Indian Centre for Endometriosis - ICE

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Indian Centre for Endometriosis - ICE ICE is an educational resource created to increase recognition about endometriosis and bridge the de

This is, in my view, one of the most valuable studies to come out of the IFEM Endo group.Why? 10 YEARS of follow-up.In e...
17/08/2026

This is, in my view, one of the most valuable studies to come out of the IFEM Endo group.

Why? 10 YEARS of follow-up.

In endometriosis surgery, we often debate techniques based on short-term outcomes, retrospective series and individual surgical philosophy. This study is different: patients with significant re**al endometriosis were prospectively followed for an entire decade after surgery in an expert endometriosis centre.

And the message is important.

We need to move beyond surgical “camps.”

It is no longer reasonable to say “I shave everyone” or “I resect everyone.”

A bowel endometriosis surgeon should be capable of all three techniques:

🔹 Re**al shaving
🔹 Full-thickness disc excision
🔹 Segmental bowel resection

The technique should be determined by the lesion and the ability to achieve appropriate complete excision — not by the surgeon’s limited repertoire.

And wait until you see the fertility results.

85.3% of women who wanted pregnancy conceived after surgery. Those results deserve serious attention when counselling patients about surgery versus proceeding directly to assisted reproduction.

10-year data changes the conversation.

📄 Long term outcomes of surgical management of re**al endometriosis: 10-year follow-up of patients enrolled in a randomized trial

Proud to be a co-author of this work.

Bowel endometriosis is not one operation.

There are three important surgical tools:

🔹 Shaving — removing the lesion while preserving the bowel wall where complete excision can be achieved.

🔹 Disc excision — removing a full-thickness portion of the bowel wall containing the disease.

🔹 Segmental resection — removing a segment of bowel and reconnecting it.

The question should never simply be:

“Do you shave or resect?”

The better question is:

Which technique is appropriate for THIS lesion?

Good endometriosis surgery requires the ability to make that decision intraoperatively — and the technical ability to execute all three.

This is what makes this study so valuable.

55 women. Significant deep re**al endometriosis. Followed for 10 years.

Long-term surgical data like this are extremely difficult to obtain.

The study didn’t just ask whether

“ROBOTIC SURGEON” IS A TITLE.VOLUME IS EVIDENCE.It has become remarkably easy to put “Robotic Surgeon” on a profile.But ...
16/08/2026

“ROBOTIC SURGEON” IS A TITLE.
VOLUME IS EVIDENCE.

It has become remarkably easy to put “Robotic Surgeon” on a profile.

But here’s the thing about robotic surgery:

The console keeps receipts.

It tracks your cases.
It tracks your operative time.
It tracks your procedure volumes.
It tracks the types of surgery you actually perform.

These numbers are difficult to argue with.

My console currently shows:

638 robotic cases
515 endometriosis resections
81% of my robotic practice is endometriosis surgery

And these are not 515 identical operations. They include ovarian disease, complex pelvic dissection, hysterectomy, colore**al involvement, low anterior resections and other advanced procedures.

Why does this matter?

Because complex surgery has a learning curve.

Experience comes from repetition.
Judgment comes from experience.
And difficult surgery requires both.

A surgeon who has performed 5 or 10 robotic cases and a surgeon who has performed hundreds are simply not at the same point on that learning curve.

Yet increasingly, I see the term “robotic surgeon” being used after minimal console experience — sometimes followed by attempts at extremely complex endometriosis surgery.

The consequences of that learning curve are not theoretical. Patients bear them.

So if you are considering robotic surgery, particularly for complex endometriosis, ask a very simple question:

“How many of these operations have you actually performed robotically?”

Not how many robotic courses they have attended.
Not how many certificates they have.
Not whether their hospital owns a robot.

How many cases have they personally operated?

And for complex disease, ask about their specific case volume, case mix and outcomes.

Robotic surgery is an extraordinary tool.

But owning access to a robot does not make someone an experienced robotic surgeon.

The title is easy to claim.
The numbers have to be earned.

Robotic surgery leaves a digital footprint.

Cases accumulate one operation at a time.

You cannot shortcut hundreds of hours at the console, hundreds of anatomical variations, difficult dissections, unexpected findings and intraoperative decisions.

