Laparoscopy for Endometriosis
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Medically reviewed by Cordelia Nwankwo, MD
Laparoscopic (keyhole) surgery is a minimally invasive surgical technique. Surgeons use it to diagnose and treat endometriosis (endo).
Laparoscopy can help by locating, staging, and removing endometrial lesions. but it is not the first line of treatment or a cure. It can help reduce pain, but laparoscopy does not guarantee long-term pain relief.
This article reviews when you may need laparoscopic surgery for endometriosis, how to prepare for it, and its various methods, risks, complications, recovery, chance of recurrence, and long-term pain management strategies.
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When Is Laparoscopy Needed for Endometriosis?
Healthcare providers typically recommend lifestyle changes, hormones, pain management, and physical therapy before recommending surgery to diagnose or treat endometriosis.
They may recommend laparoscopy when:
Severe endometriosis symptoms continue with other treatments.
Endometriosis affects organs in the pelvis.
Endometriosis causes infertility (inability to get pregnant).
Laparoscopy for Diagnosing Endometriosis
Laparoscopic surgery is the only way to get a definitive endometriosis diagnosis.
If the surgeon sees endometriosis during the laparoscopy, they will remove it and send a sample to the lab. The lab views it under a microscope to confirm the diagnosis.
Laparoscopy for Treating Endometriosis
While surgery is not the first-line treatment, removing endometrial lesions through laparoscopy can be part of the care plan.
In surgery, your provider can also identify the amount and location of endometrial tissue, which helps them determine the stage of the disease and targeted treatment approaches.
How to Prepare for Endometriosis Laparoscopy
To maximize your recovery, consider taking the following steps.
Quit smoking.
Eat a healthy diet.
Drink plenty of water.
Stay active.
Before your laparoscopy, you'll have a preoperative appointment that involves lab work and a vital sign check. This ensures you are in good health and not pregnant.
Before your surgery, you will receive instructions on when to take medication, eat, and shower. Your provider may give you a special soap to decrease your risk of infection.
On the day of surgery, wear comfortable clothes, leave valuables at home, and ensure you have a driver for after surgery.
Laparoscopic Endometriosis Surgery Methods
Surgeons perform laparoscopy with two to four tiny keyhole incisions, each about one-quarter inch long. The first usually is made inside the navel (belly button) and the rest will be elsewhere in the abdomen.
Surgeons use a laparoscope (tube with a tiny camera attached) and air injected into the abdomen to visualize and perform surgery without making a large incision.
The surgeon may use the following techniques to remove endo lesions during the procedure:
Excision: Surgical removal of an endometriosis lesion using a scalpel or laser
Ablation (fulguration): Removal through electrosurgery or cautery, which burns or melts the lesion
Excision vs. Ablation
Ablation removes the surface of the lesion but not the root. It is beneficial for smaller, superficial endometriosis lesions.
Surgical excision removes the entire lesion, including the root. It is typically the best choice for deep infiltrating endometriosis (DIE) and endometriomas (chocolate ovarian cysts). Excision also helps preserve fertility because it is less damaging than the ablation of ovarian tissue.
Questions to Ask Your Surgeon
The following are examples of questions to ask your healthcare team before surgery:
What is the goal of surgery?
Is the surgery treating superficial or infiltrating endometriosis?
If symptoms continue, what are the next steps?
Will surgery completely get rid of endometriosis?
What technique will the surgeon use?
How many incisions will there be?
How long will the surgery take?
How much pain should I expect after surgery?
When can I return to normal activities, including work, school, exercise, and sex?
Will surgery affect my ability to get pregnant?
Additional Procedures That During Laparoscopy for Endo
Depending on your health and goals, your surgeon may recommend one of the following concurrent surgeries with the laparoscopy:
Appendectomy: Removal of the appendix (a small organ attached to the large intestine)
Adhesiolysis: Removal of adhesions (scar tissue)
Tubal sterilization: Cutting the fallopian tubes to prevent pregnancy (permanent birth control)
Hysterectomy: Removal of female reproductive organs (only for those who do not wish to get pregnant)
Does Laparoscopy “Cure” Endometriosis?
Laparoscopy can help manage symptoms but is not a cure for endometriosis. The surgery results depend on the stage of endometriosis stage, the type of surgery, and additional medical treatments you have had. For example, removing all lesions with stage 4 endometriosis is more challenging than removing superficial lesions.
The surgeon will stage endometriosis using the following system:
Stage 1: Minimal small lesions with no scarring
Stage 2: Mild with more lesions but less than 2 inches of scarring
Stage 3: Moderate with deeper lesions, potentially with ovarian cysts and scar tissue around the fallopian tubes or ovaries
Stage 4: Severe, with multiple lesions, potentially with larger cysts and scar tissue between the uterus and lower intestine and around the fallopian tubes and ovaries
Risks and Complications of Laparoscopy for Endometriosis
Risks and complications of laparoscopy for endometriosis are rare. However, they can be severe and include:
Infection
Internal bleeding
Organ damage (including the ovaries and bladder)
Blood clots in the legs or lungs
Failure to remove all the lesions (or not improve symptoms)
Scarring
Hernia
How Long Is Recovery for Laparoscopy?
Recovery from laparoscopy is faster and easier than after traditional open surgery. Incisions are smaller, hospital stays are shorter, and the scarring is minimal.
