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Dr Yamal Patel On Advancing Endometriosis Management

Dr Yamal Patel On Advancing Endometriosis Management

BY MAHAK DAGAR

Dr Yamal Patel, a distinguished and board-certified OB GYN in Nairobi has two decades of expertise in advanced women’s healthcare. Trained at PGIMER, India, he excels in advanced minimally invasive surgery (MIS) as an endometriosis and excision surgeon, coupled with advanced hysteroscopic expertise. Beyond his clinical practice, Dr Patel, as the immediate past chair of Kenya Society of Endoscopic Specialties (KESES), has significantly propelled the progress of endoscopic techniques in Kenya. As the director of a hospital, founding trustee of an initiative that provides free laparoscopic surgeries in rural areas and one of the founding members of Pan African Society of Endometriosis (PASE), he showcases his commitment to advancing the understanding and management of endometriosis on a broader scale.

Explain the conditions of endometriosis and adenomyosis?

Endometriosis is a condition where tissue similar to the lining inside your uterus grows outside of it, like on the ovaries, fallopian tubes or other organs. It can cause pain, especially during periods, and sometimes leads to fertility issues.

Adenomyosis is a condition in which tissue similar to the lining of the uterus grows into the muscular wall of the uterus. It can make your periods very painful and heavy, and in some cases, it can cause the uterus to become enlarged. It is commonly associated with endometriosis and has implications on pregnancy outcomes.

What inspired you to specialise in advanced minimally invasive surgery?

It started with seeing some of my close relatives and friends suffer from these conditions. This challenged me to undertake this journey for the betterment of the lives of these girls and women. I have the potential to significantly improve the quality of life for women with endometriosis and adenomyosis by utilising my skills to alleviate pain, preserve fertility and enhance overall well-being. Specialising in these conditions can lead to better understanding, diagnosis and treatment, promoting earlier intervention and improved patient outcomes worldwide.

How does excision surgery specifically target the treatment of the conditions and improve a patient’s quality of life?

Surgical treatment, when required, could be either diagnostic or operative, either radical or conservative, either ablative or excision, either complete or incomplete. Excision surgery involves carefully cutting out endometrial or adenomyotic tissue while preserving healthy tissue. This precision reduces the chances of recurrence compared to other methods like ablation. Excision is like uprooting the weeds compared to slashing them by the ablation route. By removing the abnormal tissue causing pain, heavy bleeding, and other symptoms, excision surgery can provide substantial relief, often leading to improved quality of life. For patients wishing to conceive, excision surgery can help preserve fertility by removing tissue that may be impacting reproductive organs, potentially increasing the chances of natural conception or success with assisted reproductive technologies It can reduce or eliminate the need for long-term medication use, such as painkillers or hormonal treatment, which can have side effects and impact overall well-being. Properly performed excision surgery can provide long-lasting relief, with many patients experiencing a significant reduction in symptoms for years after the procedure. This could avoid unnecessary repeat surgeries.

You are renowned for your expertise in conducting detailed Deeply Infiltrative Endometriosis (DIE) ultrasound scans. How do these scans aid in the diagnosis and treatment planning of patients?

Detailed DIE ultrasound scans (mainly TVS – transvaginal scan) are invaluable for diagnosing, categorising and planning the treatment of patients with endometriosis, especially deep infiltrating endometriosis. They can accurately identify the presence, location and extent of endometrial implants, including those deep within the pelvic cavity. The scans help surgeons plan the most appropriate surgical approach as they can assess the involvement of nearby organs which is crucial for planning surgery and minimising the risk of complications. For patients undergoing treatment, DIE scans can be used to monitor the progression of the disease and the effectiveness of treatment, allowing for adjustments to the treatment plan as needed. They help educate patients about their condition, providing a visual representation of the disease and helping them understand the rationale behind the recommended treatment plan. This helps patients take a collective and informed decision with the team.

As the director of 3rd Park Hospital, how significant is the existence of an endometriosis centre, the first in Kenya, in addressing the challenges faced by endometriosis and adenomyosis patients?

The centre facilitates early and accurate diagnosis of endometriosis and adenomyosis through specialised imaging techniques and expert evaluation, reducing the time to diagnosis and improving outcomes. Patients have access to a range of treatment options, including medical management, minimally invasive surgery, infertility management via multidisciplinary care.

It also facilitates research and innovation in the field, leading to advancements in diagnosis, treatment and overall care for patients with endometriosis and adenomyosis.

The hospital regularly undertakes training of MIS surgeons. This would help in propagating the expertise to more healthcare providers and hence allowing for a diverse option of care centres and providers for our patients.

In what ways is it possible to make endometriosis and adenomyosis treatment accessible and affordable to those who can’t afford it?

Governments can implement public health programs that provide subsidised or free treatment for endometriosis and adenomyosis, especially for low-income individuals. Establishing community health clinics that offer low-cost or free screenings and treatments, can help reach underserved populations. Having routine medical camps will aid in this screening to allow early diagnosis.The Government and private insurers can provide comprehensive health insurance coverage that includes treatment for endometriosis and adenomyosis, ensuring that more people can afford the necessary care.

Increasing awareness about endometriosis and adenomyosis can help women recognise symptoms early, leading to earlier diagnosis and treatment, which can be more cost-effective in the long run. Education in schools and in the media would really go a long way in this awareness program.

Investing in research and innovation can lead to the development of more affordable treatment options for endometriosis and adenomyosis. Utilising telemedicine services can help reach remote and underserved populations, providing them with access to specialist care without the need for travel.

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