Led by Dr. Vasilev, an internationally recognized integrative excision surgeon, our team uses a very special combination of minimally invasive robotic surgery, precision medicine based on molecular sciences and holistic integrative healing.
Dr. Vasilev has been nationally listed in, and internationally consults for, “Best Doctors” for 20 years.
Dr. Vasilev is the first and only physician triple board certified in Ob-Gyn, Gynecologic Oncology and Integrative & Holistic Medicine in the United States.
Dr. Vasilev is internationally video vetted by iCareBetter as a minimally invasive robotic excision expert.
Extremely common = 1 in 10 women.
Extremely under-diagnosed = years of pain & suffering
What? Endometrium-like tissue, which is normally inside your uterus, grows abnormally around your ovaries, pelvis, bowel and other organs.
Why? Uncertain. Probably differs person to person due to molecular changes, immune changes, retrograde Fallopian tube bleeding specifically of stem cells, pelvic tissue transformation called metaplasia and more
When? As early as childhood, teens or even earlier in-utero as a fetus.
Symptoms? Pelvic & abdominal pain, bloating, painful sex, infertility, urinary frequency, painful bowel movements, back and leg pain, and more.
Superficial endometriosis (on peritoneal surface)
Deep Infiltrating endometriosis (invading tissues)
Ovarian endometriomas ("chocolate cysts")
Metastatic endometriosis (spread to distant areas) and malignant degeneration (rare but life-threatening)
Endometriosis usually affects pelvic organs and delicate structures nearby, which include your bladder, ureters and rectum. It can move to your abdomen and intestines and, rarely, to other organs and tissues in your body.
Get the diagnosis straight and get it right early! Don't “grin and bear it” with your pelvic pain with no answers from your doctor. Get a second opinion. The earlier endometriosis treatment starts, with or without minimally invasive or robotic surgery excision, the better the outcomes and the faster you can get back to a good quality of life!
Very common yet under-diagnosed
Atypical pain, bloating, silent infertility and many more symptoms
Proactive lifestyle mods
Diet, exercise, fitness can reduce excess estrogen which may reduce growth and progression of endometriosis
Integrative holistic support
Endometriosis and symptoms may be reduced by herbals/botanicals and lifestyle modification.
Surgical biopsy is the only way to diagnose endometriosis. Imaging and biomarkers MAY help plan treatment.
Endo is best treated with a personalized combination of medical and surgical approaches.
Best surgery for endometriosis is excision of implants using minimally invasive surgery with laparoscopy or robotic surgery.
Master endometriosis surgeons
Hit it with HIIT. "High intensity interval" or "burst training" means best BMI, more lean muscle mass and increased human growth hormone (HGH).
Low percentage body fat (low BMI) means a lean fat burning machine which, in turn, means less excess estrogen.
Make veggies the “base” of your diet, meaning "whole food plant-based"......not sugar-laden junk food!
Losing weight means less fat. Fat makes & stores estrogen. Decrease it!
Regular longer cycles, less estrogen, means less endo stimulation.
Maintaining healthy fiber and probiotics in your diet also helps digest, bind and flush excess estrogen.
In this video actress Tia Mowry explains endometriosis, and how dietary changes helped her. Consider doing it.
Alcohol causes estrogen spikes in your body which can feed endo growth. It can also make you fat, which also feeds endo. So, cut the drinking down.
Consuming caffeinated drinks can also cause estrogen levels to rise and stimulates the bladder, worsening interstitial cystitis (co-exists with endo).
Seek less caffeinated solutions like some teas, which also contain other healthy phytonutrients.
What's that !? It's part of all that stuff you put on or in your body!
Toxins are all around.....you're exposed to ~30,000 per year.
These are hormone-like endocrine disruptors and store in your fat cells.
Where are these coming from? Long list! Processed meat and dairy, insecticides, unfiltered tap water, food additives, hair and skin products, even toothpaste. Learn more: EWG.org
No! If you're worried about the GMO part, buy organic or grow your own.
Soy isoflavones mainly block standard estrogen at the receptor level.
This means less potential stimulation of endometriosis cells.
Seaweeds, like bladderwrack, may gently lower estrogen levels.
500-700mg a day will do it.
