QC Understanding Post-Op Imaging: What It Reveals About Your Endometriosis Surgeon

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Dr. Abhishek Mangeshikar shares critical insights on evaluating surgeon skill and the importance of comprehensive treatment for endometriosis. His expertise reveals that clean, meticulous surgical technique with respect for tissue significantly improves outcomes and reduces post-operative adhesions.

• Red flag if surgeon plans to "just remove the cyst" in a quick procedure
• Endometriosis cysts never exist as single entities—always accompanied by other disease
• Proper imaging should identify connections to surrounding structures
• Wait at least six months for post-operative imaging due to healing processes
• Original surgeon should review follow-up imaging to distinguish between fibrosis and disease
• Clean surgical technique with minimal bleeding significantly reduces adhesion formation
• "Tissue respect" approach leads to better outcomes than aggressive dissection
• Different bodies heal differently, affecting individual adhesion formation

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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.

(00:42):
Today we're honored to have DrAbhishek Mingashikar join us.
Dr Ming is a leadingendometriosis specialist and
minimally invasive gynecologicalsurgeon known for his
groundbreaking work at IndianCenter for Endometriosis in
Mumbai.
With expertise in advancedlaparoscopic and robotic
surgeries, he's dedicated toimproving care for those
battling this complex disease.

(01:03):
Let's dive in and get answersto the questions that matter
most to you.
How much can post-operativeimaging reveal about a surgeon's
skill?
Like, for instance, if imagesappear clean with minimal blood?
Does this indicate more of ameticulous surgery?
Or rather, should they focussolely on the immediate post-op

(01:23):
imaging?
Should patients prioritizecomprehensive preoperative
imaging and a surgeon's thoroughapproach to excision, or what
role does the post-operativefollow-up imaging play in
assessing outcomes, and how doestiming impact its accuracy?

Speaker 2 (01:39):
So there's a couple of things that this is a very
good question brings up a coupleof important points of things.
That this is a very goodquestion brings up a couple of
important points.
So one is before surgery, ifyour provider is telling you I'm
just going to go in and takethe cyst, I'll be in and out in
half an hour, big red flag.
So an endometriosis cyst neverexists as a single entity.

(01:59):
So there's always accompanyingdeep or peritoneal disease along
with a cyst.
So if somebody is just planningto remove the cyst, you're in
trouble.
The imaging is also quiteincomplete if the report of the
ultrasound or the MRI comes backjust describing a cyst.
So if they've not picked upthat it's stuck to say the

(02:20):
pelvic side wall or the back ofthe uterus or the uterus sacral
ligament, that's incompleteimaging.
So they need to do a betterlevel of ultrasound or MRI.
Then the next point is if youshould repeat imaging
immediately after surgery.
I don't think it's a good ideato do so immediately because you
have a lot of in the immediatepost-op period.

(02:42):
There's a lot going on, andeven in the late post-op period,
for at least a going on, andeven in the late post-op period
for at least a couple of months.
There's a lot of healing,fibrosis, whatnot going on
inside.
That can confuse some of thefindings.
I don't repeat imaging, atleast for six months or so, when
they see me at follow-up ingeneral, and I also ask them to
track symptoms during that kindof recuperative period.

(03:04):
So usually at the end of thatperiod when you do your scan
it's very important to assesswhat was there before versus
what's there now.
Yes, some healing can occur byfibrosis.
So it's very important for meas the surgeon to do the imaging
myself or at least read the MRImyself or do the ultrasound
myself.
So I know the areas that I'veexcised and if I find fibrosis

(03:28):
in an area, I know that, okay,I've already excised that part
and yes, there can be somehealing by fibrosis there.
It's not really the diseasethat was left behind or a
disease that has grown back orsomething like that.
So you were saying aboutadhesion prevention.
So there's a lot of talk aboutthat in surgery in general.
But endometriosis is known foradhesions and you know very

(03:50):
distorted anatomy.
So I think one of the mainfeatures of adhesion prevention
is how clean the surgeon is.
So I was discussing this withShanti Bowling a few days ago.
So we were like we both operatevery similarly.
So we're very clean, we're verymeticulous with catching even
like the tiniest bleeders, and Ithink that plays a big role not

(04:15):
in just the efficiency of yoursurgery but also minimizing
adhesions, because the lessblood and oozing you have in
your surgical field, the lessadhesions you're going to form.
And also this comes about byjust dissecting gently in
anatomical spaces.
You know having a lot of tissuerespect.
I watch a lot of surgery ingeneral because I have no life

(04:37):
other than that, and I see somecases.
You know where the surgeonslook like they're just angry
with the tissue and you knowtearing it apart, trying to get
space in between them.
But you have to kind of.
One of the important lessonsyou learn as a surgeon is like
you have to have tissue respect.
If you're kinder to it it'sgoing to kind of show you the

(04:58):
way forward and I think thoseare very important roles in
preventing adhesions.
Of course it's veryindividualistic, so everybody
heals differently.
So that also depends on thebody's tissue processes and
reactions to insults of surgery.
So those are the main thingsand then of course you have
industry driven lesionprevention barriers, which, you

(05:20):
know, nobody knows how it works,nobody knows what doesn't.
We just try them and see.

Speaker 3 (05:25):
Yeah, and definitely different surgeons have
different approaches with thatand like what they like and you
know that's individualized,which is important to talk to
your surgeon if it's importantto you I mean if that makes you
feel more confident in yoursurgery and talking to them,
it's important to be on the samepage.

Speaker 1 (05:44):
This Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, Send them inand I'll bring you the expert
answers.
And I'll bring you the expertanswers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
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(06:08):
Until next time, keep feelingempowered through knowledge.