Around the endometriosis patient, a disease with multiple faces and implications, it takes a joint effort from patients and doctors and the work of an entire team of doctors from different specialties. From diagnosis to treatment, from drug treatment to surgery, from allopathic therapies to complementary therapies, this pathology is multidisciplinary.

Which specialists are needed to treat patients with endometriosis?

First of all, the patient must be referred to a centre specialised in endometriosis, to a gynaecologist and surgeon who is also specialised, who knows the pathology, the effects of the disease and the complications that may occur, who knows how to coordinate a complex therapeutic pathway, offer solutions and refer the patient to the specialists she needs.

Right from the moment of diagnosis, a gynaecologist trained in this super-specialisation has an essential contribution to make, because a correct diagnosis starts from a correct anamnesis and a gynaecological examination supplemented by a very accessible and inexpensive means of imaging, transvaginal ultrasound, which carried out by a gynaecologist “with a trained eye” in endometriosis can provide sufficient data to initiate the optimal therapeutic path.

Once the diagnosis has been established, the gynaecologist will guide the patient towards choosing the optimal therapeutic path, and the best decision is to refer her to an audited and certified Centre of Excellence in the diagnosis and treatment of endometriosis.

Endomedicare Academy, Bucharest, Romania, coordinated by Professor Elvira Bratila, MD, PhD, is an internationally certified centre by EuroEndoCert and the European Endometriosis League at the highest level of expertise in the diagnosis, treatment and surgery of endometriosis, being the centre that laid the foundations for the training of the medical community in Romania in the education, guidance and therapeutic management of patients with endometriosis.

The medical teams in Romania have benefited from training in our centre starting from the diagnosis stage of the disease, to address the multidisciplinary team of the centre in complex cases, when endometriosis lesions require excision and in cases of deeply infiltrative endometriosis.

The medical teams in Romania have benefited from training in our centre, starting with the disease’s diagnosis stage. They now have access to the multidisciplinary team of the center for complex cases, when endometriosis lesions need to be removed, in cases of deeply infiltrative endometriosis.

It is very important that the surgical management of patients is done correctly and completely from the first surgery. This is what we call: “one-stop-shop surgery”, the eradication of endometriosis lesions in a single operation, so that patients do not undergo repeated surgeries with a high risk of recurrence.

Endometriosis specialist surgeon Elvira Bratila, MD, PhD, is the coordinator of Endomedicare Academy’s multidisciplinary surgical team, knowing this complex surgery and establishing the role of each team member in time and steps.

The specialized surgeon performs an integrative medical act, thoroughly understanding the anatomy of the pelvis as well as the innervation of the pelvis, ensuring a correct and rigorous excision surgery of endometriosis lesions, but with great finesse in preserving the nerve threads and structures that ensure normal sensitivity and reflexes, so the surgery is gentle and conservative and does not invalidate the patient post-surgery.

The colorectal surgeon Dr. Rubin Munteanu completes the team in surgical cases of deep endometriosis, in a surgery of territory that exceeds the pelvic area, extending to the bowel. The experience of the colorectal surgeon in complex EID surgery is very important, as colorectal surgery can mean resection of the rectum, shaving, colostoma – complications that endometriosis patients fear and whose risks are minimized when the team is trained in complex cases.

Urological surgeons Dr. Mircea Onaca and Dr. Gheorghe Nita join the team in complex cases in which endometriosis lesions extend to the urinary bladder, interventions at this level being optimally performed by integrating a doctor specialized in this area of expertise.

Anesthesiologist Dr. Gabriela Zugravu. The challenge for the anaesthesiologist in this surgery is twofold: to provide surgical comfort to the operating team throughout the procedure, which requires the use of hypnotics, analgesics and muscle relaxants, and on the other hand, to lessen the impact of the adverse effects of these substances on the patient.

Interventions in cases of deep, extensive endometriosis are highly complex, laborious and time-consuming. Perhaps more useful than estimating the duration of the whole procedure is to estimate the intermediate times during the procedure, so that the pace of anaesthetic administration is consistent with the course of the operation.

Our anaesthesiologist is present with our patients throughout the procedure. Her post-surgery presence is equally important to ensure the patient’s comfort and rapid recovery after surgery.

Specialist in assisted human reproduction. Because endometriosis often comes in tandem with infertility, more than 50% of patients need infertility specialists to make decisions about managing the disease and its impact on their reproductive future.

Professor Elvira Bratila MD, PhD, has the knowledge and experience in the management of infertility and infertility-producing gynaecological pathologies, providing patients facing infertility with a conservative therapeutic plan and personalised therapeutic guidance before and after endometriosis interventions.

It is essential that the gynaecologist specialising in endometriosis have knowledge of infertility and Assisted Human Reproduction/AHR. Sometimes the patient may need to consult an infertility specialist before surgery. There are numerous studies showing that the presence of endometriomas does not influence the results of IVF, so if surgery is not necessarily required, the gynaecologist will refer the patient to an RUA procedure, such as IVF, if the patient wants children. If the endometriotic lesions are extensive (cases of deep endometriosis), are strongly symptomatic or have a risk of spreading/increasing, the operation is necessary and the specialist surgeon, in agreement with the infertility specialist will guide the patient in a stepwise therapeutic plan to achieve the surgical object as well as a pregnancy planning, if this is a desirable goal.

Endomedicare Academy started in 2017 on this therapeutic mission with this “core team” – a multidisciplinary core which has been joined over time by doctors from different specialties – medical imaging, kinesiotherapy, psychotherapy, alternative therapies, etc.

We are open to discover what other facets this pathology may show us. We understand that we are facing a struggle on all fronts, and that our patients’ needs do not stop at a well-done therapeutic gesture, but it is an arduous road with ups and downs, in which we have chosen to accompany them and offer therapeutic solutions and 360 degree support.

We have surrounded ourselves with professionally and humanly valuable people and we always meet in a fertile exchange of opinion and in consensus towards the well-being of our patients.