Common Questions

This site is here to educate and guide you about endometriosis, related gynecologic cancers, and complex pelvic conditions. Our goal is to empower you to make informed choices about your health. While we hope to serve you as a patient, the information here is general and should be combined with the advice of a trusted healthcare provider.

Endometriosis can invade tissues much like cancer, sometimes involving the bowel, bladder, ureters, or even the diaphragm. These are delicate, high-risk areas that require a surgeon trained in complex pelvic surgery — the same skills used in advanced cancer operations.

Because endometriosis is also linked to a higher risk of ovarian cancer, having a gynecologic oncologist like Dr. Vasilev involved ensures that any suspicious tissue can be addressed immediately and safely.

The primary benefits include:

• Faster recovery: Most patients go home the same day or next morning.
• Less pain & blood loss: Smaller incisions and gentler tissue handling.
• Better outcomes: More complete excision with less trauma.
• Cosmetic benefit: Tiny incisions that often fade to near-invisible scars.

Yes. The robot does not operate on its own — your surgeon controls every movement. The technology simply improves precision and steadiness, making complex pelvic surgery safer and more effective.

When hysterectomy is recommended for severe endometriosis or related conditions, it is performed through several tiny incisions — often hidden near the bikini line or belly button — and the uterus is usually removed through the vagina. This avoids large abdominal cuts, reduces pain, and speeds healing. Whether a hysterectomy is right for you depends on your age, fertility wishes, and overall treatment plan.

Excision surgery is the “gold standard” treatment for endometriosis. It removes visible endometriosis implants rather than just burning or cauterizing them. At the Lotus Endometriosis Institute, we use advanced, robotically assisted minimally invasive surgery to precisely excise implants, even in hard-to-reach places, while protecting vital organs like the bladder, bowel, and ureters. This approach leads to better pain relief, fertility outcomes, and lower recurrence rates compared to less complete techniques.

Robotic-assisted surgery uses very small incisions and a 3D camera system that gives your surgeon a magnified view inside your pelvis. The instruments move like tiny wrists, allowing extremely precise dissection around sensitive structures. This is especially important for advanced endometriosis, where implants can be deep or hidden. Robotic technology helps minimize complications, pain, and recovery time while achieving a more thorough excision.

Simple laparoscopy can accomplish the same result in skilled hands, but this is typically only true for less advanced endometriosis. For advanced disease, robotically assisted minimally invasive excision is today’s gold standard due to its extremely precise level of control and advanced optics.

No. Think of the robot as a highly sophisticated tool, not an autonomous machine. Dr. Vasilev sits at the console the entire time and directs each movement with full control.

Endometriosis is endometrial-like tissue outside the uterus, while adenomyosis is endometrial-like tissue within the uterine muscle. Both cause pain and bleeding but differ in location (Kho et al. 2021). How these abnormal cells get to these locations is a matter of much debate and ongoing research. 

MRI and high-resolution transvaginal ultrasound can detect adenomyosis, endometriomas and deep endometriosis, though small lesions and the most common superficial spreading endometriosis may be missed (Chapron et al. 2020).  Therefore it can help plan surgery and treatment but should not be used to rule out endometriosis or adenomyosis. 

Currently, no validated biomarker (e.g., CA-125) is reliable for diagnosis; research is ongoing (Hirsch et al. 2018).  Molecular tests are likely to be available within the next 5 years or so.

Yes, unfortunately coexistence is common and complicates diagnosis and treatment (Kho et al. 2021).

Yes, modern imaging allows diagnosis even in adolescents and nulliparous women (Dason et al. 2023).

Endometriosis most often causes pelvic pain, infertility, and painful periods, as well as bowel symptoms; adenomyosis typically causes heavy, painful bleeding and an enlarged, soft tender uterus (Chapron et al. 2020).

Currently, no validated biomarker (e.g., CA-125) is reliable for diagnosis; research is ongoing (Hirsch et al. 2018).  Molecular tests are likely to be available within the next 5 years or so.

Symptoms mimic many other conditions, many providers lack training, and patients often face dismissal, leading to diagnostic delays (Hirsch et al. 2018). Often the various specialists who are consulted (gynecologists, urologists, gastroenterologists, surgeons) look at the symptoms through a very narrow perspective, leading to incomplete or uninformed opinions. 

No, but adenomyosis is strongly associated with heavy, painful periods, especially in women in their 30s–40s (Chapron et al. 2020). Myomas can also cause pain and abnormal bleeding.

Sadly, patients wait 7–10 years on average before proper diagnosis, primarily due to lack of quality medical care. However, earlier use of imaging and awareness can reduce this (Hirsch et al. 2018).  It is important to consult an endometriosis specialist who can order the proper tests and map out the right strategy for you.

NSAIDs (e.g. Motrin) reduce pain, and hormonal therapies (combined contraceptives, progestins, GnRH analogues) suppress symptoms but don’t cure disease (Hirsch et al. 2018).

They are effective for pain but have side effects like bone loss and menopausal symptoms, so use is often time-limited (Kho et al. 2021).  Some effects can be very damaging and long lasting.

Hysterectomy is a definitive cure, but conservative options may exist for symptom control and fertility preservation (Dason et al. 2023).  This is highly individual but if the adenomyosis is widespread in the uterine muscle it is like a spider web and not removable short of a hysterectomy. 

Evidence is limited but diet changes, acupuncture, and pelvic floor physiotherapy can help manage pain alongside medical care (Hirsch et al. 2018).

Endometriosis recurrence is common, especially in the case of endometriomas or incomplete surgical excision of visible disease (20–40% within 2-3 years post-surgery), while adenomyosis symptoms may recur after uterine-sparing procedures (Kho et al. 2021). However, with a specialist surgeon, proper excision and by optimizing hormones after surgery, recurrence risk can be as low as <5% long term.  Endometriosis is not likely one single disease, so the biology of the disease in individuals can vary and influence recurrence.  

Yes, combined oral contraceptives and the levonorgestrel IUD can reduce pain and bleeding in both conditions (Dason et al. 2023).  However, they are not curative.

Excision surgery has better long-term outcomes and lower recurrence compared to ablation for endometriosis (Hirsch et al. 2018).

Adenomyomectomy, uterine artery embolization, and high-intensity focused ultrasound may reduce symptoms, though recurrence is likely (Chapron et al. 2020).

Both conditions can impair fertility in general. Fertility-sparing surgery or assisted reproductive technologies (like IVF) may be needed (Dason et al. 2023).  Endo excision can improve successful pregnancy and take home baby rate.

By and large, general gynecologists lack the training for accurate diagnosis and optimal endometriosis excision surgery.  Seek multidisciplinary centers or vetted surgeon lists (e.g., Nancy’s Nook, iCareBetter), as expertise varies extremely widely (Omtvedt et al. 2022).  There is no reliable long-term outcomes database.  So, the only options are objective video-vetting (iCareBetter) and patient experience reviews (Nancy’s Nook and others).  Neither is  perfect but taking time to seek out the best, highest trained and experienced surgeon is well worth the time.