Table of ContentsView AllTable of ContentsLaparoscopyEndo Lesion Removal TechniquesCo-Occurring ProceduresQualifying for SurgeryRecoveryRepeat SurgeryWho Is an Endo Specialist?
Table of ContentsView All
View All
Table of Contents
Laparoscopy
Endo Lesion Removal Techniques
Co-Occurring Procedures
Qualifying for Surgery
Recovery
Repeat Surgery
Who Is an Endo Specialist?
Laparoscopic excision is the most common surgery to removeendometriosis(endo) lesions. Lesion removal aims to reduce pain,stagethe disease (e.g., stages 1, 2, 3, or 4), and increase fertility when applicable. However, a healthcare provider may consider other surgical techniques based on your health and treatment goals.
This article discusses surgical techniques, other surgeries that may occur simultaneously, when surgery is medically necessary, endometriosis specialists, and recovery expectations.
Thomas Barwick / Getty Images
Laparoscopy Is the Most Common Endometriosis Operation
Forlaparoscopy, the most common endometriosis operation, surgeons make two to four small, keyhole incisions in the navel (belly button) and lower abdomen. They then insert a laparoscope (thin tube with a light and camera) into the incisions to perform surgery.
Alaparotomy(open abdominal surgery with a large incision) is a more extensive and less common surgery. However, it is a valuable option for severe endometriosis cases in which the surgeon needs to remove thick scar tissue.
In the Operating Room: Techniques to Remove Endometriosis
Excision surgeryis the gold standard for endometriosis and involves the removal of the entire endometriosis lesion—including the root—with a scalpel-like cutting tool. This technique is most common for those with deep infiltrating endometriosis andendometriomas(chocolate ovarian cysts).
Ablation (fulguration) is when the surgeon uses electrosurgery or cautery (lasers or heat) to burn or melt the lesions' surfaces. This technique does not remove the root of the lesion. Ablation is helpful for smaller, superficial lesions or in cases in which excision may prove challenging.
Your surgeon may use arobotic-assisted techniqueduring laparoscopy. This is when the surgeon controls robotic arms that attach to surgical instruments, cameras, and other tools from a console.
What Size Endometriomas Are Removed?The standard suggestion is that surgeons remove endometriomas more than 4 centimeters (cm) wide.
What Size Endometriomas Are Removed?
The standard suggestion is that surgeons remove endometriomas more than 4 centimeters (cm) wide.
Procedures That May Also Be Provided in Endometriosis Surgery
Depending on your overall health, thelocationof the endometriosis lesions, and your health goals, the surgeon may recommend one of the following concurrent surgeries during endometriosis surgery:
How to Have Endometriosis Surgery
The first step toward endometriosis surgery is to consult an endometriosis specialist. They can assess your symptoms, order diagnostic tests, and explore nonsurgicaltreatmentssuch as lifestyle changes, hormones, physical therapy, and pain management.
This is important because many insurance companies require you to try other therapies before approving surgery.
If your provider suggests surgery, collaborate with their office staff and insurance company to receive preauthorization. Do this four to six weeks in advance to verify coverage details and confirm potential out-of-pocket expenses.
If the insurance companydeniesthe preauthorization, engage in its appeals process with support from healthcare providers and advocacy groups.
Deeming Surgery “Medically Necessary”Your healthcare provider’s documentation helps support the case for surgery as it outlines the severity of symptoms and failure of other treatments. The following types of documentation help the insurance company decide if surgery ismedically necessary.Detailed symptom assessmentFertility concernsImaging testsImpact on your quality of lifeLaparoscopic findings (if you had one for diagnostic purposes)Pelvic examinationTreatment history
Deeming Surgery “Medically Necessary”
Your healthcare provider’s documentation helps support the case for surgery as it outlines the severity of symptoms and failure of other treatments. The following types of documentation help the insurance company decide if surgery ismedically necessary.Detailed symptom assessmentFertility concernsImaging testsImpact on your quality of lifeLaparoscopic findings (if you had one for diagnostic purposes)Pelvic examinationTreatment history
Your healthcare provider’s documentation helps support the case for surgery as it outlines the severity of symptoms and failure of other treatments. The following types of documentation help the insurance company decide if surgery ismedically necessary.
Endometriosis Surgery Recovery
In comparison to a laparotomy, laparoscopic surgery benefits include:
Short-Term Recovery
You may experience discomfort, fatigue, and bloating in the first few days. The discomfort may be in your abdomen, back, shoulders (from the gas that expands your abdomen during surgery), and throat (from the tube that helps you breathe during surgery). You can typically manage these symptoms with pain medications, throat lozenges, and rest.
Long-Term Recovery
Your healthcare team will give you post-op instructions about gradually increasing activity levels and avoiding heavy lifting or strenuous activities during recovery. Total recovery time takes several weeks.
Repeat Endometriosis Surgery
Though surgery can remove or reduce endo lesions, it does not guarantee a permanent cure. There is a 40% to 50% chance of regrowth of lesions within the first five years of surgery. Therisk of recurrenceis higher with ablation than with excision. Hormonal suppression therapy following surgery may also decrease the risk of recurrence.
