Megan Wasson, DO, on advancing endometriosis care through imaging, surgical precision, and mentorship

In an interview at the 2025 ACOG Annual Clinical and Scientific Meeting, Megan Wasson, DO, FACOG, chair of gynecology at Mayo Clinic in Arizona, discussed her presentation on “Increasing Skill and Safety in the Identification and Excision of Endometriosis” at the meeting.

Recognizing the varied appearance of endometriosis

Endometriosis can present with diverse visual features that often differ from traditional descriptions. “In residency, I was taught that endometriosis looks like a powder burn lesion, but really that’s only about 25% of the time,” said Wasson. “The other 75% looks different than a powder burn lesion.”

This variability makes visual recognition and training essential. Wasson emphasized the importance of teaching clinicians to identify atypical presentations. Advances in magnification through laparoscopy and robotic surgery have contributed to this effort. “Being able to really zoom in on these lesions and see the difference in normal versus abnormal peritoneum is incredibly helpful,” she said.

Prioritizing quality of life in treatment decisions

According to Wasson, treatment should be guided by patient-reported symptoms and quality of life. “Endometriosis, we need to step back and remember it’s a quality of life issue,” she said. For some patients, even deep infiltrating disease may not require intervention if symptoms are absent. “Even if we see deep infiltrating endometriosis on imaging, that doesn’t mean we have to tackle it,” she noted. “If someone’s not having any pain, any difficulty with bowel movements, urinary function, sexual function, we don’t have to tackle this.”

However, for those who are symptomatic, surgery must be carefully balanced. “It does become a very delicate balance of radicality, of surgery, truly treating it almost like it is a malignancy,” said Wasson. “Even though it’s a benign condition, it behaves like a cancer.”

Understanding anatomy to minimize surgical harm

Surgical treatment of endometriosis often involves working near critical structures. “We want to really get around those nodules, get around the disease and, yes, minimize damage to the surrounding structures,” Wasson said. She emphasized that a deep understanding of pelvic anatomy is essential to this goal.

The importance of mentorship in surgical training

Wasson highlighted the value of continued mentorship in building surgical expertise. “I was very fortunate that when I finished my fellowship, I stayed at the same institution [where] I trained at, so I was able to continue with that mentorship,” she said. This continuity helped “exponentiate my learning curve and advance my skill set.”

She encouraged clinicians to seek mentorship in any form. “Having another person in the operating room with you, or just providing coaching mentorship—that really can elevate your skill very quickly and give you that safety net to make sure that, yes, you are doing the best surgery you can, but still providing safe and effective care for the patients.”

Advanced imaging as a roadmap for surgery

Imaging plays a crucial role in surgical planning. “You shouldn’t be walking into the OR for a quote, unquote diagnostic laparoscopy,” Wasson said. Instead, she recommended having “a roadmap going into the operating room as to what you’re going to encounter.”

At her institution, advanced imaging techniques such as ultrasound and MRI are standard for patients with symptoms of deep-infiltrating disease. This preparation reduces the need for multiple procedures. “We really focus on advanced imaging for individuals who are having signs and symptoms… so that way, we don’t have to do multiple surgeries because we’re surprised when we get into the operating room,” she said.

Leveraging technology to enhance visualization

Wasson urged clinicians to use available technologies to improve disease detection. “Optimize our visualization, because we have technology that we can zoom in, magnify things, use that to your advantage,” she said. Thorough inspection of all areas during surgery is also key. “Make sure that you are looking in all the nooks and crannies in the abdomen and pelvis, to decrease the likelihood that we’re missing disease.”

Disclosure:

Wasson reports no relevant disclosures.

Reference:

Wasson M, Mansour T. Increasing Skill and Safety in the Identification and Excision of Endometriosis. Presentation. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.