Dr Sam Holford showing an MRI scan

Laparoscopic Resection of Endometriosis

Endometriosis is a chronic, often painful condition where tissue similar to the lining of the uterus grows outside the uterus. It can involve the ovaries, fallopian tubes, bowel, bladder, uterine ligaments, and peritoneum. Surgical treatment (typically via laparoscopy) is a cornerstone of care for many patients, particularly when conservative or medical treatments have not provided relief.

Understanding Endometriosis

Endometriosis can vary in extent and severity:

Mild (Stage I–II)

  • Few or many superficial implants
  • Minimal adhesions
  • Often associated with pelvic pain, painful and heavy periods, or infertility
  • Typically treated with laparoscopic excision

Moderate (Stage III)

  • Deeper implants
  • More significant adhesions, often involving the ovaries (endometriomas)
  • May cause more persistent pelvic pain, bowel symptoms, and subfertility
  • Requires skilled excision and reconstruction

Severe (Stage IV)

  • Extensive disease involving deep pelvic structures, ovaries, bowel, bladder, or ureters
  • Severe adhesions distorting pelvic anatomy
  • Typically requires a high level of surgical expertise, multidisciplinary care, and thorough pre-operative planning

Why Surgical Expertise Matters

Endometriosis surgery, particularly moderate and severe disease, demands advanced laparoscopic skills. Choosing a surgeon with specific expertise in endometriosis is crucial for:

  • Accurate pre-operative diagnosis with expert transvaginal ultrasound
  • Thorough excision of visible disease while preserving healthy tissue, nerves, and fertility
  • Reducing recurrence and improving quality of life
  • Managing complex cases with bowel, bladder, or ureteric involvement
Endometriosis deposits seen at laparoscopy
Endometriosis deposits on the uterosacral ligament behind the uterus.

What to Expect

  • Procedure: Keyhole (laparoscopic) surgery under general anaesthesia. The goal is to remove all endometriosis and restore anatomy.
  • Recovery: Most patients go home the same day or after one night. Expect 1–2 weeks off work for light duties and 4–6 weeks for full recovery.
  • Risks: Bleeding, infection, injury to nearby organs (bowel, bladder, ureter), adhesions, incomplete relief of symptoms, or recurrence.
Dr Sam Holford

Find relief from endometriosis pain.

As an Auckland specialist, I provide non-surgical treatments and perform advanced laparoscopic excisional surgery to thoroughly remove endometriosis. Regain your life.

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FAQs

What is the difference between excision and ablation surgery for endometriosis?
Excision surgery carefully cuts out and removes endometriosis lesions, which is considered the gold standard. Ablation (or fulguration) uses heat to burn the surface of the tissue. Excision is more thorough, allows for a tissue diagnosis, and is generally associated with better long-term outcomes and lower recurrence rates.
Will surgery cure my endometriosis?
The goal of surgery is to remove all visible endometriosis, which can provide significant and long-lasting relief from symptoms. However, endometriosis is a chronic condition, and there is a chance of recurrence. Surgery is one part of a long-term management plan, which may also include hormonal treatments or other therapies.
How do I know if I need surgery for endometriosis?
Surgery is typically recommended when symptoms like severe pain are not well-managed with medication, if there are large ovarian cysts (endometriomas), or if endometriosis is impacting fertility or other organs like the bowel or bladder. The decision is always a personal one, made after a thorough discussion of the potential benefits and risks.
How long is the recovery after laparoscopic endometriosis surgery?
Recovery depends on the complexity of the surgery. For most laparoscopic procedures, you can expect to be home the same or the next day. A return to light activities is usual within 1-2 weeks, with a full recovery taking around 4-6 weeks. I will provide you with a detailed guide for your post-operative care. Read more in my Surgical Recovery Toolkit.
Will surgery for endometriosis improve my fertility?
For many people, yes. By removing endometriosis and restoring normal pelvic anatomy, surgery can improve the chances of conceiving naturally. If you have fertility concerns, this will be a key part of our discussion when planning your surgery.

Resources for Further Reading

Final Thoughts

Endometriosis can be complex and deeply impactful - but you’re not alone. I offer compassionate, evidence-based care with surgical expertise in all stages of endometriosis. A thorough discussion of your symptoms, history, and imaging will guide whether surgery is appropriate and how it fits into your overall care plan.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.