New laser op to banish women’s monthly pain
MORE than 150,000 Irish women have endometriosis — but a new treatment that uses a beam of energy could help many of them trying to cope with chronic pain. Nursery teacher Lauren Toal, 27, was one of the first to undergo it, as she tells PAT HAGAN.
THE PATIENT
MY FREQUENT stomach pains started in 2012, when I was in my early 20s. I felt was a throbbing ache, slightly to the left of my belly button, and felt like there was something growing inside me.
I thought I’d overdone it at work, or had caught a virus. But after a few weeks I was in pain all day, every day, and over-the-counter painkillers didn’t help at all.
I work with toddlers and even getting up from the floor after playing with them was agony.
My social life also suffered because the pain meant I could not face going out with my friends. I went to my GP several times but was repeatedly told that it was probably irritable bowel syndrome and to avoid foods, such as spicy dishes, that might aggravate it. I was also prescribed stronger painkillers such as naproxen.
Nothing helped and I was having to regularly take time off work. After eight months of this I went to the GP once again and demanded a scan.
Weeks later I had an internal examination and an ultrasound scan of my abdomen revealed I had endometriosis — where cells from the womb grow elsewhere in your body. In my case it was quite severe in my ovaries.
The doctor said it’s a major cause of infertility, which really shocked me as I would like to have children one day.
In early 2014, I had keyhole surgery to remove the tissue growing in my ovaries but they couldn’t remove it all as it could have damaged them.
This meant I effectively still had endometriosis and the surgery provided hardly any relief at all. I asked to be referred to a specialist again but because I’d been discharged, I had to join the queue from the start.
SO I WAITED another nine months, during which time I was off work for long periods due to the pain and bleeding. This time, my surgeon recommended a new treatment called PlasmaJet — where they fire a fine beam of plasma (a type of energy) directly at the endometriosis tissue.
This is accurate enough to destroy the unwanted ‘extra’ cells on the surface of normal tissue, such as the ovaries, but does not penetrate deeply enough to cause harm to the healthy cells underneath.
It could mean they can remove more of the tissue that is causing problems and reduce the need for further surgery.
I was in so much pain that I was really keen to have it done — even if I was one of the first patients to have it. I underwent the procedure, which lasted more than three hours, in October last year.
Afterwards, there was some pain and I spent three days in hospital on strong painkillers.
But the PlasmaJet treatment was very successful and they managed to remove the excess tissue. I have been able to return to work but I still need painkillers most days, although far less than I did before.
Doctors told me it can take some people months to make a full recovery and even when the endometriosis is gone, there can still be neuropathic pain caused by damage to nerves.
Gradually I am gaining in strength and mobility and look forward to living a normal life.
THE SURGEON CHRIS HARDWICK is a consultant gynaecologist.
THIS condition affects one-in-ten women of reproductive age and is the most common complaint treated by gynaecologists.
Endometriosis develops when the tissue that would normally form the lining of the womb starts to grow in other parts of the body, such as the ovaries, bowel, bladder — even occasionally the spine, lungs or brain.
It behaves just like womb tissue, swelling and bleeding every month during a woman’s period.
That means endometriosis is often mistaken for painful periods and can go undiagnosed for years.
It causes pain because the blood the excess tissue produces has no way of leaving the body — unlike menstruation — and this triggers inflammation, pain and a buildup of scar tissue.
Mild to moderate endometriosis can be treated with anti-inflammatory painkillers, such as ibuprofen, as well as various forms of contraceptive used to suppress the release of oestrogen, which can otherwise promote tissue growth.
But more severe cases need surgery to remove the tissue. This usually involves keyhole surgery, under general anaesthetic, using a fine probe that generates an electric current (a treatment called diathermy) to burn it off.
Although this works well, one of the hardest things to treat is endometriomas — ovarian cysts formed as a result of endometriosis — because of the risk of the heat (up to 90C) damaging eggs in the ovaries that might affect a woman’s fertility.
Diathermy is effective but carries a relatively high risk of causing collateral damage, because it’s hard to control the depth to which the heat penetrates.
That’s where the PlasmaJet comes in particularly useful. It’s a mobile machine, with a hand-held probe — or wand — on the end.
It first emerged around ten years ago as a safer way to destroy unwanted tissue without damaging healthy cells.
It only targets cells on the surface of tissue and doesn’t penetrate into deeper layers.
This makes it more feasible to remove most, if not all, of the excess tissue.
Surgeons are able to be less ‘conservative’ in using it as they know they won’t end up doing even more damage, as might be the case with diathermy.
We give the patient a general anaesthetic and make two to four small incisions in the tummy before inserting a laparoscope — a small tube with a light and a camera on the end.
This sends images of the inside of the pelvis to a TV monitor so we can see what is going on.
At the press of a button, the PlasmaJet machine generates a bright beam of energy — similar to a Star Wars lightsaber — through the tip of the wand.
This energy is made up of argon gas and the jet of cold plasma only reaches room temperature.
It is generated by firing an electrical charge through argon gas to create nitrogen, oxygen and photons (particles of electromagnetic energy) that break apart membranes in endometrial tissue and destroy the cells themselves.
It is held about a centimetre above the area that needs treating and the gas is fully absorbed by abnormal cells on the surface of the tissue being removed — up to a depth of half a millimetre.
It takes just a few seconds to destroy a patch of abnormal tissue but because the very fine PlasmaJet beam only treats an area of 5mm at a time, the whole process can take several hours, depending upon how far the endometriosis has spread.
Five small studies in recent years looking at the use of PlasmaJet in endometriosis have found virtually no ‘thermal spread’ — where heat from the device travels beyond the treatment area and into healthy tissue, causing damage.
The treatment can be repeated if endometriosis returns.