Doc Discussions with Dr. Jason Edwards

The Laser's Edge: Revolutionizing Endometriosis Treatment

• Dr. Jason Edwards

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Challenging conventional wisdom about endometriosis, Dr. Patrick Yeung shares his pioneering approach to treating this debilitating condition that affects countless women worldwide. With specialized training including two residencies and two fellowships, Dr. Yeung has dedicated his career to developing what he calls "root cause treatment" – a surgical method that completely removes endometriosis tissue rather than simply burning or masking it.

What makes Dr. Yeung's approach revolutionary? Using a free-beam CO2 laser, he meticulously excises endometriosis layer by layer without damaging surrounding tissues, while simultaneously preventing adhesions that can cause additional problems. The results are remarkable: while traditional approaches see 50-80% of patients requiring repeat surgery within two years, Dr. Yeung's 10-year study revealed a repeat surgery rate under 5%. For women struggling with infertility, his approach offers natural pregnancy rates up to 70% - more than double the success rate of conventional IVF.

Throughout our conversation, Dr. Yeung dismantles persistent myths about endometriosis, including the flawed "retrograde menstruation" theory that has led to inadequate treatments. He explains why endometriosis remains underdiagnosed despite affecting far more than the commonly cited "one in ten" women, and why surface endometriosis can cause significant pain and fertility issues despite not appearing on imaging studies.

The personal touches Yeung brings to his work – including how his wife's endometriosis journey inspired his practice – reveals the profound impact this disease has on women's lives. "To help a woman get her life back, get answers, or be a part of having a baby... it has eternal value," he shares, underscoring why his Restore Center for Endometriosis has become a destination for patients nationwide seeking comprehensive care beyond the band-aid approaches so common elsewhere.

Ready to learn more about this groundbreaking approach to endometriosis treatment? Visit restore-endo.com to discover how Dr. Yeung and his team are changing lives through their commitment to complete disease removal and restoration of natural function.

Dr. Jason Edwards:

Hello, this is Jason Edwards with Doc Discussions, and I'm here with Dr Patrick Yeung . Patrick, how are you doing today, sir?

Dr. Patrick Yeung:

Great.

Dr. Jason Edwards:

Thanks so much for having me. You bet Now, Patrick, you're an OB-GYN, is that right?

Dr. Patrick Yeung:

Yes, sir.

Dr. Jason Edwards:

But you specialize in a very niche field. Can you tell us about that?

Dr. Patrick Yeung:

Yes, no, thank you. I always say I'm a slow learner, but hopefully when I get it, I get it. I did two residencies and two fellowships to do what I do. Which? Which residents and fellowships did you do? I did a family practice first. Okay, At St John's mercy, it was called at the time.

Dr. Jason Edwards:

Yeah.

Dr. Patrick Yeung:

Now it's, you know, mercy, and then OBGYN, and then a fellowship in minimally invasive gynecologic surgery, and then a mini fellowship or an extra fellowship to learn to use the laser. We can talk about that, but that is my cutting tool of choice. That's a very precise, non-contact cutting tool To be able to treat endometriosis. That is what I treat. So I have a what's called a restore center for endometriosis. We talk about offering a root cause treatment to remove this disease. Most people just burn it, for lack of a better word. They're trying to destroy the tissue or the implants with energy, but they don't remove it. By removing it we're showing great outcomes that are better than or different from the usual or status quo treatments for pain or for fertility, which are really Band-Aid therapy or bypass therapy.

Dr. Jason Edwards:

I'm going to back up just a touch. So you did your training at Duke, is that right?

Dr. Patrick Yeung:

I was there for three years, my first real job. I say yes. And then you ran their endometriosis center.

Dr. Jason Edwards:

Is that right I?

Dr. Patrick Yeung:

began a center for endo at Duke Very good. And then I'm going to go back and endometriosis center.

Dr. Jason Edwards:

Is that right began a center? For endo at duke very good and then, and then I'm going to go back and and um endometriosis. Now I'm going to give my definition. You tell me if I'm right or wrong and then slew after that.

Dr. Patrick Yeung:

So st louis university began a center there.

Dr. Jason Edwards:

I was there for 10 years very now private practice here at st luke's, and you and don summers work closely together. Is that right?

Dr. Patrick Yeung:

yeah, I have an independent but we operate here at St Luke's for mostly the deep endo or advanced endo cases that can involve the bowel, sometimes the bowel resection. Those are done with Dr Summers, who's here.

