Surgical Procedures

“Bladder surgery for endometriosis” means your surgeon is addressing endometriosis that’s irritating the bladder or the tissues around it—often a reason for cyclical urinary symptoms and pelvic pain. Depending on where the disease sits, treatment may involve carefully excising endometriosis from the surface of the bladder, freeing scar tissue that tethers the bladder, or (less commonly) removing a small full-thickness area of bladder wall when endometriosis grows deeper. The goal is long-term relief by removing the disease (not just burning it), while protecting bladder function.

Because the bladder and nearby urinary structures are delicate, surgeon experience matters—especially when symptoms overlap with UTIs or bladder pain syndrome. At Lotus Endometriosis Institute, bladder involvement is evaluated as part of comprehensive endometriosis care and, when appropriate, treated with minimally invasive surgery and advanced excision by Dr. Steven Vasilev. If you have bladder flares around your period—like urgency, pressure, or pain with urination—consider schedule a consultation to review your symptoms, imaging, and options.

If you’re told you may need “bowel surgery for endometriosis,” it usually means endometriosis is irritating or growing into tissues on or near the bowel—most commonly the rectum or sigmoid colon—and may be contributing to symptoms like painful bowel movements, constipation/diarrhea around your period, bloating, or deep pelvic pain. Depending on how deep the disease goes, the surgical plan may range from carefully removing disease from the surface (“shaving”), to removing a small full-thickness spot (“disc excision”), to removing a short segment of bowel and reconnecting it (“segmental resection”). The goal is to remove the endometriosis completely when safe to do so, while preserving bowel function and improving quality of life.

Because bowel involvement can be complex, surgeon experience matters—especially when the disease is deep or close to critical structures. At Lotus, bowel endometriosis is evaluated and treated as part of comprehensive endometriosis care, with minimally invasive excision through surgery and advanced excision when appropriate. If this term came up during your workup, it’s a good sign your team is looking beyond “IBS” and taking your symptoms seriously—consider schedule a consultation to review imaging, symptoms, and fertility goals, and to understand what approach is most likely to help you.

Diaphragmatic endometriosis excision means surgically removing endometriosis that has grown on (or near) the diaphragm—the muscle that helps you breathe. If you’ve been told you may have diaphragm involvement, it can explain symptoms that feel “not pelvic,” like period-linked shoulder pain (often the right shoulder), chest pain, or even shortness of breath. Many patients worry these symptoms mean something is being missed; hearing this term usually means your care team is taking your pattern seriously and evaluating endometriosis beyond the pelvis.

This procedure is typically performed as part of comprehensive Endometriosis Excision Surgery to treat endometriosis wherever it’s found, not just where it’s most common. Because the diaphragm is a more complex area, surgeon experience matters for thorough removal and safety—this is the kind of advanced case we routinely plan for at Lotus with Dr. Steven Vasilev. If your symptoms are cyclical or you’ve had persistent pain despite prior treatments, you can schedule a consultation to review your history, imaging, and options within our services.

“Excision of Deep Infiltrating Endometriosis (DIE)” means your surgeon is planning to remove endometriosis that has grown deeper beneath the surface and may be tethering or irritating nearby organs and nerves. For patients, this often connects to symptoms like severe painful periods, persistent pelvic pain, deep pain during intercourse, or bowel/bladder flares. Because deep disease can be harder to see on imaging and may be mistaken for other conditions, a careful specialist evaluation is important (see endometriosis and evaluation and diagnosis).

The goal of DIE excision is to treat the root cause by precisely removing disease while protecting the organs involved—this is why surgeon expertise and experience matter for outcomes. At Lotus, complex endometriosis is within our scope through surgery and advanced excision led by Dr. Steven Vasilev, and your plan may also include support like Pelvic Floor Therapy and Pain Management for recovery and long-term relief. If you’ve been told you may have deep endometriosis—or you suspect it based on symptoms—you can schedule a consultation to discuss options and what to expect.

An endometrioma is an ovarian cyst caused by endometriosis—often called a “chocolate cyst” because old blood can collect inside it. Excision of endometriomas means your surgeon removes the cyst wall and treats surrounding endometriosis with the goal of reducing pain, lowering the chance the cyst returns, and protecting your long-term ovarian health. If you’re trying to conceive, this step is often discussed carefully because the ovary needs to be treated thoroughly while preserving as much healthy ovarian tissue as possible.

