Learn about the most effective type of laparoscopy for endometriosis.
Last summer I had an appointment with my OB-GYN to figure out the next step for treating my internal pelvic pain, which she suspected was caused by endometriosis. The pain had significantly ramped up in recent months and was virtually constant. My OB-GYN recommended having a laparoscopy, which she described as a minimally invasive surgery to diagnose and removed endometriosis lesions that might be present in my pelvis. I left that appointment believing that there was only one type of laparoscopic surgery to treat endometriosis.
I was wrong.
The procedure I finally had this past winter (after months of waiting), with a type of laparoscopy called ablation or coagulation. During this procedure, endometrial lesions are burned away with a high energy heat source, usually a laser. This is the most common type of laparoscopy for endometriosis. Three months after having the surgery, my chronic pelvic pain has never been worse. Ablation was not effective for treating my endometriosis.
However, there is a second kind of laparoscopy for treating endometriosis, called excision. This procedure is less common than ablation, requires more skill, and is more time-consuming.
“Excision removes endometrial implants by cutting them away from the surrounding tissue with scissors, a very fine heat gun or a laser beam…Excision allows the gynaecologist to separate the implants from the surrounding tissue, thus ensuring that the entire implant is removed and no endometrial tissue is left.”[i]
The most important difference between these two types of laparoscopic surgeries, according to a new study, is that excision is more effective than the ablation.[ii] Researchers compared three recent studies that examined the outcomes of ablation versus excision laparoscopies for treating endometriosis. They found that excision laparoscopies, compared to ablation, resulted in:
- a significant reduction in painful periods
- a significant reduction in chronic pelvic pain
- a significant reduction in straining with bowel movements
- a non-significant reduction in painful sex
The researchers concluded that their review “showed significantly greater improvement with laparoscopic excision compared with ablation” in the treatment of endometriosis. I wish I’d known last summer. Now I’m beginning the long process of being referred for excision surgery.
[i] http://endometriosis.org/treatments/endometriosis-surgery/
[ii] Pundir, J., & Omanwa, K. (2017, April 26). Laparoscopic excision versus ablation for endometriosis-associated pain – Updated systematic review and meta-analysis. Journal of Minimally Invasive Gynecology. http://www.sciencedirect.com/science/article/pii/S1553465017302637
Skillfully Well & Painfully Aware 
So true! I’ll never forget how much pain I was in after my ablation surgery!
But not all excision is created equal, either. It all depends on the skill of the surgeon to be able to recognize endometriosis in its various appearances (the lesions can be different colors even within the same person) and to be able to remove it from any organ it appears on. It’s so hard to find a true specialist, but search as hard as you can for the best one. You really need someone who exclusively operates on endometriosis and that’s all they do. I traveled over 700 miles for my excision surgery and it changed my life.
Thanks so much for sharing your experiences! I’m in the process of getting a referral for excision and will definitely want to find a specialist in endo surgery, not a general OB-GYN. I hope it works, although it will take many months!
I haven’t had ablation but I was thinking about it because I was really desperate for answers and relief. I ended up having excision after a long time, but I still struggle with pain from Adenomyosis. 😦 Trying to sort that out now after going through so much to find a specialist who does excision, and hoping that the surgery would help, has pretty much been a nightmare for me. I hope you can get excision done by an expert soon! 🙂 Reading up on info online is truly a miracle, because we would still think that ablation is the only way! Thanks for your post! We need more awareness on Endo.
I have been dealing with painful endometriosis since I was 12.. I’m now 41. I had so many laparoscopies over the years and even a partial hysterectomy to try to help or end the pain. Right before that I tried Lupron which was a huge mistake. The pain is to the point I can’t deal with it anymore and we moved to Wilmington Nc . Do you know of any excision specialists here? I need relief ASAP I don’t know where to go from here I feel I have tried everything! Thanks in advance
Hi Angie, I’m so sorry to hear that the treatments you have tried are not effective and that your pain is unmanaged. It’s the most frustrating thing in the world. The best resource I have found is Nancy’s Nook Endometriosis Education facebook group, run by a retired nurse. It is a closed group, but once you join, you can access the dozens of resources in the ‘files’ section, including a list of patient recommended excision surgeons across the US and internationally (the file is called ‘Surgeons_International Excision Surgeon Listing’. If you have any trouble finding the list, just write a comment in discussion. Hope you find some relief soon! Xx
Angie, I have been dealing with endo since I was 14. Have had 8 laparoscopies and a complete hysterectomy. I am 39. I had my laproscopy in 2008 which was an excision surgery with the Center for Endometriosis Care in Atlanta, GA. They are expensive but all they do is work with endo patients. They were very caring and knowledgeable. They have a website and I was able to send them my medical records and discuss things with them before ever making a decision. I lived in Colorado at the time and flew there just to have my surgery. I hope you are able to find some relief soon. I know how horrible this disease is for us. I still have pain now but after that surgery I was mostly pain free for years. And even now the pain is no where near what I used to deal with. And I’m pretty sure it’s scar tissue I’m dealing with now.