With an introduction from Helena Beer, consultant gynaecologist Mr James Tibbott, lead clinician for gynaecology at Leeds Teaching Hospitals NHS Trust, discusses the Trust’s recent endometriosis centre recognition and the technology that helped them achieve it, how robotic surgery is transforming timely patient care and the latest research set to revolutionise diagnostics and treatment for this debilitating condition.
Endometriosis is the second most common gynaecological condition in the UK, after uterine fibroids, and despite its prevalence it is often misunderstood. Awareness and discussion of the condition is ramping up among the public, with the recent approval of relugolix combination therapy (brand name Ryeqo) by the National Institute for Health and Care Excellence being the latest development getting people talking.
But it’s the delays in diagnosis and treatment that tend to dominate the headlines, and this is far from the whole story in endometriosis care. There are inspirational examples of best practice, technological innovations and cutting-edge research that are set to transform patient care for the better and, in some cases, are already making a significant difference.
In January 2025, the endometriosis team at Leeds Teaching Hospitals NHS Trust (LTHT) was awarded provisional status as a British Society for Gynaecological Endoscopy (BSGE) Accredited Endometriosis Centre. This recognition highlights their commitments to excellence in endometriosis treatment, person-centred care and ongoing research and innovation.
One of the driving forces behind the accreditation was the team’s introduction of robotic surgery, which has recently led to the introduction of an Endometriosis Robotic High Intensity Theatre (HIT) list. Led by Mr James Tibbott, consultant gynaecologist and the Trust’s lead clinician for gynaecology, this HIT list offers more patients a less invasive surgical option with greater precision and shorter recovery times. And, crucially, it also reduces waiting lists.
What does achieving provisional BSGE accreditation mean for the team, and how will it impact patient care for endometriosis?
Achieving BSG accreditation puts Leeds Teaching Hospitals Trust at the forefront of gynaecological care for patients with endometriosis. It means that our patients have a quality assurance about the level and standard of care that they receive at Leeds Teaching Hospitals Trust that is independently monitored by a governing body.
I think this is important for patients, as they want the right treatment for them by the right people. It also means that for severe, complex endometriosis, there’s very much a multidisciplinary team-driven approach to their care that the patients can feel reliably that they’re getting a high standard of care.
How have you used robotic surgery to improve efficiencies, and how have surgeons and the multidisciplinary team adapted?
We have three robots at our Trust: two at the abdominal surgery hospital and one in the head and neck and paediatric surgical specialty, which is extremely underutilised.
We noticed that this underutilised robot gave us a gap in the market to start doing some simpler day cases – simple hysterectomies, simple endometriosis – and it’s improved our day case hysterectomy rate no end. That now means that I can use the technology and join colleagues at our abdominal surgery hospital [for more complex procedures].
Unfortunately, at this moment, we still don’t have a regular theatre list, but I can pick up ad hoc sessions, which improves our theatre productivity and utilisation. More importantly, I can join colleagues in theatre, so I’ve joined a colleague to do a hysterectomy and a ureteric reimplantation. I’ve joined colleagues to do complex colorectal work as well as our own surgeries.
In fact, we’ve already done a case where we’ve had a urology surgeon, colorectal surgeon and gynaecological surgeon doing three different operations on one patient, all using the same modality. We will hopefully expand that to include thoracic surgery as well.
The Endometriosis Robotic HIT list is a significant milestone. How does this technological approach improve clinical practice and patient outcomes?
So, for me, robotic surgery gives an unprecedented level of accuracy for our patients with endometriosis. It is my fastest mode of operating, both for hysterectomy and excision of endometriosis full stop. What we can achieve robotically far exceeds what we can achieve laparoscopically.
For example, a complex endometriosis case with bowel excision or resection, usually takes half a day of operating. With the robotic HIT list, we managed to do three complex operations with disc excisions of the rectum during a full day operating. So, we improved efficiency three-fold.
When we operate laparoscopically for a complex endometriosis case, after one of those cases, we’re usually absolutely exhausted, and doing more than one in a day becomes very, very difficult physically and mentally – these are mentally draining procedures.
What we’ve seen is a reduction in operating time due to robotics and a reduction in length of stay due to robotic surgery for complex endometriosis. After having had a robotic hysterectomy, patients seem to experience less pain, and that’s probably because we operate at lower pressures, and their recovery time is significantly quicker.
How do you see technology making a difference more generally in endometriosis care going forwards, particularly around more timely referral and diagnosis?
There are more and more non-invasive tests for endometriosis that are being investigated and piloted, and this really is the key. We need a diagnostic test that doesn’t involve a laparoscopy. Ideally, it should be a point-of-care test that we can then see patients in primary care, get that test and refer to the appropriate person, if needed.
Ideally, if the point-of-care test can give us an idea of how bad their endometriosis is, it would help streamline care so everybody who tested positive for Stage Four endometriosis was referred to, for example, an endometriosis centre in the UK.
Research plays a key role in endometriosis care. It allows us to push the boundaries. For us, the most exciting piece of research that’s happening at the moment is the AMY109 study. This is where we’re taking patients with severe endometriosis and randomising them to a monthly monoclonal antibody infusion. In animal models, this has been curative and if this test of theory works, if we’re able to cure patients of endometriosis with an antibody infusion, the future for endometriosis care may be completely different.
Imagine a scenario where we can do a test that’s positive for endometriosis, perform an ultrasound scan, lavage off some peritoneal fluid, put it in an analyser, work out what complex inflammatory process is driving that patient’s endometriosis, and then arrange for an antibody infusion specifically for that patient. I think that’s a real potential game changer – an extremely exciting future.
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