Endometriosis Excision Surgery
Excision cuts endometriosis out at its root, down to healthy tissue, instead of burning the surface. It's the gold-standard surgery for many people with endometriosis, and it confirms the diagnosis.
- How
- Robotic, minimally invasive
- Home
- Same or next day
- Back to work
- Usually 2–3 weeks
Medically reviewed by Dr. Steven Vasilev, MD
Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute · Updated Nov 2026
Ablation burns the surface. Roots can stay.
Excision removes it all, with a healthy margin.
What the evidence says
For superficial endometriosis, both approaches can ease pain in the short term; the hard part is recognizing every lesion and knowing whether it goes deeper than it looks. For endometriomas and deeper disease, excision has stronger evidence for pain relief and lower recurrence, and the removed tissue confirms the diagnosis.
Who it’s for
Is it right for me?
Usually when pain or other symptoms continue despite medication, when imaging shows a cyst or deep disease, or when you still need a definite diagnosis.
If hormones or pain medicine still leave you with pain, fatigue or limits, surgery is worth asking about. So it is when imaging shows an endometrioma, deep nodules or adhesions, or when painful bowel movements, bladder pain or urgency flare with your cycle.
Some people come to it because no one has confirmed what's wrong: the symptoms point to endometriosis, and they're stuck at "maybe". Others are trying to get pregnant and endometriosis may be making it harder, or their pain came back after a previous operation.
Results vary with where the disease is, what else is going on, and how long the pain has lasted.
Often improves
- Period pain and daily pelvic pain
- Bowel and bladder flares
- Pain with sex
- A definite diagnosis, from the removed tissue
Won’t fix on its own
- Pelvic floor muscle spasm or nerve sensitization
- IBS-like symptoms or bladder pain syndrome
- Adenomyosis
That's why surgery here comes with pain management, pelvic floor therapy and integrative care.
Your options
How does it compare?
Excision removes the disease, ablation burns its surface, and medication quiets symptoms while you take it.
Excision cuts the disease out at its root, down to healthy tissue, and the removed tissue confirms the diagnosis. Ablation burns the surface, so roots can stay behind. Hormonal medication removes nothing: it quiets symptoms while you take it.
For superficial endometriosis, both surgical approaches can ease pain in the short term. For endometriomas and deeper disease, excision has stronger evidence for pain relief and lower recurrence. Medication still has a place, for symptom control before or after surgery.
| Compared | Excision | Ablation | Hormonal medication |
|---|---|---|---|
| What it does | Removes the disease at its root | Burns the surface | Quiets symptoms |
| How long it helps | Lasting relief; strongest evidence for deep disease and cysts | Roots can stay behind | While you take it |
| Confirms the diagnosis | Yes, from the removed tissue | No | No |
| Often right for | Most endometriosis, especially deep disease or cysts | Short-term relief for surface spots | Symptom control, before or after surgery |
Excision
- What it does
- Removes the disease at its root
- How long it helps
- Lasting relief; strongest evidence for deep disease and cysts
- Confirms the diagnosis
- Yes, from the removed tissue
- Often right for
- Most endometriosis, especially deep disease or cysts
Ablation
- What it does
- Burns the surface
- How long it helps
- Roots can stay behind
- Confirms the diagnosis
- No
- Often right for
- Short-term relief for surface spots
Hormonal medication
- What it does
- Quiets symptoms
- How long it helps
- While you take it
- Confirms the diagnosis
- No
- Often right for
- Symptom control, before or after surgery
From first visit to recovery
What happens, step by step?
A video consultation, the tests needed to plan your surgery, then one operation and about a month of recovery.
It starts with a video consultation about your symptoms, your goals, and the treatment and imaging you've had. Tests such as more imaging or bloodwork fill in the picture, then we agree on what the surgery may include. Insurance and a fixed price are settled before anything is booked.
The operation is robotic, through three or four small incisions, and most people go home the same day or the next. Most return to work in 2–3 weeks and to full activity by about a month. Three months on, a video check-in goes over your pathology results and any care you still need.
Before surgery
Planning consultation
By video: your symptoms, goals (pain relief, fertility, keeping your uterus), prior treatment and imaging.
If symptoms suggest overlapping conditions, such as adenomyosis, we discuss them too. Because fertility goals change the plan, raise your timeline early.
Testing
Depending on your case: more imaging, bloodwork, a SIBO breath test and other tests. The more we know, the better we can plan the surgery and your recovery.
Your plan
We go over the results together and agree on what the surgery may include. Insurance and a fixed price are settled before anything is booked.
Surgery day
The operation
Robotic, through three or four small incisions. Dr. Vasilev removes as much disease as is safely possible, with a margin of healthy tissue, and sends it to pathology.
Endometriosis can hide around the bowel, bladder, ureters, pelvic nerves or diaphragm, so the scope depends on what is found and what you agreed to beforehand.
Often in the same operation: ovarian cystectomy · adhesion release · deep endometriosis surgery
Going home
Day 0–1
Usually the same day or the next, depending on how complex the surgery was.
Recovery
Early recovery
Weeks 1–2
Soreness, tiredness, bloating and some shoulder pain are normal.
Back to your life
Weeks 2–6
Most people return to work in 2–3 weeks and to full activity by about a month.
Inflammation and nerve irritation can take longer to settle after complex surgery or years of pain. You'll get guidance on activity, incision care, bowel support, and when to resume sex, exercise, work and travel.
Follow-up
Follow-up
3 months
Your pathology results and a video check-in. Pelvic floor therapy or pain care if you still need them.
Ongoing symptoms don't automatically mean surgery failed. They may point to adenomyosis, pelvic floor dysfunction, bowel or bladder conditions, or nerve sensitization, which is why follow-up is coordinated.
Your surgeon
Who should do it?
A specialist who operates on endometriosis exclusively and regularly, and can treat the bowel, bladder and ureters in the same operation.
Excision depends on skill. Lesions can be subtle, or sit on the bowel, bladder, ureters or nerves. An experienced specialist finds more of the disease and removes it safely, protecting fertility and organ function.
“Excision versus ablation isn't the only question. The question is whether your surgeon can tell what to remove, when, and why.”
Patients often ask
What if deep pelvic pain isn’t controlled by medication?
If medication doesn’t control deep pelvic pain, the next step is usually a tailored plan that reassesses all pain drivers. This can include pelvic floor therapy and, if evaluation suggests persistent endometriosis is a primary driver, excision surgery.
Is robotic surgery safe?
Yes, robot-assisted surgery is considered safe when performed by an experienced surgical team. The robot does not operate independently; your surgeon fully controls every movement in real time. It may help improve precision in complex pelvic surgery.
How long is recovery after endometriosis excision surgery?
Most patients can do light, gentle activities within a few days after endometriosis excision surgery. Many people can return to typical day-to-day routines over the next several weeks, depending on the extent and locations of disease treated and their work.
Can endometriosis come back after excision surgery?
Yes, endometriosis can come back after excision surgery, even when it is performed well, though more often over years than weeks. Disease left behind is the biggest driver. Signs include familiar pelvic, period, bowel, or bladder pain returning after relief, but returning pain doesn’t always mean returning disease.
You’re on step 1 of 3
Next: Who should operate?What to look for in any surgeon, and Dr. Vasilev’s results.