Dr. Jason Edwards:

Yes, so my understanding is you know you have this the lining of the uterus. It's this thin layer of cells called the endometrium and they slough off and go out of the fallopian tubes and into the pelvis and grow into these, sometimes masses, that cause trouble with the anatomy and inflammation in the pelvis. Is that?

Dr. Patrick Yeung:

Okay. So a two-word definition is ectopic endometrium Okay? Is ectopic endometrium Okay? Which means cells that are normally in the lining shed during the period, found in the wrong place, outside the uterus. So now, how do they get there, is the question. So again, they're, by definition, outside the uterus.

Dr. Patrick Yeung:

The number one symptom is painless periods. It can affect or cause pain and infertility. The number one theory of how they get outside the uterus is this backflow theory that you described, or the retrograde menstruation theory of SAMHSA, which is when a woman is having her period she bleeds backwards through the tubes in those cells and plant. That is still the most common and traditional theory.

Dr. Patrick Yeung:

But there's a lot of problems with the theory, like endo has been found before the very first period, after the last period, outside the pelvis, lungs, brain, back of the eye in men, places where backflow cannot reach, and it leads to a lot of endo myths, things that aren't true, like if you take out the uterus, you're going to take out the source of endo, based upon the backflow theory, so that you cannot have endo without a uterus.

Dr. Patrick Yeung:

That is a hundred percent not true, especially if you've left the ovaries, which can stimulate the endo again, which is, by definition outside the uterus, you've done nothing to the endo. If you just remove the uterus or they're going to say, well, if you can stop the periods, that's going to turn off the tap, stop the, and so you can't have endo after having no periods for a long time Also, 100% not true. People have said that the number one thing we can do to really help women with endo is to get rid of the bad theory because it leads to endomus. So modern day theories include stem cells metaplasia. The cells just change and that may be at a particular window in a woman's development, so it doesn't keep happening. It's not an ongoing process, which? So then, if you can cut out the endo and do that well, you can have great outcomes, which is what we're showing.

Dr. Jason Edwards:

Yeah, I got you and so, and like everything in science and medicine, it's always way more complicated than you think, and so that's fascinating to hear kind of the competing theories right, and hopefully in time we learn more and more about it. And so what you do which is very unique and there's only a few doctors like you in the country, is my understanding you go in with your CO2 laser and remove these pockets of ectopic endometrium that are in the pelvis, that are causing pain or changing the anatomy of the uterus and the fallopian tubes and the ovaries, causing infertility, and sometimes these are really tedious, meticulous surgeries that last a long time, right?

Dr. Patrick Yeung:

So this disease starts off on the surface. As the disease progresses it can go deeper. You can get a ball of it in the ovary, called a chocolate cyst or endometrioma. You can get a ball of it in the bowel or the bowel wall, called the bowel nodule. That can make things stick. In fact the disease can make all the anatomy stick. So in advanced cases you can get what's called a frozen pelvis, where uterus, bowel tubes and ovaries are all stuck together.

Dr. Patrick Yeung:

So I like to start by saying there's a TED talk called the most common disease you've never heard of. I love that title. That's endo.

Dr. Patrick Yeung:

Everybody knows somebody with endo and the common phrase out there or thinking is you know, it's one in ten, hashtag it. That's the rate of endo, but it's much more than that. Okay, the two main things that endo is associated with or causes is pain and infertility. So if you have infertility, no pain, it's at least 50%. Pain that does not feel better with hormonal suppression or birth control pills over 80% Pain and infertility it's over 90%. So it's so common. Everybody knows somebody with endo. The usual treatments the status quo I like to call it is band-aid therapy for pain, hormonal suppression of some kind, whether it be chemical pregnancy with birth control pills or chemical menopause or all the newer medications for pain bypass therapy for fertility. I call it like IVF bypass the problem, you know. Make a baby in a test tube or this idea that you're going to have to have surgery every couple of years for the rest of your life. That status quo, that usual treatment, is not satisfactory to most women.