Repeat endometriosis surgery may become necessary if your symptoms return or you have persistent issues. However, many people feel it is worth having surgery because it provides an official diagnosis and direction for their treatment plan.
Who Is an Endometriosis Specialist?
An endometriosis specialist is an obstetrician-gynecologist (OB/GYN) and surgeon with specialized training and extensive experience treating endometriosis. They have a deep understanding of the complexities of endometriosis and keep up with the latest advancements in treatment.
When evaluating an endometriosis specialist, you can ask questions such as:
Consider getting referrals from an endometriosis support group likeNancy’s Nookor online directories likeiCareBetter.
Factors Influencing Surgery SuccessFactors that influence surgery success include:Concurrent surgeries (increase risk of complications)Expertise of the surgeon and teamLaparotomy versus laparoscopy (laparotomy increases the risk of complications)Scarring from previous surgeriesSeverity of endo lesionsEven with expert excision, endo pain may continue after surgery due topelvic floordysfunction or secondary complications.
Factors Influencing Surgery Success
Factors that influence surgery success include:Concurrent surgeries (increase risk of complications)Expertise of the surgeon and teamLaparotomy versus laparoscopy (laparotomy increases the risk of complications)Scarring from previous surgeriesSeverity of endo lesionsEven with expert excision, endo pain may continue after surgery due topelvic floordysfunction or secondary complications.
Factors that influence surgery success include:
Even with expert excision, endo pain may continue after surgery due topelvic floordysfunction or secondary complications.
A Word From VerywellIt is very important that people seeking surgery for endometriosis find a specialist trained in minimally invasive surgery (MIS). The technique and the skills of such a surgeon can be the difference between a successful outcome and one that is lacking.—PETER WEISS, MD, MEDICAL EXPERT BOARD
A Word From Verywell
It is very important that people seeking surgery for endometriosis find a specialist trained in minimally invasive surgery (MIS). The technique and the skills of such a surgeon can be the difference between a successful outcome and one that is lacking.—PETER WEISS, MD, MEDICAL EXPERT BOARD
It is very important that people seeking surgery for endometriosis find a specialist trained in minimally invasive surgery (MIS). The technique and the skills of such a surgeon can be the difference between a successful outcome and one that is lacking.
—PETER WEISS, MD, MEDICAL EXPERT BOARD
Summary
Though there is no cure for endometriosis, surgery to remove lesions can help alleviate symptoms and increase fertility. Laparoscopic excision or ablation is the most common type of endometriosis surgery. The expertise of the surgeon greatly impacts the success of the procedure. Endometriosis is a chronic condition, and additional treatments or surgeries may become necessary over time.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Csirzó Á, Kovács DP, Szabó A,et al.Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis. 2024;Surg Endosc38: 529–539. doi:10.1007/s00464-023-10587-9Kalaitzopoulos DR, Samartzis N, Kolovos GN,et al.Treatment of endometriosis: a review with comparison of 8 guidelines.BMC Women’s Health2021:397. doi:10.1186/s12905-021-01545-5Tomassetti C, Johnson NP, Petrozza J, et. al.An international terminology for endometriosis, 2021.Facts, Views & Vision in ObGyn. 2021;13(4):295-304. doi:10.52054/FVVO.13.4.036Nowak-Psiorz I, Ciećwież SM, Brodowska A, Starczewski A.Treatment of ovarian endometrial cysts in the context of recurrence and fertility.Adv Clin Exp Med. 2019;28(3):407-413. doi: 10.17219/acem/90767Zanelotti A, DeCherney AH.Surgery and endometriosis.Clinical Obstetrics and Gynecology. 2017;60(3):477. doi:10.1097/GRF.0000000000000291HealthCare.gov.Appealing a health plan decision.The American College of Obstetricians and Gynecologists.Laparoscopy.Zakhari A, Delpero E, McKeown S, et al.Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis.Hum Reprod Update. 2021;27(1):96-107. doi: 10.1093/humupd/dmaa033Parasar P, Ozcan P, Terry KL.Endometriosis: epidemiology, diagnosis and clinical management.Current obstetrics and gynecology reports. 2017;6(1):34. doi:10.1007/s13669-017-0187-1Horne AW, Missmer SA.Pathophysiology, diagnosis, and management of endometriosis.BMJ.2022;379:e070750 doi:10.1136/bmj-2022-070750Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A.Complications following surgeries for endometriosis: a systematic review protocol.PLOS ONE. 2023;8(5):e0285929. doi:10.1371/journal.pone.0285929
