On August 27, 2013 Dr. Levey presented a webinar on on endometriosis resection in women with chronic pelvic pain. He highlighted the use of indocyanine green. Dr. Levey is the first to have used this advance technology for diagnosing endometriosis intraoperatively. The webinar can be found on you tube by clicking here.
Our director, Dr. Kenneth Levey will speak and present techniques is robotic surgery and endometriosis removal to an international audience at UCLA’s David Geffen School of Medicine. He will be presenting techiques in robotic hysterectomy as well as proper patient selection. He will also be presenting groungbreaking techiques in endometriosis resection using the daVinci robotic surgery platform. Click here for a link to the course brochure.
We are excited to announce the launch of our brand new website http://www.nycomprehensivewomens.com
The new website is designed to give patient essential information about our practice location @ 18 east 41st Street.
Our new location will offer women the convenience of a great location and the straightforward hassle free service required fit your women’s health visit into your busy day. Patient will continue to be able to access our award winning patient portal in order to communicate with their physician, request prescriptions and schedule appointments.
So, I have said this before and I will say it again and again and well, I guess again.
Endometriosis is a common disease. It causes infertility, inflammation, painful intercourse, painful periods, bladder problems, pelvic floor problems and bowel problems among others.
I always have to ask the question – why, if so many women have endometriosis do they not all have pain?
That’s correct – not all women with endometriosis have pain. As a busy gynecologic surgeon I frequently see endometriosis (and prove it with a biopsy) in women who are having surgery for other problems such as fibroids and cysts. They may have no pain complaints but they definitely have endometriosis.
The general answer to the question is that different people have different thresholds for pain. Pain in and of itself is a complex disease. We are just beginning to scratch the surface in our understanding of pain as a disease. So, rather than focus on endometriosis, when present,as the sole disease in a women with pelvic pain I believe it is important to treat endometriosis as a critical pain generator in such patients.
This way of thinking allows me to treat endometriosis and at the same time consider underlying pain mechanisms in a patient in whom not all pain may be accounted for by endometriosis. This way of thinking allows me to manage women with much more complex pain problems than simply managing endometriosis would allow. Further, it guides my understanding of the best way to intially manage endometriosis.
If endometriosis is thought of as a pain generator that over a long period of time can effect the way the central nervous system (brain and spinal cord) views and handles pain signals then one must come to the conclusion that the best way to manage such a pain generator is to remove it. A poor way to manage such a pain generator is to put a hormonal band aid (such as lupron) on it and expect great long term results.
So, in my practice I have become a nationally recognized expert at removing endometriosis. I call the procedure a fertility sparing (for women who wish to retain their fertility) radical resection of endometriosis. During this procedure I remove all visible areas of endometriosis. In doing so, I go all the way to the root of the endometriosis lesions. I sometimes have to remove endometriosis from the ureter and sometimes from the bowel and areas in between the vagina and rectum. Sometimes the endometriosis is so severe that I call in a colorectal surgeon to remove a portion of bowel.
Having said all of that here’s my advice in choosing an expert to manage your endometriosis and pelvic pain:
1. Choose someone who has advanced skills in laparoscopic and robotic laparoscopic surgery. Generally, people who focus on gynecology and gynecologic surgery only may be qualified. Ask your surgeon is he or she is able to perform the surgery as described above.
2. Choose someone who understands and can manage all the aspects of pain associated with endometriosis. If your surgeon says, “I only do removal of endometriosis” then it is likely he will miss other pain issues that will crop up later. This single modality approach almost never works for long term relief.
3. Choose a doctor who isn’t afraid to explore the possibilities and work with doctors in other specialties. Pain is a problem that can effect your entire body and multiple systems. Just because you have endometriosis – this does not have to be your only problem. To treat patients with endometriosis as if it the only problem is too narrow and poor practice of medicine.
4. Choose someone who takes your insurance. There are several qualified surgeons across the NY area who can manage these problems effectively. There is no reason to shell out more than $20,000 when you can do it for a $15 copay. Arguably, the surgeons such as myself who do take insurance carry a higher level of ethics (because we are not in it for the big money) and are more experience because we see more patients.
I wish you the best of luck in your search for relief from your pain. Please feel free to visit our website -
Dr. Levey will be presenting an innovative and cutting edge lecture on the management of complicated cases of chronic pelvic and endometriosis. The lecture will take place on May 8th, 2012.
As a very busy surgeon who sees a high volume of women with fibroids I often get referrals for women in their late 40′s who have completed childbearing with large fibroids. Many of these patients, the patients I am specifically referring to in this post, have completed childbearing and expressly no longer desire to have additional children by either natural or assisted reproductivetechnologies. A lot of these patients present requesting to have a myomectomy.
A myomectomy is a procedure performed for the removal of fibroids. This is a procedure that in most cases can be performed laparoscopically with advanced robotic technology. This sounds simple doesn’t it? So, why do I find myself in my office counseling most of these patients that the best and safest surgery for them is a hysterectomy (remember – a hysterectomy does not mean removing the ovaries)?
I have no desire to remove a woman’s uterus if it is not necessary. I have built my practice on allowing my patients to choose from a menu of options. It is not about money because I certainly do not get paid more to do a hysterectomy. And it is certainly not about my enjoyment of surgery because a difficult myomectomy is far more interesting to me than a hysterectomy. So, what’s the story?
This all comes down to one very important concept in surgery and surgical decision making – RISK VERSUS BENEFIT.
In performing a myomectomy on a large uterus with multiple fibroids (evenif it is done with an open technique) there can be very large amounts of blood loss. Is it really worth the risk of massive blood transfusion, possible transfusion reaction, hypovolemic shock, blood transfusion associated infections, possible need for an intensive care unit stay just to perform a procedure that saves an organ with no future value (ie childbearing)? I don’t think so and I think most of my patients agree.
In performing a myomectomy on a large uterus with multiple fibroids there can be at least double the infection risk for post-operative infections versus a hysterectomy. Is it really worth the risk to have to possibly go back to the operating room for repeat surgery, abscess drainage, prolonged hospital stay, prolonged IV antibiotics and possible need for hysterectomy to treat the infection? I don’t think so.
So, when we are counseling you to have a hysterectomy instead of a myomectomy and you have no desire to have children in the future – it is for your safety and benefit.
Please feel free to email me with any questions – firstname.lastname@example.org. I am happy to review your imaging and set up a phone / video consultation or see you in the office to find the best way to manage your fibroids.
More on Endometriosis
Periodically I share new and relevant information about common deseases, treatments, and cures with my patients. I normally share this information by sending out an email to our confidential email list. However, the 2 articles I will discuss today present information that is very new so I thought it was important to share with all. Read the rest of this entry »
So, we work with a fantastic acupuncturist here is the office and I asked him what we could do to raise awareness of some of the ways in which acupuncture could possibly help women with various gynecologic conditions. The items below are for you information and were written by Robert Branch. He has over 20 years of experience in acupuncture and traditional Chinese medicine. I trust him to help you and welcome him into the fold of my network of specialists. Read the rest of this entry »
It’s not a new idea to me that patients sometimes balk as treatments they have never heard of or don’t believe in.
Read the rest of this entry »