QC: Pre-Surgical Mapping: The Critical Step Before Endometriosis Surgery

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Dr. Ramiro Cabrera explains how surgical mapping revolutionizes endometriosis treatment by allowing surgeons to visualize deep infiltrating disease before operating. This European-originated technique enables personalized surgical planning and proper specialist involvement, replacing outdated diagnostic approaches with comprehensive pre-surgical imaging.

• Endometriosis has three types: peritoneal (superficial), deep infiltrating, and ovarian endometriomas
• Only endometriomas are easily visible on standard ultrasound, while deep disease requires specialized imaging
• Surgical mapping uses special protocols including rectal gel, vaginal gel, and bowel preparation
• Expert radiologists need 5-10 years of experience to accurately detect deep endometriosis
• Modern ENZIAN classification provides detailed disease location instead of simple staging
• Mapping shows precisely which organs are affected and to what extent
• Pre-surgical knowledge allows assembly of the right surgical team (urologists, colorectal surgeons, etc.)
• Even the best surgeons cannot see through tissue without proper mapping
• No surgeon should perform diagnostic laparoscopy without first completing imaging mapping

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights Short, powerfuland right to the point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember

(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.

(00:41):
Today I'm joined by my guest, drRomero Cabrera, who is a
distinguished endometriosisexcision specialist based in
Mexico, with extensive expertisein diagnosis and surgical
treatment of endometriosis.
Dr Ram has earned a reputationfor his innovative and
patient-centered approach.
His commitment to advancing thefield of gynecological surgery,
combined with his compassionatecare, has made him a leading

(01:03):
figure in the management ofendometriosis.
Dr Ram's work not only improvesthe quality of life for his
patients, but also contributessignificantly to the global
understanding of thischallenging condition.
You know, one of the thingsthat I've learned on this
journey with endometriosis andchronic illness is that life
likes to throw curveballs, likemedical kind, the emotional kind

(01:23):
, even the oh no, the power'sout and the freezer's full of
meal prep kind of curveballs,like medical kind.
The emotional kind even the ohno, the power's out and the
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(02:07):
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Now let's dive in to learninghow to prepare for surgery with

(02:51):
surgical mapping.
Can you explain to us what ismapping?
What do you do for mapping?

Speaker 2 (02:58):
Of course it's not something that I create.
It's something that wereplicate in Mexico and now it's
being replicated worldwide.
Mapping of the endometriosisstarted in Europe, in France and
in Italy.
They found out that theradiologists who are used to see
the endometriosis with thespecial protocols because
everyone in the US have an MRIevery hospital, every hospital

(03:20):
has the best ultrasound.
I can even assure you they havethe best ultrasound of the rest
of the world.
But the problem is that theradiologist needs to go to a
learning curve to see deependometriosis.
But we have to remember thatendometriosis has to be
subdivided in three types.
Something is peritoneal.
This is superficial.
That is the one that is solittle that even sometimes the

(03:42):
human eye cannot see.
Deep endometriosis is the onethat is so little that even
sometimes the human eye cannotsee.
Deep endometriosis is the onethat infiltrates itself to other
organs and that's the one wecan see through special imaging
studies and ovarian endometrioma.
That is the one that's supereasy to diagnose With a normal
office ultrasound.
You can see the chocolate cystand then we can suspect
endometriosis.
Now in Europe and France, inItaly, they started seeing that

(04:08):
the radiologists to see thisevery day have better
sensibility.
That means that the eyes cansee better deep endometriosis
than the normal radiologypopulation and they started to
see that if they go before thestudy to do a rectal enema and
when they perform MRIs they puta rectal gel, a vaginal gel and

(04:28):
some medication for the bowel tonot move, then they can see
better the disease.
You get me.
And with this, without goingthrough surgery, they can
diagnose if you haveendometriosis, deep
endometriosis in the bowel, inthe bladder, in the diaphragm.
So with this the surgeon canindividualize the treatment and
then get a special team ofsurgeons.
If you have endometriosis inthe diaphoregum, then we need a

(04:51):
cardiothoracic surgeon and so on.
If you have endometriosis inthe bladder, a urinary surgeon.
If you have endometriosis inthe colorectal area, we need a
colorectal surgeon.
So in Italy and France theystart doing something that is a
high quality treatment.
High quality treatment definesitself by doing a mapping of
deep endometriosis.
The mapping of deependometriosis is a specialized

(05:11):
imaging study in which an expertin radiology that has a super
long learning curve at leastfive to 10 years with a
specialized protocol.
That means with bowel gel,rectal gel, bowel inhibitory
movement medication, with an MRIor if they are going to do an
ultrasound.
It's not a normal ultrasound, Iwill say to you.

(05:33):
It's an algorithm in which wehave to see the african, we have
to see the appendix, the sesum,we have to see the full bowel.
That's an abdominal ultrasoundwith a bowel preparation.
And then we go to thetransvaginal ultrasound and see
not only the uterus and ovariesBecause, remember, by definition
endometriosis is outside theuterus.
So we have the bowel, thebladder, the ureters and with

(05:56):
this a true expert in imagingcan send us a classification, a
presurgical classification thatit's mandatory worldwide.
It's called the ANCclassification In the US they
are still doing something thatit's an association for
Reproductive Society of Medicineclassification that divides the
disease in stages, stage one tostage four.

(06:18):
Right now that classification isreally old.
It's the one that my father usedto use, because if they go
under surgery and they classifyyou with a stage four, like they
did with my sister, my sisterwill tell you oh, thank you very
much, but that doesn't meananything.
That means that I have in everyplace.
With the NCM protocol we can dothe classification before

(06:41):
surgery.
That's mandatory and with thiswe can see if the disease is
affecting the intestine, thebladder or other organs, and not
only see if it's affecting, wecan also see the size of the
nodule, the length, thepercentage of bowel affection.
So with this we can plan thesurgery before going in, because
we'll never do again alaparoscopic diagnosis surgery

(07:05):
without the mapping If they aregoing to do a laparoscopic
surgery.
The human eye cannot seethrough tissue, so if they enter
and see everything attached toitself like a frozen pelvis, no
surgeon, no surgeon worldwide,even the best surgeon in the
world, even myself, if I gowithout a mapping, I cannot see
the nodule because I can onlysee the superficial layers of

(07:26):
the organs.

Speaker 1 (07:28):
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(08:56):
That's a wrap for this quickconnect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming.
Send them in and I'll bring youthe expert answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact

(09:18):
at endobatterycom or visitingthe endobatterycom contact page.
Until next time, keep feelingempowered through knowledge.