What Happens During Endometriosis Surgery?
The great majority of endometriosis surgery is performed laparoscopically, either as conventional keyhole surgery or with robotic assistance, meaning through a small number of very small incisions rather than a large abdominal cut.
During the procedure, endometriosis is excised, which means it is cut out at its base rather than burnt on the surface. Adhesions are carefully separated, and any endometriomas, ovarian cysts formed by endometriosis, are removed while preserving as much healthy ovarian tissue as possible.
What Are the Benefits of Operating This Way?
A laparoscopic approach offers several practical advantages over open surgery:
- Smaller incisions, which means less pain afterwards
- A shorter hospital stay and a faster return to normal activity
- Reduced bleeding and lower risk of infection
- Less internal scarring than open surgery tends to cause
How Is Surgery Planned?
Planning starts well before theatre. Endometriosis mapping with 2D and 3D ultrasound, and MRI where needed, shows where the endometriosis is and how deeply it has grown. That information determines how extensive the operation needs to be and which other specialists should be involved. It also gives you a realistic sense of recovery before you commit to surgery. Just as importantly, the surgery can aim to remove all visible disease in one operation, rather than discovering its full extent on the day.
What Is Robotic Excision Surgery?
Robotic surgery is a form of minimally invasive surgery in which Dr Groenewald controls fine, wristed instruments from a console beside the patient, using a magnified three-dimensional view of the pelvis. The robot does not operate on its own. Every movement is made by the surgeon, with the system translating hand movements into precise movements of the instruments inside the body.
The incisions are similar in size to those used in conventional laparoscopy. Robotic assistance tends to be most useful in deep pelvic surgery, for example when endometriosis needs to be excised from around the ureters or the bowel wall, where the added range of movement helps with careful dissection in a confined space.
Laparoscopic or Robotic: How Is the Choice Made?
Both approaches allow endometriosis to be excised thoroughly, and neither is the right choice for every patient. The decision depends on what mapping shows about the extent and location of your endometriosis, as well as practical considerations such as your medical aid, since cover for robotic surgery varies between schemes. Dr Groenewald will explain which approach he recommends for your operation, and why.
What If Endometriosis Involves the Bowel or Urinary Tract?
Deep infiltrating endometriosis can grow into the wall of the bowel or into the urinary tract, including the bladder and the ureters, the tubes that carry urine from the kidneys to the bladder.
Because mapping identifies this before surgery, the operation can be planned as a combined procedure. A colorectal surgeon joins Dr Groenewald where bowel endometriosis needs treatment, and a urologist where the bladder or ureters are involved. They operate alongside him during the same procedure, which means you have one anaesthetic and one recovery period rather than a series of separate operations.
Depending on how the disease presents, the combined surgery may involve:
- Shaving a nodule from the surface of the bowel wall
- Removing a small disc of bowel wall containing the nodule
- Removing a short segment of bowel and rejoining the two ends, where disease is more extensive
- Freeing a ureter from surrounding endometriosis
- Removing a nodule from the bladder wall
Which of these applies to you is discussed in detail beforehand, along with what it means for your recovery.
What About Endometriosis on the Diaphragm?
Less commonly, endometriosis is found on the diaphragm, the muscle that separates the chest from the abdomen. It often causes pain in the right shoulder tip or lower chest around the time of a period. Where symptoms or MRI suggest diaphragmatic disease, the surgical plan includes a careful inspection of the upper abdomen, and in many cases this endometriosis can be excised during the same laparoscopic or robotic procedure. More extensive involvement may call for input from a thoracic surgeon.
What Can I Expect Afterwards?
Recovery after laparoscopic endometriosis surgery is typically measured in days rather than the weeks needed after open surgery, although this varies depending on how extensive the procedure was. Most women notice a meaningful reduction in pain once they have recovered, though as with any surgery for endometriosis, symptoms can return over time, particularly with more advanced disease.
Does Surgery Affect Fertility?
For women trying to fall pregnant, removing endometriosis implants and adhesions can improve the chances of conception, particularly where scar tissue has been affecting the ovaries or fallopian tubes. Where an endometrioma needs to be removed, care is taken to preserve as much healthy ovarian tissue as possible, and this is always discussed with you beforehand.
