Centre Of Excellence in Advanced Grade IV Endometriosis
Centre Of Excellence Overview
Specialised Care Unit
CENTRE OF EXCELLENCE IN ADVANCED GRADE IV ENDOMETRIOSIS
Advanced Laparoscopic Management of Complex, Deep Infiltrating & Extra-Pelvic Endometriosis
At Sunrise Hospital, New Delhi, we offer specialised care for women with advanced, deep infiltrating and complex endometriosis, including disease involving the bowel, ureter, bladder, pelvic sidewall, abdominal wall and pelvic nerves.
Led by Dr. Nikita Trehan, internationally recognized for her expertise in advanced gynaecological laparoscopy, our endometriosis programme combines detailed pre-operative assessment, advanced imaging, minimally invasive surgery and comprehensive post-operative care.
Our Team Of Doctors
A dedicated multidisciplinary surgical team collaborating to deliver world-class clinical outcomes in complex, severe and deep infiltrating endometriosis.
Dr. Pooja Garg
Consultant Gynaecologist & IVF Specialist
Dr. Sanjay Verma
Minimally Invasive Bowel & Colorectal Surgeon
Dr. Sadiya Naqvi
Consultant Gynaecologist & Endometriosis Care
Dr. Asad Ahmed
Specialist in Minimally Invasive Pelvic Surgery
A Centre Dedicated to Complex Endometriosis
Endometriosis can range from superficial lesions to extensive Grade IV and deep infiltrating disease that significantly alters normal pelvic anatomy.
Advanced Endometriosis May Involve:
Such cases can be technically challenging and may require meticulous dissection around vital organs, blood vessels, ureters and nerves. At Sunrise Hospital, complex cases are approached with detailed anatomical planning and advanced laparoscopic techniques, with treatment tailored to the patient's symptoms, extent of disease, fertility goals and previous surgical history.
Excellence in Grade IV Endometriosis
Managing the Most Complex Forms of Pelvic Endometriosis
Grade IV endometriosis may be associated with extensive adhesions, ovarian endometriomas, obliteration of the posterior cul-de-sac and involvement of the bowel, ureters, bladder or pelvic sidewall. Surgical treatment of such disease requires expertise in advanced pelvic anatomy and minimally invasive surgery.
Our Comprehensive Surgical Approach May Include:
The objective is not simply to remove visible lesions. It is to understand the entire extent of disease, restore anatomy as safely as possible and address the patient's long-term health and reproductive goals.
Pioneering Surgical Technologies
Advanced 3D Laparoscopy & ICG
Precision matters in complex endometriosis.
Sunrise Hospital is equipped with advanced 3D laparoscopic technology, providing enhanced depth perception and visualisation during complex minimally invasive procedures.
For selected procedures, Indocyanine Green (ICG) fluorescence technology assists intra-operative visualisation of vascular and anatomical structures, particularly valuable when operating in anatomically distorted pelvises where critical structures are obscured by dense adhesions.
CO₂ Laser for Advanced Endometriosis
Precision treatment for selected endometriotic lesions.
Advanced energy technologies, including CO₂ laser, may be used in selected cases of endometriosis where precise tissue treatment is appropriate.
CO₂ laser technology offers highly controlled tissue interaction and can be incorporated into a carefully planned laparoscopic approach. At Sunrise Hospital, the emphasis remains on appropriate patient selection and disease-specific surgical planning.
Organ-Specific Advanced Management
Ureteral Endometriosis
Protecting the urinary tract in advanced pelvic disease
Deep endometriosis may involve or compress the ureters, potentially causing narrowing and, in severe cases, obstruction of urinary flow. Management may require meticulous identification and mobilisation of the ureter during laparoscopic surgery.
The primary objective is to achieve disease control while protecting the ureter and preserving renal function.
Bowel Endometriosis
Advanced management of intestinal involvement
Bowel endometriosis can occur in patients with deep infiltrating disease and may involve the rectum, sigmoid colon or other portions of the bowel.
Patients may experience:
- Severe cyclical pelvic pain
- Pain during bowel movements
- Bloating and bowel symptoms
- Constipation or diarrhoea
- Deep pain during intercourse
- Difficulty conceiving
Management depends on the depth and extent of bowel involvement. Selected patients may require advanced laparoscopic techniques including shaving, disc excision or segmental bowel resection, with multidisciplinary surgical planning.
Sciatic Nerve Endometriosis
Expertise in rare and anatomically challenging disease
Sciatic nerve endometriosis is a rare manifestation of deep endometriosis that may cause cyclical sciatica-like pain, buttock pain, altered sensation or weakness. Because symptoms can resemble spinal or neurological disorders, diagnosis requires careful clinical assessment and appropriate imaging. Where surgery is indicated, meticulous identification of the affected anatomy and preservation of neurological structures are fundamental principles.
