‘I watched surgery performed through a patient’s belly button – it’s a game changer’

A top surgeon is pioneering life-changing treatment for women suffering from endometriosis — by performing operations entirely through a patient’s belly button. The agonising condition affects one in 10 UK women and occurs when cells similar to the lining of the womb grow elsewhere in the body.

Consultant gynaecologist Mr Amer Raza uses a single port (SP) robotic system to remove diseased tissue through one small incision. The Express watched an hour-long operation at London’s Cromwell Hospital, where he used the da Vinci SP robot’s arm to cut away lesions from the lining of a 26-year-old woman’s pelvis.

Sitting at a console a few feet away from the anaesthetised patient, Mr Raza used hand controls to precisely slice with scissors that cauterised as they cut. He said: “The single port has absolutely revolutionised every speciality. It has taught us to operate in a different way. I’m looking at this screen, we have the cameras in the patient’s pelvis, and it gives me a 3D view.

“It feels like the surgeon is sitting in the pelvis and all the instruments are in my fingers. As I move them, without any delay, the movements are translated into the patient’s abdomen. The precision of excision — removal of the disease — is second to none.”

The robotic arm has a greater range of motion than the human hand or standard keyhole tools, and the magnified view helps Mr Raza spare nerves. The ureter glows green on the screen for better visibility thanks to the insertion of a special dye.

Mr Raza explained: “Endometriosis simply means that all the structures inside are glued together. The anatomy is distorted. Anything which helps me to separate each layer safely, without causing bleeding or injury to ureters or blood vessels, is absolutely game-changing.”

Standard laparoscopic surgery for endometriosis involves using handheld tools to operate through multiple keyhole incisions. Mr Raza added: “When doing it laparoscopically, my assistant would be holding the camera with a 2D view, and my hands can shake.

“Now, you take all these variables away, and I’m sitting on a machine with no tension in my body. It allows us to very precisely excise the tissue without making them bleed, without tissue trauma, less risk of complication.”

The single port system was also approved last week in the UK and Europe for transvaginal procedures — surgery performed using the vagina as a natural entry point. Mr Raza said the new approval was “an exciting step forward for women’s surgery” that “brings together two powerful principles: the precision, control and advanced technology of robotic surgery with the potential to perform hysterectomy without visible abdominal incisions”.

A number of NHS hospitals are now using robotics for these procedures, but none are using the single port, which reduces scarring and can help patients recover faster.

Mr Raza was the first UK surgeon to adopt this approach. He started using the single port at Cromwell, a private hospital run by Bupa, in April 2025.

He has since performed more than 360 SP procedures. And he has clocked up more than 1,200 in total using da Vinci systems, which are made by medical device company Intuitive.

It was the consultant’s expertise in robotics that led Sahir Ahmed Evans to choose the hospital when she needed a full hysterectomy for severe adenomyosis. The condition is closely related to endometriosis and occurs when the inner lining of the uterus grows into the outer muscular wall.

Sahir, 50, suffered from debilitating periods, anxiety, migraines and chronic pain for more than a decade after giving birth to her fourth child. She said: “I struggled to look after the kids. I struggled to run my business. It was a constant health battle.

“It was 10-15 years of constantly seeking some kind of medical help and advice, going to the GP. I was sent for several scans that I don’t think were ever actioned. I had several collapses.”

The former fitness instructor was finally referred to an NHS specialist in 2023. She was put into medical menopause, but her symptoms returned after 18 months.

Sahir said the dismissive attitude of some doctors she encountered made her believe “that I had an issue, that I was weak, and I should be able to manage better”. She added: “I started searching privately.”

After tests at Cromwell, Mr Raza confirmed she had adenomyosis with lesions all over her bowel. She also had rare umbilical endometriosis, which had caused bleeding from her belly button.

Sahir needed a hysterectomy performed by a multidisciplinary team, including a bowel surgeon, and was warned she might require a stoma bag. She said: “It was very scary. I was apprehensive, nervous, anxious, but I also knew I had to get it done.”

Sahir travelled from her home in Cardiff to London with her husband Dennis last October, renting an Airbnb for 10 days so she could recover before returning home.

The consultations, tests, procedure and travel arrangements cost her more than £32,000 — but she says it was worth every penny. She added: “Thankfully, they got away with a bowel resection; it was about 7cm of the bowel they had to take out.

“I didn’t have this post-surgery excruciating pain that people talk about, and I believe that was thanks to the robotic surgery and the expertise of my surgeons. They were just fantastic. Talking to other women who’ve had just the general endometriosis excision and hysterectomy, their recoveries are vastly different.”

Sahir is still recovering and recently started training and lifting weights again. She has suffered no more painful flare-ups.

She remembers Mr Raza telling her she must have been strong to endure her condition for so long. Sahir added: “I just broke down because it was the first time somebody said it to me. I realised that I’m not actually weak and my body has been through so much.”

NHS waiting lists for endometriosis surgery can stretch to two or three years. Cromwell aims to treat patients within three months of a diagnosis. Most surgical theatres perform three endometriosis operations per day, but using the SP robotic system means Mr Raza’s team routinely gets through four or five daily.

During our visit, two surgeons had travelled from Romania to observe the operation. NHS clinicians are also regular guests, Mr Raza said. He added: ”That’s how we are contributing towards the NHS, even in the private sector.

“We are teaching and training doctors who can’t access it now. They’re coming, seeing how we operate, and going back to their trusts to say: ‘Can we have the system?’”

Patients also come from abroad — around 30% of Cromwell’s endometriosis patients are from the Middle East, Europe or the US.

The NHS last year announced plans to increase the number of procedures performed with robotics annually from 70,000 to half a million over the next decade.

Mr Raza previously worked as a consultant at Chelsea and Westminster Hospital NHS Foundation Trust. He said he would like to see the NHS given the resources to increase capacity for this vital surgery and boost the use of technology such as the single port.

But he hopes that, ultimately, fewer complex surgeries may be needed if more cases of endometriosis are identified early. Women currently wait an average of eight years and ten months from a first GP appointment to receive a diagnosis.

Mr Raza added: “The dream has to be that this whole thing of normalising endometriosis goes out of the window. Why do women have to have severe pains for seven, eight years? Can [diagnosis] happen in the first year, first six months?

“If that happens, then possibly we will not need these very complex operations that we do now. When [patients] are diagnosed on time, when they are treated in the correct way, when they have proper excision surgery, it changes their life.

“No doctor can claim to have cured endometriosis, but we can achieve some degree of normality in the pelvis. We can reduce the pain and suffering.”

A Department of Health and Social Care spokesperson said: “For millions of women, endometriosis has a devastating impact on their wellbeing, their relationships, and their participation in the workforce.