More is not "better", because of iodine content....good in moderation.
Japanese women, on a traditional local diet, have among the lowest rates of breast, endometrial, and ovarian cancers, as well as longer menstrual cycles and lower estrogen levels circulating in their blood.
Endo is bio-inflammatory, so biomarkers like hsCRP and CA-125 can be elevated.... but any inflammation can cause elevation.
"Omics" is the almost-here future! Genomics, metabolomics, proteomics can all spawn diagnostic tests
MicroRNA (miRNA) signatures are being studied in our research lab and others, and some are in clinical trials for diagnosis, monitoring and treatment of endo.
Why is surgery helpful for endometriosis? TWO reasons:
Definitive biopsy diagnosis of endometriosis
Cornerstone excisional treatment of endometriosis
Earlier excision may mean more pain-free years for you and less organ damage from scarring and fibrosis.
Less scarring means enhanced chances for fertility.
Individualized surgical planning is crucial for best results.
The original "keyhole" or "belly button" surgery
5mm incision around belly button and 2-4 additional incisions
2-Dimensional camera (no depth perception; like operating with one eye closed)
Instruments are "straight sticks" with graspers and scissors at the tips. Push, pull, cut, tear....so can be traumatic and lacks finesse.
So...laparoscopy is better than big open incision surgery (laparotomy), it's "ok" for "basic" cases with a good surgeon, but it's oh so yesterday....
Q: How do we know if a case is "basic" before the surgery happens?
A: We don't.... that's the problem.
BOTTOM LINE: For more advanced surgery not having that visual magnified 3-D third dimension is like operating with one eye closed. You lose the depth perception that is very important for delicate surgery in difficult spaces. Try closing one eye and doing things around the house, picking things up, and so on. It’s harder to do isn’t it?
You can certainly compensate, as people do when they lose an eye, but it’s harder to judge what is further from or closer to you. So, given a choice, using both eyes is better and 2-D laparoscopy screens mimic having one eye closed. This is part of why robotic surgery adds safety to endometriosis excision.
21st Century endo excision tool of choice. Period! Why?
Robotics is laparoscopy "on steroids" because:
3-D magnified high definition camera for ultimate depth perception and magnification on demand
Instruments that are "wristed" making them like tiny human hands holding scissors and graspers.
Advanced artificial intelligence and programming limits any jittery moves a surgeon may make, smoothing it all out.
Less trauma and tissue injury internally due to finesse "wristed" instruments
Less blood loss because of the precise instruments and better visibility
Less trauma to your abdominal wall because the instruments do not move as much as with laparoscopy
Shortest possible recovery time
Fewer complications, transfusions and readmissions
Very rare “conversions” to a big incision due to inability to finish the surgery via minimally invasive approach
Better ability of surgeon to fully excise endometriosis even in hard to get to areas
BOTTOM LINE: Robotic surgery is based on far superior technology, both the 3-D high definition magnified optics and the instruments. This all but guarantees safer surgery, even for complex high stage or recurrent endo.
But......it's not the robot that is operating. It's the surgeon. Many surgeons have completed basic robotic surgery training, but you do not want a rookie surgeon for complex endo surgery. You don't even want one that does this some of the time. Select wisely, and go with a master surgeon that devotes all of their time to endo excision and even more complex gynecologic surgery.
Medical endometriosis treatment is largely based on hormonal options and/or pain symptom management. At this time we focus on what we do best, which is our very specialized and advanced surgical help, as well as counseling about cancer risk. We will advise you and collaborate with your gynecologist or reproductive endocrinologist but do not provide extended medical therapy for endometriosis. If you do not have someone that can manage the medical and hormonal part of your endo care, we can help you find someone to be part of your local endometriosis-fighting team!
For mild symptoms of endometriosis, there are integrative natural support options to consider and here is an example of just a few:
This spice contains a bioactive ingredient called curcumin, which is a strong anti-inflammatory. Pepper helps its absorption. It’s best to use the root or spice and just add to your salads or as part of curry dishes.
This natural root also reduces inflammation and helps reduce nausea that may be caused by the pain of endometriosis. You can make ginger tea by boiling 1 tablespoon of grated ginger into 2 cups of water for 10 minutes. After straining it, add honey. You can also get some ginger pieces and simply chew on them as needed.
