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

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This European-originated technique enables personalized surgical planning and proper specialist involvement, replacing outdated diagnostic approaches with comprehensive pre-surgical imaging.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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Chapters

• 0:00 Introduction to Quick Connect
• 1:14 Prep Starts Now Sponsorship
• 2:47 Dr. Romero Explains Surgical Mapping
• 6:41 Specialized Imaging and Classification Protocols
• 8:21 Playground Activewear Sponsorship
• 9:20 Episode Wrap-up and Contact Information

Transcript

Speaker 1: 0:00

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect.

Speaker 1: 0:41

Today I'm joined by my guest, dr Romero Cabrera, who is a distinguished endometriosis excision specialist based in Mexico, with extensive expertise in diagnosis and surgical treatment of endometriosis. Dr Ram has earned a reputation for his innovative and patient-centered approach. His commitment to advancing the field of gynecological surgery, combined with his compassionate care, has made him a leading figure in the management of endometriosis. Dr Ram's work not only improves the quality of life for his patients, but also contributes significantly to the global understanding of this challenging condition. You know, one of the things that I've learned on this journey with endometriosis and chronic illness is that life likes to throw curveballs, like medical kind, the emotional kind, even the oh no, the power's out and the freezer's full of meal prep kind of curveballs, like medical kind. The emotional kind even the oh no, the power's out and the freezer's full of meal prep kind of curveballs. And if there's one thing that keeps me grounded, it's being prepared. That's why I'm excited to share something I personally love Prep starts now.

Speaker 1: 1:39

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Speaker 1: 2:17

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Speaker 2: 2:58

Of course it's not something that I create. It's something that we replicate in Mexico and now it's being replicated worldwide. Mapping of the endometriosis started in Europe, in France and in Italy. They found out that the radiologists who are used to see the endometriosis with the special protocols because everyone in the US have an MRI every hospital, every hospital has the best ultrasound. I can even assure you they have the best ultrasound of the rest of the world. But the problem is that the radiologist needs to go to a learning curve to see deep endometriosis. But we have to remember that endometriosis has to be subdivided in three types. Something is peritoneal. This is superficial. That is the one that is so little that even sometimes the human eye cannot see. Deep endometriosis is the one that is so little that even sometimes the human eye cannot see. Deep endometriosis is the one that infiltrates itself to other organs and that's the one we can see through special imaging studies and ovarian endometrioma. That is the one that's super easy to diagnose With a normal office ultrasound. You can see the chocolate cyst and then we can suspect endometriosis. Now in Europe and France, in Italy, they started seeing that the radiologists to see this every day have better sensibility. That means that the eyes can see better deep endometriosis than the normal radiology population and they started to see that if they go before the study to do a rectal enema and when they perform MRIs they put a rectal gel, a vaginal gel and some medication for the bowel to not move, then they can see better the disease. You get me. And with this, without going through surgery, they can diagnose if you have endometriosis, deep endometriosis in the bowel, in the bladder, in the diaphragm. So with this the surgeon can individualize the treatment and then get a special team of surgeons. If you have endometriosis in the diaphoregum, then we need a cardiothoracic surgeon and so on. If you have endometriosis in the bladder, a urinary surgeon. If you have endometriosis in the colorectal area, we need a colorectal surgeon. So in Italy and France they start doing something that is a high quality treatment. High quality treatment defines itself by doing a mapping of deep endometriosis.

Speaker 2: 5:09

The mapping of deep endometriosis is a specialized imaging study in which an expert in radiology that has a super long learning curve at least five to 10 years with a specialized protocol. That means with bowel gel, rectal gel, bowel inhibitory movement medication, with an MRI or if they are going to do an ultrasound. It's not a normal ultrasound, I will say to you. It's an algorithm in which we have to see the african, we have to see the appendix, the sesum, we have to see the full bowel. That's an abdominal ultrasound with a bowel preparation. And then we go to the transvaginal ultrasound and see not only the uterus and ovaries Because, remember, by definition endometriosis is outside the uterus. So we have the bowel, the bladder, the ureters and with this a true expert in imaging can send us a classification, a presurgical classification that it's mandatory worldwide. It's called the ANC classification In the US they are still doing something that it's an association for Reproductive Society of Medicine classification that divides the disease in stages, stage one to stage four.

Speaker 2: 6:18

Right now that classification is really old.

Speaker 2: 6:21

It's the one that my father used to use, because if they go under surgery and they classify you with a stage four, like they did with my sister, my sister will tell you oh, thank you very much, but that doesn't mean anything. That means that I have in every place. With the NCM protocol we can do the classification before surgery. That's mandatory and with this we can see if the disease is affecting the intestine, the bladder or other organs, and not only see if it's affecting, we can also see the size of the nodule, the length, the percentage of bowel affection. So with this we can plan the surgery before going in, because we'll never do again a laparoscopic diagnosis surgery without the mapping If they are going to do a laparoscopic surgery. The human eye cannot see through tissue, so if they enter and see everything attached to itself like a frozen pelvis, no surgeon, no surgeon worldwide, even the best surgeon in the world, even myself, if I go without a mapping, I cannot see the nodule because I can only see the superficial layers of the organs.

Speaker 1: 7:28

Now that we've talked about pre-surgical mapping and empowered you with the knowledge to make the best decision for your health, let's talk about something that's just as important comfort, because if surgery is in your future, comfort is key. But let's be honest, that doesn't mean we have to swap fashion for frump. That's where Playground comes in. Playground creates luxurious, sustainable activewear that's as stunning as it is comfortable. Their pieces transition seamlessly from the couch to casual outings, so you can feel confident and beautiful, whether you're recovering, running errands or heading back into your fitness routine, or sitting and recording a podcast. Every piece is meticulously designed gorgeous prints, a fit that feels like it was made for you, and premium fabrics that breathe, move. And last, and here's the best part, I've arranged for the highest exclusive discount for my listeners 20% off any products when you use my promo code EndoBattery, and a little inside scoop when you use that code code endobattery and a little inside scoop when you use that code, I do earn a small commission. It doesn't cost you anything extra, but it helps me keep bringing you the expert insights and conversations you count on here at Endobattery.

Speaker 1: 8:40

So say goodbye to bland, baggy recovery wear and hello to active wear that makes you feel like you again stylish, comfortable and empowered. Visit wearplaygroundcom and use my promo code, endobattery, to enjoy the upgrade you deserve. That's a wrap for this quick connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming. Send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.