Choosing an Endometriosis Surgeon in Los Angeles

Defining What “Best” Means in Endometriosis Surgery

Many patients begin their search for care by typing phrases like “best endometriosis doctor”, “best endometriosis surgeon in Los Angeles”, or “endometriosis specialist near me” into search engines. While these queries are understandable, they tend to produce a mix of clinicians with widely varying levels of training and surgical capability. The term “best” becomes difficult to interpret without a clear understanding of what differentiates one surgeon from another.

This article aims to clarify what “best” actually means in the context of endometriosis care by explaining the major differences in surgical training pathways, operative skills, and case complexity. It provides a structured, objective framework that helps patients identify which level of expertise aligns with their medical needs. In doing so, it moves beyond generic search results and toward a concrete, evidence-based understanding of surgical quality. Selecting the right surgeon for endometriosis is one of the most consequential decisions a patient will make. Endometriosis is a complex disease, and cases vary widely—from superficial peritoneal implants to deep infiltrating endometriosis involving the bowel, bladder, ureters, nerves, and diaphragm. These variations directly influence which type of surgeon is most appropriate. Unfortunately, many patients are not aware that "endometriosis surgeon" can describe clinicians with dramatically different levels of training, experience, and operative capability.

This article outlines the three main categories of surgeons who treat endometriosis, explains the differences in their training, and clarifies what each category is equipped to manage. This framework allows patients to make informed decisions and understand why surgeons with advanced subspecialty backgrounds—particularly those trained in gynecologic oncology—bring a distinct level of surgical expertise for complex cases.

The Role of Surgical Training in Endometriosis Care

Endometriosis often affects anatomical structures well beyond the reproductive organs (Becker et al., 2022; ESGE/ESHRE/WES, 2020). Deep infiltrating endometriosis may involve the bowel, bladder, ureters, and pelvic nerves (Becker et al., 2022; ESGE/ESHRE/WES, 2020; Leborne et al., 2022). Treating these forms of the disease requires precise knowledge of pelvic anatomy and the ability to safely dissect in areas of dense scarring or altered anatomy.

The surgeon's training pathway determines the extent of their operative capabilities. While many surgeons perform laparoscopy or laparoscopic excision, only a small subset have formal subspecialty training in multi-organ pelvic surgery.

Tier 1: General Obstetrician–Gynecologists

General OB-GYNs complete a four-year residency that includes training in a broad range of women’s health concerns. They perform routine laparoscopic procedures and can usually treat mild or superficial endometriosis. However, their residency training does not include advanced retroperitoneal dissection, ureteric surgery, bladder reconstruction, or bowel surgery. As a result, general OB-GYNs typically:

• • Treat mild to moderate disease.
  • Avoid operating on bowel, bladder, or ureteric endometriosis.
  • Rely on ablation or partial excision.
  • Refer complex cases or work with co-surgeons.

They serve an important role but are not equipped for advanced disease.

Tier 2: Minimally Invasive Gynecologic Surgeons and High-Volume Excision Surgeons

Some OB-GYNs pursue additional minimally invasive gynecologic surgery (MIGS) training or build high-volume laparoscopic experience. MIGS fellowships focus on advanced laparoscopy, including excision of endometriosis (Cho et al., 2023).

These surgeons generally:

• • Perform high-quality laparoscopic or robotic excision.
  • Manage superficial to moderately deep infiltrating endometriosis.
  • Are much better at fertility-preserving approaches.
  • Collaborate with colorectal or urologic surgeons for bowel or ureteric disease and gynecologic oncologists for general pelvic distorted anatomy such as "frozen pelvis."

This group includes many excellent, well-known clinicians; however, fellowship training in MIGS does not encompass the full spectrum of multi-organ pelvic surgery required for the most complex cases. Few have a background and training focused on endometriosis only. Most have broad training which including management of multiple benign gynecologic diseases.

Tier 3: Gynecologic Oncologists Specializing in Endometriosis Excision

Gynecologic oncology is the most surgically intensive fellowship within pelvic medicine (Becker et al., 2022; ESGE/ESHRE/WES, 2020). This training includes extensive experience in:

• • Retroperitoneal dissection.
  • Ureterolysis and ureter reconstruction.
  • Bladder dissection and repair.
  • Bowel surgery.
  • Management of severe adhesions and altered anatomy.
  • Complex multi-organ operations.

Surgeons with this background perform procedures that many other specialists are neither trained nor credentialed to undertake. When these skills are applied to endometriosis, they offer a level of surgical capability that is particularly valuable for:

• • Deep infiltrating endometriosis (DIE).
  • Multi-organ involvement, including upper abdomen and diaphragm
  • Recurrent or failed prior surgeries.
  • Cases with extreme adhesions.
  • Situations where anatomy is significantly distorted.

