Extreme Anatomy: When Endo Goes “North” – A Conversation with Dr. Joe Raccuia & Dr. Andrea Vidali
In the world of gynecology, there is an invisible line drawn across the abdomen, roughly at the level of the navel. Below this line is the “South”—the pelvis—where every gynecologist feels at home.
But endometriosis does not respect invisible lines. It travels “North.”
It invades the diaphragm, the muscle that helps you breathe. It attaches to the liver. It wraps around the upper bowel. When the disease goes North, most gynecologists—even skilled ones—stop.
Dr. Andrea Vidali does not stop. He is one of the few endometriosis surgeons in the world with the skill and experience to operate directly on the diaphragm and liver. But at ESSI, we believe that for the most extreme cases, two experts are better than one.
We sat down with Dr. Vidali and Dr. Joe Raccuia, a renowned General Surgeon and Liver Specialist, to discuss why they join forces to treat “Extreme Anatomy.”
Breaking the “Pelvic Ceiling”
Dr. Andrea Vidali: “For most gynecologists, the upper abdomen is a ‘no-fly zone.’ But endometriosis doesn’t care about surgical specialties. Over my career, I made it a priority to master the anatomy of the diaphragm and the liver because my patients needed me to. I treat diaphragmatic endometriosis regularly because leaving it behind means leaving the patient in pain.
However, I also know that when you are dealing with the liver—a massive, vascular organ—or a full-thickness resection of the diaphragm near the heart, the stakes are incredibly high. That is why I bring Dr. Raccuia in. It’s not because I can’t do it; it’s because together we can do it faster, safer, and with more precision.”
The Power of the Double-Scrub
Dr. Joe Raccuia: “Andrea is unique. He is one of the very few gynecologists I’ve seen who is truly comfortable operating in the upper right quadrant. He knows the liver and diaphragm intimately.
But my background is different. As a liver and general surgeon, I’ve spent my life performing major hepatic resections and diaphragm repairs for non-gynecologic reasons. When we ‘double-scrub’ (operate together), you get the best of both worlds. You get Andrea’s expert eye for identifying subtle endometriosis lesions, combined with my general surgical capability to handle major organ repair if the disease has gone deep.”
Why “Ablation” Fails on the Diaphragm
Dr. Vidali: “Exactly. We see patients who were told their diaphragm was ‘treated,’ but the surgeon only burned the surface because they were afraid to go deeper. The diaphragm is thin. Behind it is the lung.
Because Dr. Raccuia and I are both comfortable in this space, we don’t just burn (ablate). If the disease has penetrated the muscle, we have the confidence to fully resect (cut out) that portion of the diaphragm and repair it instantly. We can strip disease off the liver surface without fear of bleeding because we both know how to control it.”
The Ultimate Safety Net
Dr. Raccuia: “It’s about redundancy and speed. If we encounter a massive nodule fusing the liver to the diaphragm, we tackle it together. Two pairs of expert hands, two brains that know the anatomy inside and out. It turns a 4-hour struggle into a 1-hour precise procedure. That means less time under anesthesia for the patient and a better recovery.”
Dr. Vidali: “It’s the ultimate safety net. We don’t just treat the pelvis; we treat the whole patient. Whether the disease is on the uterus or the diaphragm, we have the expertise in the room to remove it 100%.”
Do You Have “Northern” Symptoms?
If you experience these symptoms, your endometriosis may have traveled to the upper abdomen:
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Cyclic Shoulder Pain: Pain in the right shoulder tip during your period (caused by nerve irritation from the diaphragm).
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Pain with Deep Breathing: Sharp pain under the ribs when you take a deep breath during your cycle.
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Upper Abdominal Pain: Pain occurring high in the belly, near the ribs or stomach.
Don’t settle for a surgeon who stops at the belly button. At ESSI, Dr. Vidali and Dr. Raccuia provide expert, collaborative care for the most complex upper abdominal disease.