The number has to be earned.

Thi

Manila. PSGE 2026.Bridging Innovation and Practice in MIGS. Then the keynote: Robotic Endometriosis Surgery — Friend or ...
22/07/2026

Manila. PSGE 2026.
Bridging Innovation and Practice in MIGS. Then the keynote: Robotic Endometriosis Surgery — Friend or Foe?

Three hats in two days:
Panellist. Keynote speaker. Video competition judge.

My answer: friend. But only if you build the programme, not just buy the machine.You’re not starting over. You’re starting higher.”
Your laparoscopic skill isn’t wasted on the console. It’s the foundation the console amplifies.

Enough about me. It’s about the team.

Finally — judging the young endoscopic surgical video competition. The standard was high. Genuinely high. The next generation of Filipino endoscopists is not waiting for permission.

This was a real case discussion from a recent society panel in the Philippines where I was an invited speaker — and I wa...
21/07/2026

This was a real case discussion from a recent society panel in the Philippines where I was an invited speaker — and I wanted to share it (anonymised) to raise awareness. 🧵👇
A woman was diagnosed with endometriosis at 30. By 39, she was at risk of losing both kidneys.
Not because it was missed — she was diagnosed early. But because a disease we already knew she had was never properly watched.
Here’s the part that keeps me up at night: the endometriosis creeping toward her kidneys caused no pain at all. The o***y hurt, the bowel hurt — so they got attention. The ureters stayed silent until her kidney function was already dropping.
Deep endometriosis around the urinary tract can be silent in up to half of cases. Up to a third already have reduced kidney function by the time it’s found. And this shouldn’t be a surprise we discover in an operating room years too late.
The fix isn’t a fancy new test. It’s discipline:
🔎 An ovarian cyst is a warning sign — map the deeper disease, don’t just remove the cyst.
🩺 In deeper disease, scan the kidneys at every review.
📅 Endometriosis is chronic — it needs ongoing follow-up, not one-off firefighting.
❤️ Less pain does not mean less disease.
If you or someone you love has endometriosis, please swipe through — and ask your doctor about the deeper disease, and about your kidneys.
Save this. Share it. It might change someone’s trajectory.
—
ChronicPelvicPain WomensHealth EndoWarrior Endowarriors EndometriosisSurgery MinimallyInvasiveSurgery Gynaecology Gynecology UrologyAwareness KidneyHealth WomensHealthMatters EndoAwareness PatientAdvocacy

Honoured to deliver the keynote address at EPOG 2026, Armed Forces Medical College, Pune. 🇮🇳Speaking on robotic surgery ...
25/06/2026

Honoured to deliver the keynote address at EPOG 2026, Armed Forces Medical College, Pune. 🇮🇳

Speaking on robotic surgery and advanced endometriosis surgery at one of India’s most prestigious medical institutions was both a privilege and a responsibility.

What made this invitation especially meaningful was the opportunity to contribute to the future of robotic gynecologic surgery within the Armed Forces Medical Services.

I’m incredibly proud that the Indian Centre for Endometriosis has been recommended as the training centre for this initiative. Even more special is seeing my current fellow, Surgeon Commander Devdutt Pitale, preparing to help establish robotic gynecologic surgery programs across Armed Forces hospitals, bringing advanced minimally invasive care to those who serve our nation.

Teaching has always been one of the most rewarding parts of my career. Knowing that this knowledge will ultimately benefit the brave men and women of our Armed Forces makes it even more meaningful.

My sincere thanks to the Department of Obstetrics & Gynaecology, AFMC, for the invitation, the warmth, and the trust.

Here’s to building the next generation of robotic surgeons.

🇮🇳

MedicalEducation SurgicalTraining Robotics Women’sHealth ProudMoment EndometriosisIndia DrMangs

Had the pleasure of participating in the Gynobotics webinar alongside an exceptional faculty, including Dr. Arnold Advin...
21/06/2026

Had the pleasure of participating in the Gynobotics webinar alongside an exceptional faculty, including Dr. Arnold Advincula, discussing some of the most challenging aspects of advanced gynecologic surgery.