Dr. Patrick Yeung:

At Restore Center for Endo our approach is to remove the actual disease. We call that root cause treatment. Remove the disease to avoid the need for long-term suppression, basically because it's gone to lead to natural fertility and hopefully recurring natural fertility, and for the hope of one and done surgery, which no one thinks is possible but we're showing is possible. We just published our 10-year study from our experience at SLU, st Louis University, and our rate of repeat surgery was very low. It was under 5% in 10 years and even without most patients taking any long-term suppression post op, the usual rates of repeat surgery after the burning, which is what most people do, is 50, 60, 80%. That's great In two years. So again, we're showing a very low rate of repeat surgery and so we're saying one and done surgery is possible and we would say the way to get there, which should be the goal of all centers of endo, is to try to offer to patients one and done surgery.

Dr. Patrick Yeung:

I think you know surgery surgeons have kind of given up. They're going to burn what they can, but if it's near a vital structure they're going to put them on long-term suppression, post-op. They don't have to remove it all, or for fertility, they don't have to optimize the anatomy because they're just going to bypass the pelvis and refer to IVF or just come back and do it again in two years. That's a very different surgical mindset versus trying to remove it all and optimize the anatomy now, and so I think that's a very different surgical mindset on behalf of the surgeon. But also we're showing, I think, a very different surgical result for the patient. And so we're trying to combine the best of cutting it all out. We call that optimal excision and adhesion prevention, so very few cut it all out. We call that optimal excision and adhesion prevention, so very few cut it all out. Well, but the other half is to prevent adhesions and that's how we would say you achieve such great results or achieve the goal of one and done surgery.

Dr. Jason Edwards:

Yeah, and you use the CO2 laser to do that.

Dr. Patrick Yeung:

So my cutting tool of choice, as you say yes, is this free beam, non-contact CO2 laser. So I don't have to touch the tissue to cut the tissue. It's very precise. It's literally cutting one layer at a time. You can see the layers separate and so there's not that kind of danger of pushing too far. People ask why I don't use the robot. I used to use the robot. I think well, the robot doesn't have this type of laser.

Dr. Jason Edwards:

Do you do your surgeries open or laparoscopic? So they're all laparoscopic, minimally invasive.

Dr. Patrick Yeung:

Okay, less holes than a robot.

Dr. Jason Edwards:

Yeah.

Dr. Patrick Yeung:

Less visible holes than the robot. The robot's only been shown to really, you know, not improve outcomes but only increase time and cost in benign surgery. So I don't use it for what I do, and especially surface endo or stage one to three. I wouldn't use it Now, stage four maybe. Why is that? Just because by then it's not really delicate surface endo, it's more just deep endo and maybe the robot would be fine for that.

Dr. Jason Edwards:

What are the side effects from the surgery or potential side effects from the surgery?

Dr. Patrick Yeung:

So the main criticism of surgery or excision, cutting it out, is that you're going to create all these raw surfaces which will promote adhesions, so it's going to make things worse for fertility. That's a theory. That's a theory that has not been shown to be true. With our anatomy optimization and non-surgical optimizations for patients with fertility, when you treat the endo, they feel better and they have improved chances of fertility, and I think they actually go hand in hand. Feeling better and chances of pregnancy go hand in hand, yeah for sure. What are the rates of fertility? So the national average for IVF is 32%. When you're talking about root cause treatment and restorative reproductive medicine, or optimizing the anatomy and the non-surgical factors for fertility, the rates of pregnancy can be up to 70% in one to two years.

Dr. Jason Edwards:

Did you in the study? You guys did, did you guys measure that as an endpoint?

Dr. Patrick Yeung:

fertility- In the 10-year study. Yeah Well, it was a database, and so we had different endpoints, gotcha. This one was focused on rates of repeat surgery.

Dr. Jason Edwards:

Yeah.

Dr. Patrick Yeung:

There are other studies, yes, that show up to 70% fertility rates, even in advanced endo. Yeah, so it's very effective and, again, patients are feeling better and it can lead to recurring fertility and if it's one and done surgery, it's very cost effective.

Dr. Jason Edwards:

Yeah, for sure, yeah, and and yeah, and there's the and there's, it's a big picture. I mean, you're not only looking at fertility, you're not only looking at pain obviously significant psychological benefits if you're not in pain, if you're not having to, you know, continuing to have surgeries and so, you know, seems like a lot of positives on a lot of fronts.

