Laparoscopic surgery is a minimally invasive approach that can be used to treat endometriosis. Instead of making one large abdominal incision, the surgeon uses a camera and specialized instruments through small incisions to examine the pelvis and, when appropriate, remove or treat endometriosis and release adhesions.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
For some people, laparoscopic surgery can improve endometriosis-related pain and address anatomical changes caused by the disease. However, surgery is not automatically required for everyone with endometriosis.
The decision depends on symptoms, the location and extent of disease, previous treatment, fertility plans, and individual preferences. For a broader overview, you can explore the Endometriosis Treatment guide.
Why Is Laparoscopic Surgery Used for Endometriosis?
Laparoscopy allows the surgeon to directly examine the pelvic organs and treat visible endometriosis during the same procedure when appropriate. Depending on the findings, surgery may be used to:
- Remove visible endometriosis lesions
- Treat or destroy selected superficial lesions
- Release adhesions that are causing organs or tissues to stick together
- Treat ovarian endometriomas in selected cases
- Remove or treat deeper endometriosis when appropriate
- Restore normal pelvic anatomy where endometriosis has caused significant distortion
Laparoscopic surgery may also be considered when symptoms remain troublesome despite medical treatment or when endometriosis is affecting structures such as the bowel, bladder, or ureter.
Is Laparoscopic Surgery Necessary for Everyone With Endometriosis?
No. A diagnosis of endometriosis does not automatically mean that surgery is needed. Hormonal treatment and pain-management approaches may provide adequate symptom control for many people.
Surgery is generally considered when the expected benefits outweigh the potential risks and when it fits the person's treatment goals. For example, surgery may be discussed when:
- Pain remains significant despite appropriate medical treatment.
- There is an ovarian endometrioma or deep endometriosis.
- Endometriosis has caused significant adhesions or anatomical changes.
- Deep disease involves the bowel, bladder, or ureter.
- Fertility considerations make surgery appropriate in a particular situation.
The extent of endometriosis seen on imaging or during surgery does not always match the severity of pain. Therefore, the decision should not be based on the stage of disease alone.
What Happens Before Laparoscopic Endometriosis Surgery?
Before surgery, your healthcare team will usually review your symptoms, medical history, previous treatments, medicines, allergies, and reproductive plans. Imaging may also be used to understand where endometriosis is located.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Transvaginal ultrasound can help identify endometriomas and some forms of deep endometriosis, while MRI may be useful when deeper or more extensive disease needs to be mapped. If bowel, bladder, or ureteral involvement is suspected, additional specialist assessment may be arranged before surgery.
Discussing the surgical plan
Your surgeon should explain what they expect to find, what treatment may be performed, and what the possible alternatives and risks are. It is also important to discuss whether the plan involves:
- Excision of endometriosis
- Ablation of selected lesions
- Adhesion removal
- Ovarian surgery
- Possible bowel or urinary tract treatment
- Additional procedures if unexpected disease is found
What Happens During Laparoscopic Surgery?
Laparoscopic endometriosis surgery is performed under general anaesthesia, so you will be asleep during the procedure.
The surgeon generally makes a small incision near the navel to insert the laparoscope, a thin instrument with a camera. Additional small incisions may be made to allow surgical instruments to be introduced into the abdomen.
Gas is introduced into the abdominal cavity to create space for the surgeon to see and work around the pelvic organs. The surgeon then examines the pelvis and identifies areas of endometriosis, adhesions, ovarian endometriomas, or other abnormalities.
Excision vs Ablation: What Is the Difference?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Two techniques commonly discussed in endometriosis surgery are excision and ablation.
Excision involves surgically cutting out endometriotic tissue. The removed tissue can also be sent for laboratory examination when appropriate.
Ablation involves destroying or treating the surface of endometriotic tissue using an energy-based technique.
The choice depends on the type and location of disease and the surgeon's assessment. For deeper endometriosis, excision is generally more relevant because superficial ablation may not adequately address tissue that extends deeper into surrounding structures.
What Happens If Adhesions Are Found?
Endometriosis can cause scar tissue known as adhesions. These bands of tissue can cause pelvic organs to stick to one another and may contribute to pain or distortion of normal anatomy. During laparoscopy, adhesions may be carefully divided when appropriate.
Releasing them can help restore the normal relationship between pelvic organs and make it easier for the surgeon to assess and treat the underlying disease. However, adhesions can develop again after surgery, so their removal does not guarantee that they will never return.
What If an Ovarian Endometrioma Is Found?
