as a teacher. Her symptoms also had a huge impact on her personal life, robbing her of intimacy with her late partner, Craig, in the few months before his sudden death.
After being referred, her surgeon at the time suspected she might have endometriosis cysts or even ovarian cancer – the possibility of cancer caused Michelle a lot of worry and anxiety.
Michelle said: “The guy doing my first internal scan said, ‘oh yeah, I can see a mass’. In those moments where I was getting changed, I just assumed I had cancer. Those few minutes were horrific.”
An endometriosis diagnosis didn’t come into play until Michelle met her current surgeon, Manou Manpreet Kaur, Consultant Gynaecological Surgeon and Robotic-assisted Surgery Lead at Liverpool Women’s Hospital, in April 2021.
“I felt pleased that there seemed to be a solid reason for what I was experiencing, and I was able to put the pieces together as soon as Manou mentioned the bowel symptoms.”
Due to the infiltration of her endometriosis on the bowel and on the surface of her bladder, detected through an MRI scan, Michelle was told that she would need to undergo complex surgery to treat her endometriosis. Given that she wasn’t planning on having children in the future, it was then decided that Michelle could undergo a full hysterectomy. Despite having mixed feelings about the surgery, Michelle felt overwhelmingly positive that she was finally going to be receiving the right treatment that would enable her to get her life back.
"I didn’t know you could do major surgery through keyhole. When Manou told me about the robot, I thought about her and the robot and felt very reassured. I was looking forward to having the operation rather than dreading it.”
Michelle underwent robotic-assisted surgery for her endometriosis on the 2nd of December 2021 and was discharged from the hospital a few days later.
Manou, who performed Michelle’s surgery, said: “Michelle had quite severe stage endometriosis – in the most generic terms ‘stage 4’. Prior to planning the type of surgery, the patient’s case history and findings from clinical examination are discussed by a multidisciplinary team, together with the images obtained from scans such as an MRI pelvis. This enables us to predict the extent of surgery.
“Michelle had a large amount of endometriosis, both superficial and deep infiltrating, some of which was not possible to see on MRI images. It took us several hours to complete her individual case, which was joint case with a colorectal surgeon colleague, Mr S. Ahmed. Despite a long surgery, she made a remarkably quick recovery and was sitting upright in her chair the next day without any issues eating or drinking.”
Linda, 42, also from Liverpool, has a family history of endometriosis, with her mum and other members of her family all having suffered from the same problem, so when she started struggling with her periods, she knew that she was following in their footsteps. Despite this knowledge, getting the correct diagnosis from a doctor was all but easy for Linda.
Linda said: “I was told that endometriosis doesn’t run in families. There were times where I couldn’t stop sobbing because I felt like I was being stabbed – but I just got prescribed more painkillers. I was at the stage of collapse when I was finally diagnosed.”
After Linda received her diagnosis, she then had her first child, easing her symptoms for approximately two years. But following the birth of her second child, the condition came back with a vengeance shortly after she stopped breastfeeding, and she was diagnosed with stage 4 endometriosis.
“I tried all sorts to deal with the pain, including the pill, but nothing agreed with me – I just learned to live with it.”
After her fourth baby, Linda lost her dad and was diagnosed with post-natal depression, only exacerbating her struggle with her endometriosis.
“My mental health would coincide with my periods. I was on medication for that, but I just couldn’t cope.”
Linda was then referred to Liverpool Women’s Hospital, where she met Manou. It was there that she found out that she was suffering from premenstrual dysphoric disorder and endometriosis, and that her endometriosis had spread to the area between her rectum and uterus, causing it to fuse together, which explained the bowel pain she had been experiencing.
Together, Linda and Manou decided that surgery was the best way forward for her endometriosis. The surgery was performed robotically.
“I felt amazing after my surgery. Compared to my c-sections, where I was awake and felt groggy, this was so different. Following my recovery, I went swimming for the first time and found that I could stretch my body and elongate my torso – everything felt so stuck together before. I’m still finding new things I wasn’t able to do before the surgery. I feel so lucky. It’s made such a difference to the family.”
Manou added: “Linda went home the following morning after her surgery and made an excellent recovery. At her postoperative review, she was feeling much better with regards to her overall pain symptoms, only now and then experiencing a twinge in her bowel, which was significantly less than her previous pain.”
The introduction of the da Vinci Robot at Liverpool Women’s Hospital has enabled teams to evolve their knowledge and skills. Manou said: “I have seen my colleagues being robotically trained and quickly evolving their learning curve. Our anaesthetic and theatre staff also made big leaps of progress in terms of their knowledge and skillsets with the da Vinci surgical system in comparison to a year ago – it’s impressive to witness.”
The system has been in place at the hospital for over 12 months, providing an alternative procedure for Gynaecology patients, and they are reaching the 200 milestone for cases performed.
Gary Price, Chief Operating Officer, added: “Robotic assisted surgery is making a big difference to our patients. We are really pleased to have the da Vinci robot at Liverpool Women’s Hospital. We have had the robot for just over a year, as well as improving and shortening recovery times after procedures for patients, the robot has also provided an opportunity for our staff to use cutting edge treatment and technology helping to provide a better experience for our patients.”
A woman who is suffering with endometriosis can experience the following symptoms:
- Premenstrual pain
- Painful periods
- Pain on passing stool or change in bowel habit only on a period
- Pain on passing urine only on a period
- Subfertility with one of these symptoms above
- Lower back pain/ bloatedness with one of the symptoms above
If you are experiencing any of these symptoms and have been doing so over a course of a few months you should visit your GP to look at how you can be helped. Start to keep a regular diary, this will help to identify, also include any abnormal changes to your stool consistency.