Excision surgery (as opposed to laser ablation or electrocoagulation/diathermy) is the gold standard of treating endometriosis and highly-skilled endometriosis surgeons can excise (remove) endometriosis and adhesions during a laparoscopy to restore anatomy and improve fertility during this diagnostic procedure.
Some studies have shown that following surgery the risk of recurrence can be significantly reduced with a long-term hormonal treatment, which may be a major consideration in the lifetime choice of therapies.
Excision Laparoscopy (keyhole surgery)
Excision laparoscopy is the gold standard of endometriosis treatment. Performed under general anaesthetic by a gynaecologist with specialist surgical skills, laparoscopy is the preferred surgical treatment because the smaller incisions lead to quicker healing and faster recovery time.
During surgery a laparoscope (thin viewing scope) is inserted into the pelvis via a small incision (cut) on the navel (tummy button). Other instruments are inserted into the pelvic/abdominal area via other small cuts. The surgeon will search for any signs of endometriosis deposits, lesions and cysts as well as adhesions (scar tissue). These may be on the pelvic organs including uterus (womb), ovaries, fallopian tubes, bowel, and bladder - and surrounding areas including the peritoneum (membrane lining) and Pouch of Douglas (POD or cul-de-sac).
Helpful information for laparoscopic surgery
Laparoscopic surgery is different for everyone, and your experience will be based on the extent of your surgery, length of stay, your surgeon, how you respond to pain, and your expectations. Each person also heals differently, and from other people’s experiences recovery can take several weeks.
Read our 'Laparoscopic Surgery Tips' information sheet for additional information about preparing for surgery and what happens post-surgery based on other people's experiences.
Highly skilled gynaecologists specialising in endometriosis surgery can both diagnose and remove (excise) endometriosis in the same surgical procedure, which aims to remove all endometriosis nodules, tissue, and cysts which will then be sent to pathology for assessment and to divide adhesions to free organs and restore anatomy.
If fertility is of concern, the patency of the fallopian tubes can be checked with a dye test, with a view to clearing them if blocked during excision surgery.
A laparotomy involves a larger cut in the abdomen, which may sometimes be necessary. Recovery times are much longer with a laparotomy than laparoscopy.
A hysterectomy is not a cure for endometriosis, however it may be suggested for adenomyosis, and is a cure for adenomyosis, if hormonal treatments have proven ineffective.
Hysterectomy refers to the removal of the uterus (womb) and is performed under general anaesthetic. It can often be completed vaginally using minimally-invasive surgical techniques.
It is important to have a gynaecologist who specialises in endometriosis for this surgery, so concurrent endometriosis can be excised (removed) in the same procedure.
Oophorectomy is the removal of the ovaries; the removal of one ovary is called a ‘unilateral oophorectomy', while the removal of both ovaries is called ‘bilateral oophorectomy’ causing instant and irreversible menopause.
Due to considerable ongoing and long-term risks to health from cardiovascular and bone density issues, an oophorectomy would seldom be considered pre-menopause unless there is also a genetic risk of ovarian cancer. Those who have completed families and who have concerns about ovarian cancers may wish to discuss the option of removing fallopian tubes (salpingectomy) in conjunction with other surgeries.