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Csirzó Á, Kovács DP, Szabó A,et al.Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis. 2024;Surg Endosc38: 529–539. doi:10.1007/s00464-023-10587-9Kalaitzopoulos DR, Samartzis N, Kolovos GN,et al.Treatment of endometriosis: a review with comparison of 8 guidelines.BMC Women’s Health2021:397. doi:10.1186/s12905-021-01545-5Tomassetti C, Johnson NP, Petrozza J, et. al.An international terminology for endometriosis, 2021.Facts, Views & Vision in ObGyn. 2021;13(4):295-304. doi:10.52054/FVVO.13.4.036Nowak-Psiorz I, Ciećwież SM, Brodowska A, Starczewski A.Treatment of ovarian endometrial cysts in the context of recurrence and fertility.Adv Clin Exp Med. 2019;28(3):407-413. doi: 10.17219/acem/90767Zanelotti A, DeCherney AH.Surgery and endometriosis.Clinical Obstetrics and Gynecology. 2017;60(3):477. doi:10.1097/GRF.0000000000000291HealthCare.gov.Appealing a health plan decision.The American College of Obstetricians and Gynecologists.Laparoscopy.Zakhari A, Delpero E, McKeown S, et al.Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis.Hum Reprod Update. 2021;27(1):96-107. doi: 10.1093/humupd/dmaa033Parasar P, Ozcan P, Terry KL.Endometriosis: epidemiology, diagnosis and clinical management.Current obstetrics and gynecology reports. 2017;6(1):34. doi:10.1007/s13669-017-0187-1Horne AW, Missmer SA.Pathophysiology, diagnosis, and management of endometriosis.BMJ.2022;379:e070750 doi:10.1136/bmj-2022-070750Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A.Complications following surgeries for endometriosis: a systematic review protocol.PLOS ONE. 2023;8(5):e0285929. doi:10.1371/journal.pone.0285929
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Csirzó Á, Kovács DP, Szabó A,et al.Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis. 2024;Surg Endosc38: 529–539. doi:10.1007/s00464-023-10587-9Kalaitzopoulos DR, Samartzis N, Kolovos GN,et al.Treatment of endometriosis: a review with comparison of 8 guidelines.BMC Women’s Health2021:397. doi:10.1186/s12905-021-01545-5Tomassetti C, Johnson NP, Petrozza J, et. al.An international terminology for endometriosis, 2021.Facts, Views & Vision in ObGyn. 2021;13(4):295-304. doi:10.52054/FVVO.13.4.036Nowak-Psiorz I, Ciećwież SM, Brodowska A, Starczewski A.Treatment of ovarian endometrial cysts in the context of recurrence and fertility.Adv Clin Exp Med. 2019;28(3):407-413. doi: 10.17219/acem/90767Zanelotti A, DeCherney AH.Surgery and endometriosis.Clinical Obstetrics and Gynecology. 2017;60(3):477. doi:10.1097/GRF.0000000000000291HealthCare.gov.Appealing a health plan decision.The American College of Obstetricians and Gynecologists.Laparoscopy.Zakhari A, Delpero E, McKeown S, et al.Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis.Hum Reprod Update. 2021;27(1):96-107. doi: 10.1093/humupd/dmaa033Parasar P, Ozcan P, Terry KL.Endometriosis: epidemiology, diagnosis and clinical management.Current obstetrics and gynecology reports. 2017;6(1):34. doi:10.1007/s13669-017-0187-1Horne AW, Missmer SA.Pathophysiology, diagnosis, and management of endometriosis.BMJ.2022;379:e070750 doi:10.1136/bmj-2022-070750Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A.Complications following surgeries for endometriosis: a systematic review protocol.PLOS ONE. 2023;8(5):e0285929. doi:10.1371/journal.pone.0285929
Csirzó Á, Kovács DP, Szabó A,et al.Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis. 2024;Surg Endosc38: 529–539. doi:10.1007/s00464-023-10587-9
Kalaitzopoulos DR, Samartzis N, Kolovos GN,et al.Treatment of endometriosis: a review with comparison of 8 guidelines.BMC Women’s Health2021:397. doi:10.1186/s12905-021-01545-5
Tomassetti C, Johnson NP, Petrozza J, et. al.An international terminology for endometriosis, 2021.Facts, Views & Vision in ObGyn. 2021;13(4):295-304. doi:10.52054/FVVO.13.4.036
Nowak-Psiorz I, Ciećwież SM, Brodowska A, Starczewski A.Treatment of ovarian endometrial cysts in the context of recurrence and fertility.Adv Clin Exp Med. 2019;28(3):407-413. doi: 10.17219/acem/90767
Zanelotti A, DeCherney AH.Surgery and endometriosis.Clinical Obstetrics and Gynecology. 2017;60(3):477. doi:10.1097/GRF.0000000000000291
HealthCare.gov.Appealing a health plan decision.
The American College of Obstetricians and Gynecologists.Laparoscopy.
Zakhari A, Delpero E, McKeown S, et al.Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis.Hum Reprod Update. 2021;27(1):96-107. doi: 10.1093/humupd/dmaa033
Parasar P, Ozcan P, Terry KL.Endometriosis: epidemiology, diagnosis and clinical management.Current obstetrics and gynecology reports. 2017;6(1):34. doi:10.1007/s13669-017-0187-1
Horne AW, Missmer SA.Pathophysiology, diagnosis, and management of endometriosis.BMJ.2022;379:e070750 doi:10.1136/bmj-2022-070750
Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A.Complications following surgeries for endometriosis: a systematic review protocol.PLOS ONE. 2023;8(5):e0285929. doi:10.1371/journal.pone.0285929
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
