The Expertise Gap: Why “Good” Isn’t Good Enough in Endometriosis Surgery
In the world of medicine, patients often rely on the comforting assumption that a “standard of care” exists across the board—that any board-certified surgeon provides roughly the same level of skill and safety. But the reality of the operating room tells a very different, and statistically stark, story.
Dr. Fred Moll, the visionary co-founder of Intuitive Surgical and the man largely responsible for the da Vinci robotic revolution, has spent decades observing the reality of surgical performance. Dr. Moll left the practice of medicine over forty years ago to invent the future, eventually launching the robots responsible for some 3 million surgeries a year. With over 10,000 machines deployed globally and a career spent analyzing surgical outcomes, his perspective is definitive.
“I’ve spent my career watching other people do surgery,” Moll recently told Forbes. “The difference between a good surgeon and an average surgeon is massive.”
Moll is currently investing millions into the next generation of robotics and AI, betting that technology can eventually raise the capability of the “average” surgeon. But for a patient suffering today—especially with a disease as invasive and complex as endometriosis—waiting for technology to bridge that gap is not an option.
When it comes to your body, “average” is dangerous. And as new data reveals, even the “top 10%” of surgeons are far from the elite standard required for complex excision.
The Data: Defining the “1%” Standard
At Endometriosis Surgical Specialists International (ESSI), we believe in radical transparency. We analyzed the volume of GYN robotic procedures performed in 2023 to understand the landscape of surgical experience.
Source: 2023 Da Vinci GYN Surgical Data
The results reveal a shocking “Expertise Gap.”
The Median (The “Average”): The data shows that 50% of surgeons perform fewer than 20 procedures annually. That is less than two surgeries a month. At this volume, it is impossible to maintain the high-level muscle memory, three-dimensional spatial awareness, and crisis management skills required for complex pathology.
The ESSI Standard (The Top 1%): To meet the criteria of a high-volume expert, a surgeon performs over 240 surgeries per year. At this volume, a surgeon is in the operating room almost daily. They reach the critical 1,000-case milestone in just 4 years, compared to the 14 years it takes a “top 10%” surgeon. This “velocity of experience” means that a high-volume surgeon sees more pathology in a month than an average surgeon sees in a decade.
The “Part-Time” Pilot: Why We Normalize Danger in GYN Surgery
To understand why this “median” of 20 surgeries a year is so concerning, we have to look outside of medicine.
Imagine you are boarding a trans-Atlantic flight. You ask the pilot how often they fly. If they replied, “I mostly work a desk job, but I fly this plane about once or twice a month,” would you stay on that plane?
Absolutely not. You would demand a pilot who flies daily, who knows how to handle turbulence instinctively, and whose skills are sharp. We demand “high volume” from our pilots, our contractors, and our athletes because we know that dabbling is dangerous.
Yet, in Gynecology, we have normalized the “Surgical Dabbler.” Many OB/GYNs are excellent physicians who split their time between delivering babies, managing office visits, and primary care. Surgery is something they do “on the side.” While well-intentioned, a surgeon who operates 20 times a year simply cannot navigate a “frozen pelvis” where the uterus is fused to the bowel. They are the “part-time pilots” of the operating room.
In no other complex surgical field—like neurosurgery or cardiac surgery—is this acceptable. It shouldn’t be acceptable in endometriosis care either.
The Complexity Multiplier: Why Endometriosis is Different
Endometriosis is a multi-organ, invasive, and unpredictable disease. It does not respect anatomical boundaries. It fuses the uterus to the bowel; it invades the bladder; it wraps around the ureters, the liver, and the diaphragm.
In this field, the gap Dr. Moll speaks of becomes a chasm.
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The “Dabbler”: Relies on ablation (burning) because they lack the skill to excise deep tissue safely. They leave disease behind because they are afraid of complications, leading to “failed” surgeries and continued pain.
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The Top 1% Surgeon: Has the repetitions and the confidence to navigate complex anatomy. They excise the disease entirely while preserving vital organs because they have done it thousands of times before.
The Multidisciplinary Advantage: Vidali & Raccuia
Closing the expertise gap requires more than just high volume; it requires a diversity of expertise. This is why ESSI relies on a truly multidisciplinary approach.
Consider the collaboration between Dr. Andrea Vidali, a world-renowned endometriosis specialist, and Dr. Joe Raccuia, an expert in liver and general surgery.
Dr. Vidali brings decades of experience in reproductive immunology and pelvic excision. But when the disease travels upward—to the diaphragm, the liver, or the upper bowel—most gynecologists stop. This is where Dr. Raccuia steps in. As a general surgeon with expertise in liver surgery, Dr. Raccuia is comfortable in the upper abdomen, an area many GYNs fear to tread.
“Endometriosis can mimic cancer in how it spreads,” explains Dr. Vidali. “We must treat it with the aggression of cancer surgery but the delicacy of fertility preservation. Having a partner like Dr. Raccuia means we can go where the disease goes—whether that’s the diaphragm, the liver, or the bowel—with the same level of mastery we bring to the uterus.”
Don’t Settle for the Median
Dr. Fred Moll’s insight is a warning: do not assume competence is distributed equally. The gap between “good” and “average” is massive.
When facing a disease that affects your daily life, your fertility, and your long-term health, you cannot afford to be treated by a “dabbler.” You need a team that operates in the top 1%—where high volume meets multidisciplinary excellence. At ESSI, that is our baseline.
