With over 13 years of experience dealing with complex endometriosis problems related to pain and fertility, The Endometriosis Clinic recognises that this disease affects all facets of a woman’s life, hopes, aspirations and achievements.
We understand that you need to be listened to carefully and empathetically, and so initial consultations are always booked for one hour as we have found that it usually takes this long to establish a rapport and trust, to really elucidate your story, worries and concerns, and to deal with them effectively.
We don’t pretend to have cures or answers to all problems but our success rates are high and risks low and we can usually find someone from the multidisciplinary team to take things forward even if we cannot do this ourselves directly. Many of the women who visit us have found this approach to be positive, frank, honest and a significant step forward from multiple previous attempts to get help.
As a result, we often attract women who have complex cases and have failed to get significant help despite often trying many times before (see our testimonials).
One Stop Clinic
Since many of the women who visit us have come from long distance either in the UK or from overseas we aim to gather enough information in one visit to be able to make meaningful decisions about care.
Initially this usually involves a telephone conversation or email with Mr Barton-Smith once you have expressed an interest in visiting us in order to find out a bit more about your situation and ascertain that you would not be wasting time or money in coming, and to explain some of the process that would be followed.
Most women have already had standard quality ultrasound scans that have been done by someone not capable of picking up deep infiltrating disease, characterising adenomyosis, or identifying other unusual causes of pelvic pain. Therefore, we arrange for the majority of women to have an ultrasound by world-expert in gynaecological and endometriosis scanning, Mr Davor Jurkovic, at the Gynaecology Ultrasound Centre on Harley Street, a five minute walk away, immediately prior to their consultation with Mr Barton-Smith.
If fertility is an issue, we usually need women to have had a test of ovarian reserve locally before coming and bring the result as this is an important part of the assessment. This needs one of either an Antral Follicle Count Scan or Follicle Stimulating hormone blood test done on day 2-4 of a period or an Anti-Mullerian Hormone blood test done at any time during the cycle.
If arranged in advance it is sometimes possible to have surgery, if needed, carried out within a few days of the assessment so that everything is managed in a single visit but we prefer to avoid this if possible to allow women time to consider the options.
In rare situations we can manage Skype consultations before visiting the clinic, if this is necessary, then the availability of meaningful diagnostic information needs to be available to make this work.
Many women who visit us have come by word of mouth and have complex issues that have not been resolved elsewhere. The combination of expert scan and hour consultation has been successful in identifying problems that have previously been overlooked and that we have subsequently rectified.
We are also finding that there are an increasing number of women who have rarer deeper pelvic neurological lesions, in areas such as the sciatic or pudendal nerves, that require more specialist assessment and management from the multidisciplinary team including MR neurography and nerve blocks for diagnosis and treatment (read more). Often these women have had minimal findings from conventional assessments and have been dismissed from care elsewhere.
Traditionally endometriosis surgery was done through large open incisions until the advent of laparoscopic (keyhole) surgery in the 1990s by pioneers such as Dr David Redwine in the USA, Professor Jeremy Wright in the UK and others in European centres. As technology has developed conventional laparoscopy has improved but still has limitations in precision, view and ergonomics.
In 2005 robot assisted surgery using the da Vinci Surgery System was introduced in gynaecology. Over 5 million robotic procedures how now been performed worldwide in a variety of disciplines.
The technology is ideally suited to complex endometriosis surgery and we believe it has halved the major complication rates from this kind of surgery in our experience. The Endometriosis Clinic has the most robotic experience of any UK centre for endometriosis and one of the largest experiences worldwide.
More information about robotic surgery and its advantages is available here
The argument between excision versus ablation as the best surgical treatment method for endometriosis has been, and still is, hotly debated. It is fair to say however, that many expert surgeons favour excision as it allows a full assessment of the depth of the disease and subsequent removal whilst protecting sensitive structures in close proximity.
The most recent evidence in a systematic review published by Mr Barton-Smith suggests that excision is more effective at relieving endometriosis pain than ablation. The problem remains that there are not a large number of excision surgeons capable of safely removing the disease even in the earlier stages.
We passionately believe that excision improves outcomes in terms of pain relief and risk of recurrence and advocate that women actively search out excision surgeons in order to receive the best care