An ovarian endometrioma is a cyst associated with endometriosis. If one is identified, the decision to operate depends on factors such as symptoms, cyst characteristics, fertility plans, previous surgery, and ovarian reserve.
Surgery on an ovary requires particular care because treatment can affect healthy ovarian tissue and may reduce ovarian reserve.
If future fertility is important, the potential benefits of treating the endometrioma should therefore be weighed carefully against the possible effect on ovarian function.
What If Deep Endometriosis Is Found?
Deep endometriosis can involve structures such as the bowel, bladder, ureters, or tissues around the uterus and vagina. Treatment can be considerably more complex than surgery for superficial disease.
When deep disease is known or strongly suspected before surgery, specialist imaging and careful surgical planning are important.
A multidisciplinary team may be required when endometriosis involves several organs. Depending on the location, this can include gynecological, colorectal, or urological expertise.
In some situations, surgery may need to be staged or modified depending on what is found and what can safely be treated during the procedure.
What Happens Immediately After Surgery?
After the operation, you will be taken to a recovery area while the effects of anaesthesia wear off. Your healthcare team will monitor your pain, vital signs, ability to eat and drink, and ability to pass urine.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Many laparoscopic procedures can be performed as day surgery or with a short hospital stay, but this depends on the extent of surgery and your individual recovery. You may experience:
- Abdominal soreness
- Bloating
- Tiredness
- Mild nausea after anaesthesia
- Shoulder-tip discomfort caused by the gas used during laparoscopy
- Light vaginal bleeding or discharge in some cases
What Are the Possible Risks of Laparoscopic Endometriosis Surgery?
Laparoscopic surgery is minimally invasive, but it is still surgery and carries potential risks. Possible complications include:
- Bleeding
- Infection
- Injury to the bowel, bladder, ureters, blood vessels, or other organs
- Blood clots
- Complications related to anaesthesia
- Adhesion formation
- Recurrence of endometriosis or symptoms
The risks can be higher when surgery is extensive or when deep endometriosis involves major pelvic structures. This is one reason complex disease is best assessed and treated by teams with appropriate experience.
Can Laparoscopic Surgery Improve Fertility?
In selected people, surgery may improve the chances of spontaneous pregnancy, particularly when endometriosis has caused adhesions or distorted pelvic anatomy. However, surgery is not automatically recommended solely to improve fertility in every person with endometriosis.
The potential fertility benefit needs to be balanced against factors such as age, ovarian reserve, the extent and location of disease, previous surgery, and other causes of infertility.
Ovarian surgery requires particular consideration because removing or damaging healthy ovarian tissue can affect ovarian reserve. If pregnancy is the immediate goal, fertility-focused planning should be part of the discussion before surgery.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Can Endometriosis Return After Laparoscopic Surgery?
Yes. Surgery can remove or treat visible endometriosis, but it does not guarantee that the disease will never return. Some people experience long-term symptom relief, while others may develop recurrent symptoms over time.
The likelihood of recurrence depends on several factors, including the extent and location of disease and the treatment used after surgery.
This is why endometriosis is generally managed as a long-term condition rather than as a problem that surgery necessarily resolves permanently.
Laparoscopic Surgery: What to Expect at a Glance
| Stage | What Usually Happens |
|---|---|
| Before surgery | Symptoms, medical history, imaging, fertility goals, medicines, and the surgical plan are reviewed. |
| During surgery | A camera and small instruments are inserted through small abdominal incisions to examine and treat endometriosis. |
| Treatment | Depending on the disease, the surgeon may excise or ablate lesions, release adhesions, or treat endometriomas and deep disease. |
| Immediately afterward | You recover from anaesthesia while pain, vital signs, and other symptoms are monitored. |
| At home | Activity is gradually increased while the incision sites and recovery symptoms are monitored. |
| Follow-up | Surgical findings, pathology results when applicable, symptom response, fertility plans, and further treatment are reviewed. |
The Bottom Line
Laparoscopic surgery is a minimally invasive way to examine and treat endometriosis. Depending on the location and extent of disease, it may involve excision or ablation of lesions, removal of adhesions, treatment of ovarian endometriomas, or more complex surgery for deep endometriosis.
What to expect from the procedure and recovery depends heavily on the type and extent of surgery. Simple laparoscopic treatment and surgery involving the bowel, bladder, or ureters can have very different recovery periods and risks.
Surgery can provide meaningful symptom relief for some people, but it is not a guaranteed permanent cure. The best approach considers not only the visible disease but also pain, fertility goals, ovarian reserve, potential surgical risks, and plans for long-term management.