Scar Endometriosis
When endometriosis develops in a previous surgical scar
Scar endometriosis, particularly after caesarean delivery, can present as a painful lump or swelling near a previous abdominal scar, with symptoms becoming more prominent during menstruation. Treatment generally involves surgical excision of the affected tissue. Larger or deeper lesions may require reconstruction of the abdominal wall.
Deep Infiltrating Endometriosis Across Compartments
Deep infiltrating endometriosis can affect multiple pelvic compartments simultaneously. The management of such disease requires an understanding of the entire pelvic anatomy, rather than treating individual lesions in isolation.
Anterior Compartment
• Urinary Bladder
• Vesicouterine Space
Lateral Compartment
• Pelvic Sidewall
• Ureter
• Parametrium
Posterior Compartment
• Uterosacral Ligaments
• Rectovaginal Space
• Rectum & Sigmoid Colon
Extra-Pelvic Locations
• Abdominal Wall
• Previous Surgical Scars
• Nerve-Related Locations
Lead Surgeon: Dr. Nikita Trehan
Dr. Nikita Trehan
Advanced Gynaecological Laparoscopic Surgeon
Dr. Nikita Trehan is an internationally recognised gynaecological laparoscopic surgeon with extensive experience in advanced and complex minimally invasive gynaecological surgery. At Sunrise Hospital, she has developed world-class expertise in managing challenging laparoscopic cases, including advanced endometriosis and complex pelvic pathology.
Her Surgical Work Encompasses Advanced Procedures Involving:
Why Choose Sunrise Hospital for Advanced Endometriosis?
Specialised Expertise
Dedicated experience in advanced and complex gynaecological laparoscopic surgery.
Advanced 3D Laparoscopy
High-definition 3D visualisation to support precision during complex minimally invasive procedures.
ICG-Assisted Visualisation
ICG fluorescence technology available for enhanced intra-operative vascular and anatomical mapping.
CO₂ Laser Technology
Advanced laser technology available for appropriately selected endometriosis procedures.
Complex Pelvic Surgery
Experience managing disease involving difficult anatomical areas including ureter, bowel, sidewall and nerves.
Fertility-Conscious Approach
For women wishing to preserve or pursue fertility, surgical planning takes reproductive goals into consideration.
Individualised Treatment
No two cases are identical. Treatment is tailored to symptoms, disease distribution and reproductive history.
Comprehensive Hospital Support
Advanced OR infrastructure, 24/7 anaesthesia, ICU facilities, pathology and diagnostic imaging under one roof.
Our Complex Endometriosis Clinical Expertise
We routinely evaluate and manage the full spectrum of severe pelvic and extra-pelvic disease:
Grade IV Endometriosis
Extensive and severe pelvic disease with distorted anatomy and dense adhesions.
Deep Infiltrating Endometriosis
Disease involving deeper pelvic structures and retroperitoneal organs.
Bowel Endometriosis
Rectal and intestinal involvement requiring specialised surgical planning.
Ureteral Endometriosis
Disease affecting or surrounding the ureter with hydronephrosis risk.
Bladder Endometriosis
Endometriosis involving the urinary bladder and vesicouterine fold.
Scar Endometriosis
Endometriosis involving previous abdominal or caesarean surgical scars.
Sciatic Nerve Endometriosis
Rare nerve-related disease presenting with cyclical sciatic symptoms.
Ovarian Endometriosis
Endometriomas (chocolate cysts) and associated pelvic adhesions.
Severe Pelvic Adhesions
Extensive adhesions causing frozen pelvis and distorted anatomical planes.
Recurrent Endometriosis
Persistent or recurrent disease following previous unsuccessful surgery.
A Holistic Approach to Endometriosis
Endometriosis is not only about a lesion seen on a scan. It can deeply impact multiple dimensions of health:
Therefore, our approach considers the complete clinical picture. Treatment may involve:
Your Journey at Sunrise Hospital
Step 1 — Comprehensive Evaluation
Detailed history, clinical examination and meticulous review of previous investigations and surgeries.
Step 2 — Mapping the Disease
Appropriate advanced ultrasound and/or MRI mapping to pinpoint the location and depth of deep infiltrating disease.
Step 3 — Individualised Surgical Planning
The surgical strategy is customized according to disease distribution, symptoms, fertility objectives and prior interventions.
Step 4 — Advanced Minimally Invasive Surgery
Where surgery is indicated, advanced 3D laparoscopic techniques are utilized to excise disease while meticulously protecting vital pelvic organs.
Step 5 — Recovery & Follow-up
Structured post-operative care, rehabilitation and long-term surveillance planned around the patient's holistic health.
When Should You Consult an Endometriosis Specialist?
Seek specialist evaluation if you experience any of the following symptoms:
Advanced Endometriosis Care at Sunrise Hospital
Complex endometriosis requires more than identifying a lesion and treating it. It requires an understanding of pelvic anatomy, disease behaviour, fertility goals and the individual needs of every woman. At Sunrise Hospital, our Centre of Excellence brings together world-class laparoscopic expertise, cutting-edge technology and compassionate care.
When endometriosis is complex, experience and precision matter.
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