If you’ve been told you have an endometrioma on ultrasound or MRI, it can feel scary and confusing—especially if you’re dealing with chronic symptoms. This is a common part of advanced endometriosis care, and surgeon experience matters for balancing symptom relief, recurrence risk, and fertility goals. At Lotus, this is typically addressed as part of comprehensive surgery and advanced excision; you can schedule a consultation to review your imaging, discuss your priorities (pain relief vs fertility), and make a plan with Dr. Steven Vasilev.

If you hear the term neurolysis for endometriosis, it usually means your surgeon is planning to gently release a pelvic nerve that has become stuck, compressed, or irritated by endometriosis inflammation or adhesions (scar tissue). When nerves are “tethered,” pain can become constant, flare with your cycle, or radiate into the back, hip, or leg—sometimes even when visible disease looks minimal. Neurolysis is often done as part of comprehensive excision rather than as a separate operation, with the goal of reducing nerve-related pain triggers and helping the pelvis move more normally again.

Because nerves are delicate, surgeon experience matters—you want an endometriosis specialist who can recognize when nerve involvement is contributing to symptoms and address it safely during surgery and advanced excision. At Lotus Endometriosis Institute, care is individualized and may also include supportive therapies like Pelvic Floor Therapy and integrative pain strategies to help calm nerve sensitization as you heal. If you’ve been told your pain could be “nerve-related” or you have radiating symptoms, you can schedule a consultation to discuss whether this approach could be part of your surgical plan with Dr. Steven Vasilev.

Pelvic adhesiolysis means your surgeon is releasing bands of internal scar tissue (called adhesions) that can form from endometriosis, past surgeries, or pelvic infections. Adhesions can make organs “stick” to each other—such as the ovaries, uterus, bowel, or bladder—which may contribute to pulling sensations, painful periods, pain with sex, bowel/bladder symptoms, and sometimes fertility concerns. If you’ve been told you have “scar tissue” or “organs stuck together,” this is the term you may hear.

For patients, adhesiolysis is often performed as part of a broader endometriosis plan—especially during surgery and advanced excision—to restore mobility of pelvic organs and improve function. Because scar tissue and endometriosis can overlap, surgeon expertise matters for safely treating the true root cause; learn more about Dr. Steven Vasilev and explore our services. If you’re unsure whether adhesions are driving your symptoms, you can schedule a consultation to review your history, imaging, and next steps.

Ureterolysis means your surgeon carefully separates the ureter from nearby endometriosis and/or scar tissue during endometriosis surgery. If disease is wrapped around the ureter or causing it to kink, stick, or narrow, freeing it can help protect kidney drainage and reduce pain caused by traction and inflammation. Hearing this term doesn’t automatically mean your ureter is “damaged”—it often means the surgical team is being proactive about identifying and safeguarding an important structure.

Ureterolysis is commonly done as part of comprehensive surgery and advanced excision, especially in deeper or more complex cases. Surgeon experience matters because the goal is to remove endometriosis thoroughly while keeping the urinary tract safe. If you’ve had urinary symptoms or deep pelvic pain, ask how your surgeon evaluates possible urinary-tract involvement and what to expect after surgery; you can schedule a consultation to review your imaging, symptoms, and options with Dr. Steven Vasilev.

An adenomyomectomy is a fertility-sparing surgical option for some people with adenomyosis. If you hear this term, it usually means your team is considering removing focal adenomyosis from within the uterine muscle while preserving the uterus, with the goal of improving symptoms like severe cramps and heavy bleeding—and, in select cases, supporting fertility goals.

Because adenomyosis is embedded in the uterine wall, deciding whether adenomyomectomy is appropriate depends on your imaging, symptom pattern, and pregnancy plans. It’s also common to have adenomyosis alongside endometriosis, so a comprehensive plan may include evaluation for coexisting disease and discussion of all options (medications, integrative care, or surgery). At Lotus, surgical decision-making is guided by surgeon expertise and a focus on outcomes—learn more about Dr. Steven Vasilev and our approach to surgery and advanced excision. If you’re weighing uterus-preserving options, you can schedule a consultation.

A hysterectomy for uterine fibroids is surgery to remove the uterus in order to treat fibroid symptoms—most commonly heavy or prolonged bleeding, anemia-related fatigue, pelvic pressure, and pain. If you hear this term, it usually means your fibroids are significantly affecting your quality of life, and either fertility preservation is not a goal or other treatments (medications, IUD, or less definitive procedures) haven’t given enough relief. After a hysterectomy, periods stop and you can’t carry a pregnancy, which is why the decision is deeply personal and should be made with clear counseling and support.