Acute
After surgery, you will go to the recovery room while you wake up. Most people go home on the day of laparoscopic surgery (after they stand and empty their bladder independently).
You might feel tired, sore, and bloated for the first few days. Some of this discomfort may be in your shoulders or back. This is from the gas they use to expand your abdomen during surgery. Moving around typically helps with gas pain.
You may also have a mild sore throat from the tube used to help you breathe during surgery.
Notify your healthcare team if you have any of the following symptoms:
Severe pain that is getting worse
Problems emptying your bladder
Passing out
Heavy bleeding
Redness, swelling, or pus at the surgical site
Related:When Can I Have Sex After Surgery?
Incision and Scar Care
The surgeon typically uses surgical glue and Steri-Strip wound closures to close the incisions because they are so small. These incisions tend to heal quickly.
Following these few tips will help you avoid infection, heal quickly, and minimize scarring:
Wash your hands often.
Leave the Steri-Strips on until they fall off.
Take showers rather than baths (you may need to wait 48 hours after surgery to shower).
Dry the incision thoroughly after showering.
Avoid touching, scrubbing, or scratching the incision.
Inspect the incision daily (watching for redness, swelling, warmth, or drainage).
Avoid using scar remedies until your incision completely closes.
Long-Term Recovery
After the first week, you will most likely feel more like yourself, but total recovery time can take several weeks.
Recovery time depends on your overall health, activity level, and how your body tolerates anesthesia. Avoid heavy lifting or strenuous exercise during this time.
Pain That Continues After Laparoscopy for Endometriosis
Between 50% and 80% of women experience symptom reduction after surgery. But the pain can take a few weeks or months to resolve. Approximately 20% of women have pain three to six months after surgery.
Recurrence vs. Incomplete Removal
There is a 40% to 50% recurrence (return or regrowth of endometriosis) rate within five years of surgery. These rates vary because some people use pain as an indicator, while others use signs of lesions or infertility as a marker for recurrence.
There is a 5% to 15% chance of recurrence after hysterectomy and ovarian removal.
There are times when endometriosis remains or recurs because the surgeon cannot remove all the lesions. The risk of incomplete removal is higher with ablation, advanced stages of endometriosis, or when removing it would damage another organ.
Studies show that complete excision results in lower recurrence rates than ablation for those with deeply infiltrating endometriosis (DIE) or ovarian disease.
Some people feel it is worth having a laparoscopy—even if the pain may return—since it provides an official diagnosis, staging, targeted treatment plan, and removal of most of the lesions.
Long-Term Endometriosis Pain Management
While there is no cure for endometriosis, there is treatment. It often requires a multidisciplinary approach involving:
Endometriosis specialists and other surgeons (if the endo affects other body systems)
Pain management specialist
Endocrinologist (hormone specialist)
Fertility expert
Pelvic Floor Physical Therapy
Pelvic floor physical therapy (PFPT) involves working with a specialized physical therapist to improve the strength and function of the muscles in the pelvis (between the hips). PFPT may include:
Pelvic floor exercises such as Kegel exercises
Biofeedback
Massage
Electrical stimulation
Ultrasound
NSAIDs and Hormonal Therapies
Nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose hormonal therapy (oral contraceptive pills with ethinyl estradiol and progestin) are the first lines of treatment for endo.
NSAIDs help control pain and inflammation, while hormonal therapy suppresses endometriosis growth. Providers often continue hormones in addition to surgery to help prevent a recurrence.
The second line of treatment involves progestin (given orally, by injection, or with an intrauterine device, or IUD), androgens, and gonadotropin-releasing hormone agonists (GnRH). GnRH shuts down ovarian hormone production.
One study notes that 16.6% of women with endometriosis had four or more surgeries.
In another study, 20% (322) of the women who had a laparoscopy for endometriosis had a second surgical treatment within three years. Of those 322 women, 39.8% had a third, and 14.9% had a fourth surgery.
Laparoscopic Surgery Cost
The average cost of a laparoscopy is around $5,800, which varies by geographic location, disease severity, and procedure length.
These costs can vary based on your insurance plan and in-network vs. out-of-network providers. Ask your insurance company about deductibles and maximum out-of-pocket expenses.
Related:How To Get Help Paying for Health Insurance
How to Find an Endometriosis Specialist
Finding an endometriosis specialist can help you get an earlier diagnosis and treatment. This helps prevent complications, including unnecessary pain and infertility.
Consider checking in with endometriosis support groups for suggestions when looking for a specialist. When you meet with an endo specialist, ensure they have the following qualities.
They have experience treating endometriosis.
They respectfully listen to your concerns.
They work with you as a partner to develop a plan.
If you don’t feel comfortable with the provider chosen or the treatment plan, consider getting a second or third opinion.
Related:Patient Rights in the American Healthcare System
Endometriosis specialists are obstetrician-gynecologists (ob-gyns). In addition, they are highly skilled surgeons with experience treating endometriosis. They typically work in medical centers, teaching hospitals, or practices with access to modern surgical equipment.
Summary
Laparoscopic (keyhole) surgery is a minimally invasive surgical technique involving smaller incisions and faster recovery than open surgery. Surgeons use this technique to locate, diagnose, stage, and remove endometrial lesions. However, laparoscopy is not the first line of treatment or a cure. Sometimes the lesions remain or grow back. It’s common for those with endometriosis to have multiple laparoscopic surgeries.