This natural herb from daisy-like flowers is also an anti-inflammatory. But beware that it is also a diuretic, so it can make you feel the urge to pee often. You can make chamomile tea by steeping 2 teaspoons of dried chamomile mix in 1 cup of hot water for five minutes, straining it and adding honey for sweetness if desired. Chamomile supplement capsules also exist if it’s inconvenient to make tea.
Bromelain is an enzyme which helps digest protein and has been used as a digestive aid and anti-inflammatory agent. It can be taken in capsule form, but fresh pineapple pulp is a great source. It can help in postoperative healing with minimal scarring.
Regarding the surgical expertise and outcomes with robotic surgery, from focal to widespread endometriosis, we are very unique on the West coast.
Basic robotic surgery training and expertise in pelvic surgery is becoming more common for many conditions, including cancer and endometriosis treatment. However, currently, complex robotic multi-quadrant excisional surgery is not standard of care because an advanced skill set for this is not sufficiently prevalent among the vast majority of surgeons.
This expertise is VERY slowly evolving with a relative handful of committed surgeons practicing nationally with adequate experience, who embrace the technique with strategies and tools to minimize risk of conversion to laparotomy while achieving as close to “complete” R0 or CC0 excision as possible. This “R” and “CC” based scoring is something we use for ovarian cancer when life is on the line. But the concept is the same, that being to remove the endometriosis as close to “complete” as possible.
Therefore, the endometriosis distribution can be pan-abdominal and pan-pelvic, and beyond. In other words, it can be anywhere and involving any organ. Literally, ALL possible situations need to be anticipated and prepared for to optimize outcomes with the lowest morbidity (complications), lowest conversion rates to a big incision and to get the best possible resection success. We have the specialized tools and advanced expertise to provide a very unique surgical benefit to you even in very advanced and recurrent endometriosis situations.
“I help and guide women to defeat endometriosis, gynecologic cancers, and complex gynecologic conditions using a unique combination of minimally invasive robotic surgery, precision cancer therapies and complementary holistic natural support towards thriving in survivorship.”
Dr. Vasilev is the only physician triple board certified in Ob-Gyn, Gynecologic Oncology and Integrative & Holistic Medicine in the United States. He is an accomplished world-renowned oncologic and robotic surgeon and has trained hundreds of fellows and residents. He served as the inaugural Medical Director of Integrative Medicine for seven years and is Co-Chair of Robotic Surgery at Providence Saint John’s Health Center, Professor at Saint John’s Cancer Institute in Santa Monica, California and is Clinical Professor at Loma Linda University School of Medicine.
His residency and fellowship, leading to two of his three board certifications (ABOG/ABMS), included extensive training in surgery not only on gynecologic organs but also bowel, bladder, ureters, diaphragms and all other organs in the abdomen and pelvis that can be affected by cancer, endometriosis and related conditions. This, combined with over three decades of experience in advanced minimally invasive surgery, allow him to safely complete very advanced surgeries.
Since completion of his fellowship training in Gynecologic Oncology at the USC Kenneth Norris Comprehensive Cancer Center he has been recognized as a surgical innovator, minimally invasive surgery pioneer (among first group in the US to regularly perform complex laparoscopic surgery such as radical hysterectomy and lymph node dissection in the late 80’s and early 90’s), and thought leader. He has held multiple leadership positions and been on the faculties of Kaiser Permanente, City of Hope, UC Irvine, USC, UCLA and Loma Linda University.
Dr. Vasilev has lifelong experience and training in integrative holistic medicine and is also board certified in that speciality by ABOIM (ABPS).
Dr. Vasilev has been involved in running research programs at multiple sites since 1977. He is a sought-after speaker, has authored over 90 publications, abstracts, book chapters and is the author-editor of a gynecologic oncology textbook and several popular books on integrative oncology and ovarian cysts.
Dr Vasilev is extensively published and according to Academia.edu his work has been cited by other professionals and colleagues hundreds of times, meaning he is a respected national expert on multiple topics related to cancer, minimally invasive surgery, peri-operative recovery and integrative medicine.
San Luis Obispo
Endo Associated Malignancy
Complex Gynecology Surgery