Excision Surgery

Evidence-based insights on surgical excision: indications, advanced techniques (ICG, robotic), expected benefits for pain and fertility, pathology, risks, recovery, and strategies to lower recurrence.

Overview

Excision surgery removes endometriosis lesions at their root rather than burning the surface, aiming to clear disease from the peritoneum, ovaries, bowel, bladder, nerves, and diaphragm. It is especially useful for deep infiltrating disease and endometriomas, where complete removal can reduce pain generators, free scarred organs, and improve the pelvic environment for conception. Outcomes depend on careful mapping, surgeon expertise, and a multidisciplinary approach when bowel or urinary organs are involved, with planning supported by Imaging for Surgery, MRI, and Ultrasound.

Learn how surgeons decide when excision is preferred over ablation, what advanced techniques (nerve‑sparing dissection, ureterolysis, cystectomy, selective fluorescence like ICG) can add, and how pathology of removed tissue confirms diagnosis and guides follow‑up. Guidance also covers realistic benefits for pain and fertility, strategies to limit complications and adhesions, and ways to lower recurrence through complete excision and coordinated aftercare in concert with Medical Management, Pelvic Floor PT, and individualized nutrition. When focal adenomyosis is the pain driver, uterus‑sparing adenomyomectomy is a different operation addressed under Focal Adenomyosis and adenomyosis Surgical Options.

How is excision different from ablation, and who benefits most?

Excision cuts out lesions with a margin, aiming to remove active and fibrotic disease; ablation burns the surface and may leave deeper disease behind. Evidence favors excision for deep lesions and endometriomas, where complete removal lowers recurrence and improves pain. Superficial lesions may respond to either approach, but choice depends on goals and surgeon skill, discussed in the context of Laparoscopy.

What pain and fertility outcomes are realistic after excision?

Many people experience meaningful pain reduction within months, with quality‑of‑life gains when deep disease is fully removed. Fertility can improve by restoring pelvic anatomy and lowering inflammation; some conceive spontaneously, while others pair surgery with timed attempts or IVF & ART based on age, ovarian reserve, and findings. Expectations should be individualized, especially in extensive Deep Infiltrating Endometriosis involving bowel or bladder.

What are the main risks, and how are they minimized?

Risks include bleeding, infection, adhesions, and injury to nearby organs such as bowel, bladder, or ureter; risks rise with deeply infiltrating disease. High‑volume teams use preoperative mapping, nerve‑sparing techniques, and meticulous hemostasis to limit complications, with support from colleagues experienced in Bowel Endometriosis and Bladder Endometriosis. Your plan also includes strategies to reduce adhesions and a clear path for Postoperative Recovery.

Do I need special imaging or prep before excision?

Targeted transvaginal ultrasound and/or pelvic MRI help map nodules, tethered organs, and endometriomas so the team can plan the safest approach. Some cases require bowel prep or ureteral stents based on imaging; details of surgical mapping and technology are outlined in Imaging for Surgery.

What happens to removed tissue, and does pathology matter?

Lesions are sent to pathology to confirm endometriosis and characterize features such as endometriomas or fibrosis, and to exclude rare malignancy in ovarian cysts. Pathology supports diagnosis but does not capture microscopic spread everywhere; symptom relief relies on thorough surgical removal and coordinated follow‑up with Medical Management to reduce recurrence.