How to Choose an Endometriosis Surgeon
The surgeon you choose decides whether endometriosis is removed or left behind. These are the questions to ask any surgeon, including us.
Medically reviewed by Dr. Steven Vasilev, MD
Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute
The short answer
Choose a surgeon who:
- excises endometriosis rather than burning it (ablation)
- specializes in endometriosis, operating on it exclusively and regularly, including deep and repeat cases
- can treat the bowel, bladder and ureters in the same operation
- tracks results and will share them with you
- explains the plan, and what could change it, before surgery
Side by side
Which kind of surgeon?
Many kinds of doctors operate on endometriosis, and their training differs a lot. The question isn't whether a surgeon is good, but whether their training covers removing deep disease from the bowel, bladder and ureters.
A general gynecologist or a fertility specialist is often the right place to start, for diagnosis, medication or IVF. Simple, intermediate and some advanced cases suit an excision (MIGS) surgeon whose training focused on endometriosis. Deep, multi-organ and recurrent disease calls for both kinds of training at once: a gynecologic oncologist who focuses on endometriosis.
| Surgeon type | Training in complex excision | Often the right fit for |
|---|---|---|
General gynecologist | Limited; many use ablation | Diagnosis and medical treatment |
Fertility specialist (REI) | Focused on IVF, rarely excision | Fertility treatment |
Colorectal surgeon or urologist | Their organ, not endometriosis | Assisting on bowel or bladder cases |
Excision (MIGS) surgeon | Good, if training focused on endo, but bowel and urinary training varies | Simple, intermediate and some advanced pelvic and ovarian disease |
Gynecologic oncologist | The most extensive pelvic surgery training, mostly for cancer | Complex pelvic surgery; most common role as assistant |
Gynecologic oncologist focused on endometriosis | Both | Deep, multi-organ and recurrent disease |
Before you decide
7 questions to ask any endometriosis surgeon
Bring these to every consultation, ours included. A good surgeon will be glad you asked.
The first three are about the disease: whether it's cut out or burned, how much of a surgeon's work is deep or repeat surgery, and who treats the bowel, bladder or ureters if it's found there. The rest are about you: their results, what they'd remove and when, how they operate, and what happens if they find something they didn't expect.
Do you excise endometriosis, or ablate it?
Ablation burns the surface and often leaves disease behind.
Listen forExcision, wherever it's found.
How many of your surgeries are deep, multi-organ or repeat cases?
Total volume can mislead: a surgeon can do a lot of simple cases in a year. Skill shows in the complex ones.
Listen forA real share of complex cases, and how those patients did.
If you find it on my bowel, bladder or ureter, who treats it?
Some surgeons stop, or bring in another surgeon who may remove more than needed.
Listen for"I do, in the same operation, sparing the organ whenever possible."
What are your complication and recurrence rates?
Surgeons who track their outcomes can tell you.
Listen forReal numbers, and how they're measured.
Would you remove my uterus or ovaries, and when?
Removing organs should follow your goals, not a surgeon's habits.
Listen forOnly when it serves your goals, and exactly when that would be.
Robotic or laparoscopic, and why?
Robotic instruments allow finer work in tight, scarred spaces.
Listen forA reason tied to your case.
What happens if you find something unexpected?
Rarely, endometriosis hides other diseases, including cancer.
Listen forA surgeon trained to handle it in the same surgery.
Your surgeon
How Dr. Vasilev answers these questions
Dr. Vasilev is the last row of that table: a gynecologic oncologist who focuses on endometriosis. So the bowel, bladder and ureters are treated in the same operation, and something unexpected, rare as it is, can be handled then and there.
Here's how he answers the questions above. The rest is what your consultation is for: ask him every one.
“Excision versus ablation isn't the only question. The question is whether your surgeon can tell what to remove, when, and why.”
His answers to the questions above
1. Do you excise endometriosis, or ablate it?
Excision, every time.
2. How many of your surgeries are deep, multi-organ or repeat cases?
Endometriosis and adenomyosis only, including deep, multi-organ and repeat cases.
3. If you find it on my bowel, bladder or ureter, who treats it?
He does, in the same operation.
6. Robotic or laparoscopic, and why?
Robotic, every time: finer work in tight, scarred spaces.
7. What happens if you find something unexpected?
Trained as a gynecologic oncologist, so the unexpected can be treated then and there.
Ask him questions 4 and 5 at your consultation.
Schedule ConsultationWhere we see you
Is it worth the trip?
No one can promise before surgery that a case will be simple.
Imaging and an exam give a good estimate, but endometriosis is often deeper or more widespread than it looks. Whatever your case looks like, choose a surgeon who is ready for whatever is found, so it's treated in one operation.
Close by?
In Southern California or on the Central Coast, we're local: Santa Monica and Arroyo Grande. Your records review and consultation are by video, so you come in for surgery.
Farther away?
Many patients travel to us, for a first surgery as often as for a complex one. Your records review and consultation are by video, so you travel to California only for surgery.
Patients often ask
Should I see a gyn, MIGS surgeon, or excision specialist for endometriosis?
A general gynecologist may be a reasonable starting point for routine evaluation or medication, while an excision specialist is usually the most direct path for suspected complex disease. MIGS training alone does not automatically mean deep endometriosis excision expertise.
Why would a cancer surgeon perform endometriosis excision?
A gynecologic cancer surgeon has skills that often translate directly to challenging endometriosis excision, including operating safely around critical organs. Their experience recognizing atypical tissue can add an extra layer of safety during surgery.
Do I need a colorectal surgeon for bowel endometriosis surgery?
Sometimes, especially if imaging or an exam suggests deeper bowel involvement that may require opening, repairing or removing part of the bowel. A general surgeon or gynecologic oncologist credentialed in bowel surgery may also provide the needed expertise.
How do I choose an excision specialist after failed endometriosis surgery?
Choose a team that routinely treats complex endometriosis after prior surgery and plans complete excision, not surface burning alone. Look for peer-vetted surgical skills, a clear explanation of what they would do differently, and coordinated specialists for multi-organ disease.
You’re on step 2 of 3
Next: How do I start?Your records, a video consultation, testing, a fixed price, then surgery.