The Division of Minimally Invasive Gynecologic Surgery (MIGS) at Duke Health partners with referring clinicians to provide a range of treatments that support the long-term health of patients with endometriosis. The approach is based on the patient’s needs and the complexity of their condition. Treatment typically includes a combination of surgery and hormonal suppression. The most common procedures include:

• Diagnostic laparoscopy
• Excision of endometriosis
• Ovarian cystectomy for patients desiring fertility preservation

Hysterectomy can be an additional option for qualifying patients. For patients with more complex diseases, Duke surgeons partner with colorectal surgeons and urologists to offer multidisciplinary care that supports the best possible outcomes. 

The first challenge, however, is ensuring that patients with endometriosis symptoms are recognized and appropriately diagnosed. Stephanie Lim, MD, MIGS surgeon, says that often, women experience years of painful, life-limiting periods before reaching a diagnosis. Many of them believed that their symptoms were typical menstrual discomfort and accepted the need to miss school, work, or important life events due to menstrual pain as usual. While some specific markers of disease can be seen using ultrasound or magnetic resonance imaging, Lim notes that laparoscopy and tissue pathology are the only ways to diagnose endometriosis definitively.

The MIGS division at Duke Health cares for patients at any stage of their endometriosis journey. Some are referred or self-referred due to suspicious symptoms. Others present after their ob-gyn performs a laparoscopy, demonstrating severe or complex disease that requires the expertise of the MIGS surgery team. 

“We meet patients and their referring clinicians wherever they are in the care process,” says Lim. “Clinicians should feel comfortable referring patients for a surgical consultation at any point in their endometriosis journey.” 

Specifically, consider referral for:

• Painful, life-limiting periods
• Unexplained infertility with a history of painful periods
• Surgical optimization before fertility treatments
• MRI or ultrasound findings demonstrating an endometrioma or bilateral endometriomas
• Concern for bowel or bladder involvement

Duke’s surgeons specialize in procedures to treat endometriosis, fibroids, and other complex conditions, all performed using minimally invasive approaches. The MIGS division is composed of fellowship-trained surgeons with extensive experience who are members of the American Association of Gynecologic Laparoscopists (AAGL). The team also trains the next generation of complex benign gynecologic surgeons through residency and fellowship programs. 

With the division’s high volume of cases and its dedication to high-quality evidence-based care for all patients, Duke’s MIGS team is poised to address complexities that may arise, especially during surgery. Specifically, Lim points to the team’s expertise and specialized training in the management of stage III-IV endometriosis, which includes large endometriomas and extensive adhesive disease.

Providing patient-centered and personalized care plans means helping patients achieve their long-term health and personal goals. 

“Referrers can think of us as colleagues who work collaboratively with them to provide medical and surgical consultation for patients whom they suspect have endometriosis,” Lim says. “Our goal is to help manage each person’s endometriosis and symptoms, both medically and surgically, to help them reach their goals while they continue seeing their own ob-gyn for routine care.”