Dr. Patrick Yeung:

Yeah, the real reason why, you know, I began Restore Center of Endo was to enter the conversation among centers of endo to say that what we're doing is different and here's how you can try to get to one and done surgery. But really it's also to pay it forward and here's how you can try to get to one and done surgery, but really it's also to pay it forward. That is the real reason for Restore Center for Endo. So my wife had painful periods her whole life. We tried from day one to get pregnant. After a year of trying she said maybe I have endo. I said no way. She had bad endo. She had one surgery to remove the endo and then multiple surgeries for adhesions. She's now pain-free and we've had recurring fertility.

Dr. Jason Edwards:

I saw your five beautiful kids on your website Praise God. Yes, thank you.

Dr. Patrick Yeung:

So you know, but going through the journey with her and again we're trying to pay that forward and in our story preventing adhesions was as important as removing all the disease but going through the the the journey with her, not knowing why somebody is not getting pregnant is as bad as not having a baby, or at least adds insult to injury. Yeah, to be told you have unexplained infertility, which you know again, mainstream would say 30 of infertility, which you know again, mainstream would say 30% of infertility is unexplained, is a slap in the face. A woman knows that her body is designed to get pregnant and if you look hard enough you will probably find an answer to why, or a factor that is, often multiple factors that are leading the woman to not be able to get pregnant and many of those women have endo. So again, a normal ultrasound and a normal exam do not rule out surface endo.

Dr. Jason Edwards:

Yeah, I mean. So I look at a lot of scans and things like that and I would assume that a focus of endometriosis would have about the same Hounsfield units as fluid or anything else, and so it would be kind of hard to see on a scan, I would think Well, if it's advanced endo, again it's gone beyond the surface and it's now a ball of it in the ovary, that's stage three endo.

Dr. Patrick Yeung:

that's an endometrioma. If it's in the bowel, that's stage four endo. You can see advanced endo when there's some thickness to it.

Dr. Jason Edwards:

And then it's deflecting other tissue and misshaping it.

Dr. Patrick Yeung:

But if it's just surface endo, stage one to two, that's not going to be picked up on exam or imaging. But stage one to two endo or surface endo can still affect pain and fertility and treating it will help both. So, again, a lot of this unexplained infertility disappears when you actually look for and treat underlying conditions or root cause treatment. And again, having an answer, having that disease removed from your body, is so important in the healing process of a woman who's not getting pregnant.

Dr. Jason Edwards:

Yeah, and, like you said, like a lot of diseases, it has a ripple effect not only in the individual's life but also you know their spouse and you know whatever it is, whether it's cancer, endometriosis or whatever and so well, that's great. This is. It sounds like kind of an avant-garde, you know, this is it sounds like kind of an avant garde. You know advanced technique and practice that you have here and sometimes with that comes, you know, if you're kind of pushing the status quo.

Dr. Jason Edwards:

Sometimes you can get a little bit of headwinds. Yes, is that the case with your practice, or not so much.

Dr. Patrick Yeung:

Well, I would say it's really a return to trying to focus on treating the patient. Yeah, again, this is not to bash on IVF. It has its role, but I would say it this way. Okay, the director of an IVF center asked me who is the most important person in the IVF center. Okay, you get to guess.

Dr. Jason Edwards:

Well, I mean, you know we're supposed to be patient first oriented, so you could say the patient Okay common answer, great answer.

Dr. Patrick Yeung:

Well, first off to say it's not the director of the clinic. Okay, it's not the person who got into med school. We love our administrators, but that's right. Completed med school. Did residency training, subspecialty fellowship training to become an REI reproductive endocrinologist and infertility specialist. Which is a difficult field to get into.

Dr. Patrick Yeung:

Right and now owns and runs the IVF center. It's not that person and it's not even the patient she posed the question. She gave the answer. Which is the most important person is the embryologist. It's the person that runs the lab, because that's where the action is.

Dr. Jason Edwards:

Okay.

Dr. Patrick Yeung:

So just to say the woman is not being treated to help produce the baby. So women? This to me was just mind blowing, or at least highlighted the point that you know, women want to be treated as patients. Women want to be healed to have the baby, and that's as important as having the baby. They want to be restored. So this title Restore Center for Endo is my wife.

Dr. Jason Edwards:

Great title.