Because they can manage bowel, bladder, ureter, and nerve involvement independently, gynecologic oncologists provide a comprehensive surgical solution rather than a multi-surgeon patchwork.

Recent published studies show that gynecologic oncologists are performing benign surgery at a higher rate, in addition to cancer surgery. This means up to 50% or more of their practice is not cancer. However, only a few focus on endometriosis other than serving as intra-operative consultants.

The handful of gynecologic oncologists that do focus on endo internationally excel in this area not just because they are capable of the highest level of pelvic and abdominal surgery but also because they deeply understand the management of this very complex condition. This includes both management of benign endometriosis and the uncommon associated cancers that become more common in older patients or in those with genetic anomalies or strong family history of certain cancers.

Dr. Steven Vasilev is one of the few that focus on endometriosis within this elite category of highest surgical training and expertise. This means any degree of disease can be handled while also applying appropriate organ and fertility sparing approaches because of a deep understanding of endo.

How This Framework Helps Patients

The purpose of defining these tiers is not to diminish the skill of surgeons in Tiers 1 or 2. Each tier serves patients with different needs. Mild disease does not require the same level of surgical specialization as deep or recurrent disease, other than to mention that correctly identifying endometriosis during surgery is not always obvious to the untrained surgical eye.

However, patients with complex presentations often benefit substantially from surgeons trained in Tier 3, where multi-organ pelvic surgery is routine rather than exceptional. Understanding these distinctions allows patients to seek care from surgeons whose training aligns with the severity of their disease.

The problem is that, even with imaging of the highest quality, the degree of disease is often not predictable. Thus, it may be prudent to have surgery with the best trained surgeon you can find whose plan resonates with your needs and preferences regarding management of pain and fertility options.

Why Patients Should Consider Subspecialty Expertise for Complex Disease

In advanced endometriosis, the quality and completeness of initial excision strongly influence long-term outcomes (Leborne et al., 2022; Roman et al., 2018). Inadequate removal of disease can result in persistent pain, recurrent symptoms, complications from repeated surgeries, and progressive organ involvement. Training in gynecologic oncology brings anatomical expertise, surgical precision, and extensive operative experience that are well-matched to the highest-complexity cases, especially when multiple organ systems are involved.

The Value of Integrative and Holistic Approaches

Endometriosis is a systemic condition but often triggered at the core by disease that can be surgically addressed. Patients frequently experience gastrointestinal dysfunction, chronic pelvic floor hypertonicity, widespread inflammation, immunomodulation disorders and hormonal imbalance. As such, comprehensive care often extends beyond surgery. Training in integrative and holistic medicine allows a surgeon to incorporate evidence-based strategies that support overall recovery, address systemic contributors to pain, and promote long-term stability.

This combination—advanced surgical capability plus integrative management—is uncommon and highly valuable.

Why Lotus Endometriosis Institute Offers a Distinct Level of Care

For patients seeking the highest level of expertise and comprehensive support, the Lotus Endometriosis Institute provides a uniquely qualified center. The Institute integrates advanced surgical capability, integrative medicine, and a patient-centered philosophy designed for complex endometriosis.

What Sets Lotus Apart

• • Single-surgeon mastery: All advanced surgical care is performed by Dr. Steven A. Vasilev, whose training and experience align directly with Tier 3 requirements described above.
  • Complete excision capability: Deep infiltrating disease involving bowel, bladder, ureter, or diaphragm can be managed in one setting by a surgeon fully trained in multi-organ pelvic surgery.
  • Advanced minimally invasive and robotic command: Oncology-grade precision is applied to endometriosis excision, improving visualization, accuracy, and safety.
  • Integrative whole-patient care: Lifestyle medicine, nutrition, and holistic strategies support recovery, reduce chronic inflammation, and reinforce long-term symptom control.
  • Dedicated endometriosis focus: For over a decade, the Institute has centered its clinical mission on the management of endometriosis and complex pelvic disease, including cancers related to endo.

Comparison Table: Endometriosis Surgeons in Los Angeles

The Lotus Philosophy

• Advanced excision surgery
• Pelvic floor and pain-focused rehabilitation partners
• Whole-person integrative lifestyle strategies
• Long-term follow-up and individualized planning

To learn more about our surgical program, visit the Institute’s page on Surgery and Advanced Excision.

Conclusion

Patients in the Los Angeles region have access to a wide range of clinicians who treat endometriosis. Understanding distinctions between general OB-GYNs, high-volume minimally invasive specialists, and gynecologic oncologists specializing in complex pelvic surgery empowers patients to choose a surgeon whose training matches the severity of their disease. This framework offers an objective, training-based way to evaluate surgical expertise. For deep infiltrating endometriosis, recurrent disease, multi-organ involvement, or complex pelvic anatomy, selecting a surgeon with advanced subspecialty training can significantly influence long-term outcomes and quality of life.