Where to Begin: Quality First
Locating a true excision specialist can be challenging for several reasons — there are relatively few surgeons with advanced skills, and the financial considerations can feel daunting once you find one who seems right for you. The process really begins with identifying the right surgeon first, then determining how to navigate the financial aspects. Reversing that order can lead to regret, as poorly performed or incomplete initial surgeries often make future procedures more complex and less effective. In endometriosis care, the second or third surgery is almost never easier than the first.
Trusted Resources for Identifying Qualified Surgeons
Only a few well-moderated sources exist that reliably help patients locate qualified excision surgeons. Among these, Nancy’s Nook stands out as one of the most valuable. It maintains strict oversight, focusing on patient outcome–based feedback, and its content is curated by Nancy Petersen, who has decades of experience in the field and previously collaborated with pioneer Dr. David Redwine. Because of this rigorous review, information on Nancy’s Nook provides a solid foundation for patients beginning their search.
However, patient experiences, while informative, shouldn’t be the sole criterion in choosing your surgeon. Technical ability is difficult to judge — especially if you don’t have a medical background. Asking about training programs or the number of surgeries performed provides only limited insight. True surgical skill goes far beyond résumé details.
Peer-Reviewed Verification: The iCareBetter Model
Another reputable resource is iCareBetter, where Dr. Steve Vasilev is also listed. This platform uses a more objective process: peer review of actual surgical videos. Surgeons who wish to be listed must undergo video-based vetting by recognized experts, who determine whether the applicant demonstrates advanced surgical competence. While this process doesn’t evaluate every aspect of patient care — such as bedside manner or communication style — it does confirm the surgeon’s ability to perform high-level excision safely and effectively. Surgeons willing to have their work reviewed by peers show a commendable level of confidence and transparency.
Excision vs. Ablation: Understanding the Difference
Excision involves carefully cutting out endometriotic tissue, while ablation (or fulguration) destroys lesions on the surface using heat or electrical energy. Studies suggest both methods may relieve symptoms when disease is superficial and located away from critical structures like the bowel or ureters. The challenge is that it’s impossible to tell how deep a lesion extends just by looking at it — meaning that ablation can easily leave behind active disease.
While some patients experience symptom relief after ablation, true excision remains the clinically preferred approach, as it removes disease at the root. Those who improved after ablation likely had only superficial disease, whereas those who did not may have had deeper lesions that were never eradicated. Unfortunately, it’s difficult to design research trials that capture this nuance, since outcomes depend heavily on the surgeon’s skill level. In short, success depends not only on what technique is used but on who performs it — and how expertly.
Surgical Techniques and Terminology
Complete excision in complex cases — such as those involving prior surgeries or distorted anatomy — can only be achieved by a surgeon with advanced, specialized training in endometriosis surgery, not just minimally invasive gynecologic surgery (MIGS). Even negative imaging cannot rule out disease, so the lead surgeon must be prepared for extensive findings.
If bowel, bladder, or ureteral involvement is suspected, the surgical team must be multidisciplinary and tightly coordinated. Ask your surgeon whether these specialists are present throughout the case or merely “on call.” In the latter situation, care can become fragmented.
Wide excision refers to removing a broader margin of tissue to ensure only healthy tissue remains. There’s no universal agreement about when or how wide margins should be, and the decision relies heavily on the surgeon’s judgment and experience. Too little excision risks recurrence; too much may cause unnecessary harm.
Some surgeons mix excision and ablation, removing a few samples for pathology but ablating many others. This approach may indicate limited belief in excision or limited technical skill. The only clear exception is treating small lesions on sensitive structures, such as the ovarian surface, where fertility preservation is critical.
Finally, incomplete removal remains common. Many general gynecologists, untrained in advanced excision, manage lesions with ablation instead. Ideally, if endometriosis is unexpectedly found during a non-specialist surgery, the case should be biopsied for confirmation and then referred to an expert, rather than incompletely treated.
What If You Can’t Afford an Excision Specialist?
It’s true that many top excision surgeons are out-of-network providers. However, more are beginning to accept insurance, and advocacy efforts continue to push for broader access.
There’s a reason many remain out-of-network: current insurance coding and reimbursement systems make no distinction between ablation and excision. An ablation that takes one hour and an excision that takes four hours are reimbursed equally. Advanced excision requires years of extra training — and significant investment by the surgeon — but the payment structure doesn’t reflect that. Until coding and reimbursement catch up to reality, this imbalance will persist.
Even when in-network surgeons perform excision, they may have limited time per visit — often only 15 to 20 minutes — compared to the longer, more personalized consultations possible with out-of-network care. Many patients prioritize cost, but others value the ability to spend time discussing surgical details, recovery, and holistic healing. Excision is only one piece of recovery; a personalized pre- and postoperative plan is equally vital.
Whatever your financial path, the most important factor is comfort and confidence in your surgeon.
Navigating the System: Practical Tips
1. Explore insurance options.
If you’re on an HMO plan with a restricted network, consider switching to a PPO or other plan during open enrollment. PPOs often offer partial reimbursement for out-of-network specialists — an important option if there are no qualified surgeons nearby.
2. Work with your insurance company.
Persistence can pay off. Patients have successfully petitioned insurers to cover out-of-network excision when no comparable in-network specialist is available. Expect to invest time and patience, as it often takes multiple calls and appeals.
3. Ask your chosen surgeon for support.
Many established excision specialists have dedicated staff who assist patients with preauthorization, gap exceptions, or single-case agreements, often reducing out-of-pocket costs significantly.
4. Reframe the investment.
It may help to view excision surgery as an investment in your long-term health rather than an expense. People often spend far more on cars or material goods that depreciate, yet hesitate to invest in health — the foundation of everything else. For many, expertly performed excision has been life-changing, restoring productivity, fertility, and quality of life.
Final Thoughts
Take time to evaluate your options carefully. The “right” surgeon isn’t just the most affordable or the most convenient — it’s the one with the skill, training, and commitment to address your disease completely and safely. The path to healing from endometriosis often begins with the courage to seek true expertise — and the persistence to secure the care you deserve.