Dr. Patrick Yeung:

But again, having lived through it, there's a real desire there by women to get answers to be restored as much as having the baby, or at least that's a very important part of the healing process. Yeah, okay, is this? So this issue is, I would say, an issue for our time. I really think this idea of restorative reproductive medicine as an alternative or as a way to try to get pregnant without bypassing the problem and really offering root cause treatment is really an issue that is a great moment in our society and that cuts across the political spectrum. People come at it from both sides, but people are wanting root cause treatment kind of to be more organic or natural, to lead to natural fertility for a patient, without big pharma, without just suppressive Band-Aid treatments or treatments that end up with a lot of hormones in the environment but that flood your body in a very artificial way, or bypass therapy with big fertility, we'll call it, and so I think it's really there's a lot of grassroots movement or desire for options for fertility that are not just the usual.

Dr. Jason Edwards:

Yeah, yeah and it and if it seems like if you have, you know, very significant endometriosis, it's, it's something that would probably give people hope. And I'm sure it's a gratifying field to be in, you know, to see patients who may have kind of given up on things or maybe didn't want to take you know a certain route, and they come into your clinic and you get to see, you know them and their spouse and how it changes. I mean, is that right? Can you talk about?

Dr. Patrick Yeung:

that, yeah, I love what I do. Again, I'm a slow learner and I went through all that, but I love what I do every day and I steal my wife's phrase all the time. But to help a woman get her life back, get answers or be a part of having a baby, I mean it has eternal value. I love it.

Dr. Jason Edwards:

Yeah's great, that's great. Well, um, how can patients if they were interested in just kind of taking that first step and um kind of looking into this? You have a website, is that right?

Dr. Patrick Yeung:

yes, so it's called restore center for Endometriosis is the name of the practice. The website is restore-endocom or restoreendocom. There's a lot of information on there, but you know. So we're here in St Louis, we're based here. There are very few centers in the country that are really focused on this type of root cause treatment and can do this type of surgery to restore the anatomy, especially for advanced endo. We're going to often take a team like we have here. You know, some places really do believe in cutting out the endo but don't have a good bowel surgeon to work with. I feel so blessed to be able to work with Dr Summers.

Dr. Jason Edwards:

We've been together now for 10 years and um yeah you know, you guys have a reputation for being meticulous and and doing what it takes to get the job done, because these are not easy surgeries. I mean, for people who don't know, doing surgery in the pelvis is kind of like doing surgery in an upside down traffic cone, Like the deeper you get, the more narrow it is, and so this is a highly specialized treatment. And that's one of the great things about health care in St Louis is you have these kind of super specialists that are available and you know all the systems have, you know, really great doctors, and so I always say with St Luke's we have incredible competition, you know, because there's really good hospitals all around, but we're fortunate to have you know something like this, and I know a lot of your patients fly in from other places to get their treatment.

Dr. Patrick Yeung:

Yeah, thank you. Now we actually see more patients out of state than in state and very few places can do this Well, people come from all over. It's very humbling, but I hesitated there because I was going to say so. I learned I hope it's okay to say Don, but Dr Summers, when he graduated residence day, I think it was you know they roast you, yeah, sure. So when he graduated he got the OCD award, which, when you're dealing with endo, is exactly the guy you want.

Dr. Patrick Yeung:

He is meticulous and for these advanced endo cases that can involve the bowel, where things can be stuck, might include a bowel resection. We allow all day. We do one case all day, yeah, so we're not rushed, we can do what needs to be done and St Luke's has been so supportive no-transcript.

Dr. Jason Edwards:

If you're doing whatever it takes to get the job done. It could be a 10 hour surgery if necessary, and and, and and you know the. The truth of it is that's a stress on the staff and it's a stress on the system, and um, and so it's it makes a big difference to have that support Right.

Dr. Patrick Yeung:

No, and St Luke's, you know they I think at first they weren't sure to be fair, but they've seen over the years the outcomes for the patient first and foremost, and that you know the patients do well and it's, you know it's really helping people, and so they, they've seen that I would call our practice a mission-based practice and I really think, you know St Luke's is on mission together with us and, first and foremost, patients are benefiting and again, their support has been wonderful.

Dr. Jason Edwards:

Well, patrick, we're fortunate to have you and Dr Donald Summers on staff here and or your practice here, and I want to thank you for the not only the work you do, but I want to thank you for being here at St Luke's. We appreciate you and the website's. Restoreendocom and check it out and reach out to Dr Yeung and his staff if you think he may be able to help you.

Dr. Patrick Yeung:

Thanks so much. Thanks, patrick, thank you.