Excision Surgery: Removing Endometriosis at the Root
Endometriosis excision surgery removes endometrial implants from the root — cutting out the tissue entirely rather than destroying only what is visible on the surface. It is the approach most consistently associated with longer-lasting pain relief and lower recurrence rates in the surgical treatment of endometriosis.
Ablation uses heat or laser energy to destroy the surface of endometriosis implants. It is faster and technically simpler, but leaves the deeper layers of the implant intact. Endometriosis tissue burned at the surface can regrow from tissue left behind — which is why many women who undergo ablation report a return of symptoms within months or years.
Excision cuts beneath each implant, removing it along with a small margin of surrounding tissue, and sends the removed specimen to pathology to histologically confirm endometriosis. Dr. Andrei performs excision — not ablation — at every operative endometriosis case at McLaren Lapeer, McLaren Flint, and Henry Ford Rochester Hospital.
Who Is a Candidate for Excision Surgery
Excision surgery is appropriate across a wide range of endometriosis presentations. Dr. Andrei evaluates each patient individually and confirms the surgical plan before proceeding.
Chronic pelvic pain from confirmed or suspected endometriosis
Pain that is cyclical, persistent, or both — not adequately controlled by hormonal suppression — and significantly limiting daily function.
Prior ablation surgery without lasting relief
Symptoms that returned after ablation, indicating surface destruction left underlying disease untreated. Excision is the appropriate next step.
Endometriosis-associated infertility
Women pursuing fertility where endometriosis has been identified as a contributing factor — excision may improve the pelvic environment and fertility outcomes.
Ovarian endometrioma
Endometriosis cyst within the ovary causing pain, growing on serial imaging, or affecting ovarian reserve in a woman pursuing fertility.
Deep infiltrating endometriosis with bowel or bladder symptoms
Endometriosis affecting the uterosacral ligaments, rectovaginal space, bowel, or bladder — causing symptoms beyond pelvic pain alone.
Desire for histologic confirmation of diagnosis
Women who have never had a surgical diagnosis and want tissue pathology confirming endometriosis as the source of their symptoms.
Systematic Excision — Complete, Pathology-Confirmed
Dr. Andrei performs a systematic pelvic survey at the start of every excision case — mapping the extent and distribution of disease before resecting anything. Each implant is then excised with sharp dissection, removing the full thickness of the lesion.
Dr. Andrei follows a consistent surgical protocol designed to find and remove all disease — not just the most obvious lesions.
- Complete pelvic survey before any resection begins
- All lesion forms identified: red, blue, black, white, clear, subtle
- Sharp dissection beneath each implant to the full depth
- All excised tissue sent to pathology for histologic confirmation
- Systematic re-inspection of entire field before closing
Endometriosis excision surgery is performed at three affiliated Michigan hospitals. LCSC is not used for excision surgery — hospital-level support is required.
- McLaren Lapeer Hospital — Lapeer, MI
- McLaren Flint Hospital — Flint, MI
- Henry Ford Rochester Hospital — Rochester Hills, MI
“Ablation is a faster operation. It also leaves the disease behind. Every laparoscopic endometriosis case I perform is an excision case — because that is what it takes to actually remove the disease.”
From Consultation to Recovery
Endometriosis excision at Lapeer Women’s Health follows a structured pathway from evaluation through pathology results and follow-up.
Consultation and Imaging
Dr. Andrei reviews your symptom history, prior surgical reports, and imaging. MRI of the pelvis is often ordered before excision surgery to map suspected deep infiltrating disease.
Surgery Day
Under general anesthesia, Dr. Andrei performs a systematic laparoscopic survey of the entire pelvis and excises all identified endometriosis. Duration ranges from one hour for limited-stage disease to four hours for extensive deep infiltrating involvement.
Pathology Results
All excised tissue is sent to pathology. Results are available in one to two weeks — reviewed at your two-week follow-up. Histologic confirmation provides a definitive surgical diagnosis.
Post-Operative Management
Dr. Andrei discusses post-operative hormonal management — including whether suppressive therapy is recommended to extend the disease-free interval — at your follow-up appointment.
Recovery After Laparoscopic Endo Excision
Physical recovery from laparoscopic endometriosis excision is typically two to four weeks.
Most patients go home the same day. Pelvic cramping managed with oral medication. Light walking encouraged.
Desk work and light activity manageable within one to two weeks for limited-stage cases. Driving resumes once off narcotics.
Most women return to full activity within two to four weeks. The full pain relief benefit often becomes clear over the first two to three menstrual cycles post-operatively.
Questions About Excision Surgery
Excision. Confirmation.
Lasting Relief.
If endometriosis is affecting your quality of life — or if prior surgery did not hold — bring your imaging and operative reports to a consultation with Dr. Andrei.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.