Thomas P. Cacciola, MD, FACOG

Thomas P. Cacciola, MD, FACOG Board cert. ObGyn. Minimally Invasive Gyn Surgeon(MIGS), Endometriosis, Fertility sparing, postsđźš«advice

Preoperative planning is extremely important both for your understanding of the surgical plan, and for your surgeon. End...
05/02/2026

Preoperative planning is extremely important both for your understanding of the surgical plan, and for your surgeon. Endometriosis absolutely can be found with ultrasound and MRI. Combine imaging with your symptoms, and your surgeon should have a good understanding of how much disease is present and where it will be.

You need three things to find endometriosis on imaging - the right person doing the imaging, the right imaging protocol, and the right person looking at the images and interpreting them.

Your surgeon should have an understanding of the extent of endometriosis, what will be found and what will need to be done for your surgery. They should specifically talk about your surgical risks and how that varies from the average surgery. They should have an idea how long it will take. They should know what other specialty surgeons, if any, may be needed or will be needed for your surgery and plan appropriately for their involvement.

With any surgery, and especially with endometriosis, there are always unknowns. Often the full extent of disease is not entirely understood until the time of surgery, so there is obviously some variability to things. Ask your surgeon these questions, be an advocate for your own care, and if you need - get a second (or more) opinion.

Every surgeon has a team. No one can do absolutely everything. For endometriosis that team often includes gynecology, co...
04/01/2026

Every surgeon has a team. No one can do absolutely everything. For endometriosis that team often includes gynecology, colore**al or general surgery, urology, and thoracic surgery.

Some surgeons are more comfortable than others with some aspects of advanced disease and will do more without involving the team for every surgery. Some surgeries require some of the team. But all of us need other surgeons to successfully excise endometriosis completely.

I have the honor and privilege to work with some amazing surgeons on a routine basis. As we grow that group of surgeons is expanding. Without their collaboration and expertise your surgical experience and outcomes would suffer. Thank you for trusting us with your care.

Did you know that can involve the pelvic nerves? Endometriosis can involve the hypogastric and pelvic splanchnic nerve...
02/04/2026

Did you know that can involve the pelvic nerves? Endometriosis can involve the hypogastric and pelvic splanchnic nerves by (among others), which can lead to pain and urinary dysfunction. During excision surgery a surgeon’s careful attention to these nerves and meticulous care to spare injuring them has been shown to improve pain and voiding functions postoperatively. Ask if your surgeon utilizes a nerve sparing excision technique.

I cannot say this enough. By definition, endometriosis is not located in the uterus and removal of the uterus will not c...
12/09/2025

I cannot say this enough. By definition, endometriosis is not located in the uterus and removal of the uterus will not cure endometriosis symptoms. Surgical treatment of endometriosis via complete excision is the gold standard. Hysterectomy can be considered if childbearing is no longer desired, but is otherwise not part of the treatment. For that matter, oophorectomy (removal of the ovaries) is similarly not routinely done or offered either.

Hysterectomy is the cure for ADENOMYOSIS- but is only one of the treatment options that are available.

This is severe endometriosis. The first picture is the typical “kissing ovaries” - where deep infiltrating endometriosis...
08/27/2025

This is severe endometriosis. The first picture is the typical “kissing ovaries” - where deep infiltrating endometriosis has caused significant scarring and the ovaries are stuck to each other as well as to the back of the uterus - and in this case - along the back of the va**na, cervix, and the re**um.

“Freeing up the scar tissue” is a term I hear when patients have had surgery with surgeons who don’t do a lot of surgery for endometriosis. Freeing these structures so they are no longer stuck together does not address the endometriosis, does not improve pain, and doesn’t improve fertility.

The second picture is how we address endometriosis. The endometriosis has all been excised. The vital structures like the ureters and the pelvic nerves have been cleared of disease and meticulously preserved. The re**al disease has been shaved away. Normal anatomy has been restored. The ovaries have been freed and elevated temporarily to prevent them from becoming scarred to the side of the pelvis as healing occurs.

One of the most important and gratifying parts of my job is ensuring that the next generations of OB/GYN physicians is w...
08/04/2025

One of the most important and gratifying parts of my job is ensuring that the next generations of OB/GYN physicians is well trained, and able to provide the highest level of medical and surgical care when they leave to practice on their own. It was an amazing honor recently to receive the ACOG CREOG National Faculty Award for Excellence in Resident Education. Thanks amc_obgyn!

Happy Mother’s Day! May today be an excellent day with those you love!
05/11/2025

Happy Mother’s Day! May today be an excellent day with those you love!

Some days it’s quite beautiful here at Albany Med Health System. I’m grateful for the opportunity to work with some incr...
04/22/2025

Some days it’s quite beautiful here at Albany Med Health System. I’m grateful for the opportunity to work with some incredible people here doing some things that are not offered anywhere else in the region for our incredible patients!

amc_obgyn

To all my physician colleagues, I am grateful for all of you. Happy Doctors’s Day!
03/30/2025

To all my physician colleagues, I am grateful for all of you. Happy Doctors’s Day!

Excision of endometriosis is the standard of care for endometriosis surgery. It works better for pain and fertility than...
03/25/2025

Excision of endometriosis is the standard of care for endometriosis surgery. It works better for pain and fertility than ablation (burning). The goal is to cut out all visible endometriosis. The problem is that oftentimes disease gets left behind, which leads to recurrence of symptoms (or no change in symptoms after surgery). We are finding more and more that complete excision with a patient’s FIRST surgery leads to better resolution of symptoms, and that relief lasts for a longer.

Recognition of different appearance of endometriosis lesions, knowledge of anatomy and anatomic spaces, and experience in surgical technique help to provide the best possible outcomes. YOU deserve the best possible outcome.

Did you know?Minimally invasive gynecologic surgery can be a game-changer compared to traditional laparotomy. I see firs...
03/21/2025

Did you know?
Minimally invasive gynecologic surgery can be a game-changer compared to traditional laparotomy. I see firsthand how these advanced techniques bring tremendous benefits to patients. Utilizing robotic surgery, laparoscopy, and other less invasive procedures can lead to better outcomes.

Here’s why:
- âś… **Smaller incisions:** Less visible scarring and faster healing.
- âś… **Quicker recovery:** Get back to your life sooner, often within days instead of weeks.
- âś… **Reduced pain:** Smaller wounds mean less discomfort post-surgery.
- âś… **Lower morbidity:** Fewer complications, like infections or blood loss.

Your health and quality of life matter most. Always explore your options—minimally invasive techniques might just be the solution you've been looking for!

It’s and I have to highlight my wife, Karrah. She has been an incredible positive force in my life for more than a dec...
03/09/2025

It’s and I have to highlight my wife, Karrah. She has been an incredible positive force in my life for more than a decade, and is the most amazing woman I know. Thank you for who you are and everything you are! I love you!

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