I spoke on “Hysterectomy in Deep Infiltrating Endometriosis (DIE)”, focusing on surgical decision-making, technical nuances, and the realities of managing complex endometriosis cases. The session generated insightful discussions on balancing radical disease clearance with preservation of function and long-term patient outcomes.

My thanks to the organizers, moderators, fellow faculty, and everyone who joined the session and contributed to a stimulating exchange of ideas.

Continued education and collaboration remain essential as we strive to improve care for women suffering from endometriosis.

MedicalEducation Gynobotics DrMangs

Not all “meta-analyses” are automatically high-quality science.A recent paper comparing Dienogest vs combined oral contr...
03/06/2026

Not all “meta-analyses” are automatically high-quality science.

A recent paper comparing Dienogest vs combined oral contraceptive pills in deep endometriosis concludes that Dienogest performs better for pain suppression. While the direction of the findings may align with existing literature, the methodology behind the paper deserves closer scrutiny.

Some important concerns:
• Extremely high heterogeneity (I² approaching 80–90%)
• Mixing randomized trials with observational and retrospective studies
• Several studies classified as high risk of bias
• Poor standardization of surgery prior to postoperative medical therapy

Perhaps the biggest issue?

The paper does not adequately define the quality or completeness of surgery performed before hormonal suppression.

In advanced endometriosis, this changes everything.

A patient with:
• residual bowel disease,
• untreated parametrial disease,
• fibrosis around nerves,
• or incomplete excision

cannot be scientifically compared with someone who underwent complete multidisciplinary excision surgery.

Pain suppression does not equal disease eradication.

Dienogest absolutely has a role in carefully selected patients:
• symptom suppression,
• postoperative management,
• delaying surgery in selected cases,
• adenomyosis symptom control,
• fertility preservation strategies.

But no medical therapy should be interpreted as a replacement for proper excision surgery in advanced disease.

Scientific literacy matters.

Not all:
• guidelines,
• publications,
• or meta-analyses

carry the same scientific weight.

In endometriosis research, methodology matters just as much as conclusions.

ExcisionSurgery Gynecology WomensHealth EvidenceBasedMedicine MedicalEducation

Bangkok bound 🇹🇭 Honored to be part of the international faculty for the Thai-German Multidisciplinary Endoscopic Works...
16/05/2026

Bangkok bound 🇹🇭

Honored to be part of the international faculty for the Thai-German Multidisciplinary Endoscopic Workshop and RTCOG-SGMIS Joint Meeting 2026.

This week I’ll be teaching advanced cadaveric dissection focused on:
• Deep endometriosis surgery
• Bowel preparation
• Pelvic nerve identification
• Pelvic neurosurgery
• Vascular entrapments of the pelvic nerves

Also privileged to be delivering a keynote lecture on:

“Surgery for Deep Endometriosis and Vascular Entrapments of the Pelvic Nerves.”

Excited to share the stage with pioneers in minimally invasive gynecologic surgery from around the world.

MIGS CadaverWorkshop Bangkok GynecologicSurgery PelvicPain ICE

25/03/2026

When cyclical shoulder pain, period-linked pneumothorax, and diaphragmatic lesions appear together, they’re not three separate problems... they’re often one diagnosis hiding in plain sight.

Recognising the pattern is what prevents years of missed calls, repeat interventions, and unnecessary morbidity.

Have questions? Drop them in the comments.

Some cases remind you just how far this disease can travel before it is finally identified.Deep-infiltrating endometrios...
23/03/2026

Some cases remind you just how far this disease can travel before it is finally identified.

Deep-infiltrating endometriosis does not stay confined to the uterus. In advanced stages, it can extend into the organs that share the same pelvic space, quietly disrupting anatomy and function over the years. By the time many patients reach a specialist centre, the condition has already rewritten the body’s internal landscape.

What this case ultimately reinforces is a simple truth: the earlier endometriosis is recognised and referred to specialised care, the more options patients have.

Have questions about the case, our approach, or anything else? Drop them in the comments.

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Madhav Nivas, 8 Laburnum Road, Gamdevi
Mumbai
400007

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Monday 9am - 8pm
Tuesday 9am - 8pm
Wednesday 9am - 8pm
Thursday 9am - 8pm
Friday 9am - 8pm
Saturday 9am - 5pm

Telephone

+919820310483

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