It’s also important to know that fibroids aren’t the only cause of heavy bleeding and pelvic pain. Conditions like adenomyosis and endometriosis can coexist with fibroids and change what the “right” surgery looks like. At Lotus Endometriosis Institute, our team focuses on a whole-picture evaluation and minimally invasive options when appropriate through surgery and advanced excision, led by Dr. Steven Vasilev. If you’re deciding between hysterectomy and uterus-sparing options—or you’re worried pain may have another cause—consider schedule a consultation to review your imaging, symptoms, and goals.

“Excision of benign adnexal masses” means surgically removing a non-cancerous growth from the ovary and/or fallopian tube (the “adnexa”). Common examples include ovarian cysts or other benign masses that may cause pain, pressure, bloating, or show up on an ultrasound. The goal is often to treat symptoms and confirm the diagnosis, while protecting healthy ovarian tissue and fertility when that’s important to you.

Because adnexal masses can overlap with conditions like endometriosis—including endometriomas (“chocolate cysts”)—your surgeon’s experience matters. At Lotus Endometriosis Institute, this type of procedure is often considered as part of a bigger plan that may also address endometriosis, adhesions, or tubal issues during the same operation when appropriate (see surgery and advanced excision). If you’ve been told you have a “benign mass” but you’re still in significant pain or worried about fertility, you can schedule a consultation to review imaging, symptoms, and options with Dr. Steven Vasilev.

A salpingo-oophorectomy means surgically removing an ovary and its fallopian tube (one side) or both ovaries and tubes (both sides). You might hear this term if endometriosis has severely damaged an ovary, if there’s a concerning or complex adnexal mass, or if an ovary is repeatedly developing painful cysts/endometriomas. For many patients, the key question is whether removal is truly necessary—or whether the ovary can be preserved with options like cyst removal and excision. That decision should be individualized based on your age, symptoms, fertility goals, imaging findings, and overall endometriosis/adenomyosis picture (see: endometriosis and adenomyosis).

If one or both ovaries are removed, it can affect hormones and fertility—especially if both ovaries are taken, which causes immediate menopause. A surgeon experienced in complex endometriosis can help you understand the tradeoffs, evaluate ovarian-sparing alternatives when appropriate, and plan for symptom control and long-term health. At Lotus, this kind of decision-making is part of comprehensive care through surgery and advanced excision with Dr. Steven Vasilev. If you’ve been told you “need an ovary removed,” consider schedule a consultation to review your options and goals.

A salpingectomy means surgically removing one (unilateral) or both (bilateral) fallopian tubes. You may hear this term if you’ve had (or are at risk for) an ectopic pregnancy, if imaging shows a fluid-filled tube (hydrosalpinx) that can worsen pain or reduce IVF success, or if you want permanent sterilization. For many patients, it’s also discussed when surgery is already planned for suspected or confirmed endometriosis, because damaged tubes and scar tissue can contribute to inflammation and fertility challenges.

What it means for you: removing a tube can sometimes protect your health and improve your fertility plan, depending on the reason. If one tube is removed, pregnancy may still be possible through the other tube (if it’s healthy). If both tubes are removed, spontaneous pregnancy isn’t possible—but IVF can still be an option because the ovaries can continue to function. Because endometriosis and adhesions can distort normal anatomy, surgeon experience matters; at Lotus, these decisions are made with a whole-pelvis view during surgery and advanced excision with a focus on your goals and long-term outcomes. If you’re weighing whether salpingectomy fits your pain or fertility plan, you can schedule a consultation with Dr. Steven Vasilev.

Tubal adhesiolysis means your surgeon removes scar tissue (adhesions) that may be “tethering” one or both fallopian tubes. Adhesions can form from endometriosis, infection, or prior surgery, and they may reduce fertility by limiting how the tube moves and picks up the egg—or by narrowing/closing the tube. If you’ve been told your tubes look “stuck,” “scarred,” or “pulled,” this term is describing an attempt to restore tubal mobility and improve your fertility potential while preserving your reproductive organs.

Because adhesions often coexist with active endometriosis, tubal adhesiolysis is commonly considered alongside expert excision to address the underlying cause and lower the chance of recurrent scarring. At Lotus, this is within the capabilities of our surgical team and is evaluated as part of a personalized plan through surgery and advanced excision with an emphasis on protecting fertility and long-term pelvic function. If you’re weighing next steps for pain, fertility, or both, you can schedule a consultation to review your imaging, symptoms, and goals with Dr. Steven Vasilev.