Two types of surgery are used to treat endometriosis, resection and hysterectomy. Resection surgery involves removing the lesions (implants) and leaving the uterus and other organs intact. Resection is generally recommended for women who still want to have children.
A hysterectomy, which is the removal of the uterus (possibly other organs), is generally recommended for women who are not planning to have children.
Both resections and hysterectomies can be accomplished with two types of surgery: open surgery, involving a large incision and long recovery; and laparoscopic surgery, which is minimally invasive and is performed through small incisions.
Dr. Willman uses the da Vinci Surgical System, a unique form of laparoscopic surgery, when appropriate for endometriosis surgery, as well as for uterine fibroids.
With da Vinci, endometriomas can be resectioned more completely decreasing the risk of recurrence. In addition, suturing can be used instead of electrocoagulation, which can decrease the risk of destroying normal ovary.
The decision when to apply surgery or IVF in endometriosis-associated infertility must take into account:
- The age of the patient
- Ovarian reserve testing
- Progression and severity of the endometriosis
- The presence of other infertility factors
- Duration of infertility
- Past treatments
- Whether or not there is pain
Generally, surgery for endometriosis is used as a first line treatment and not repeated. If surgical treatment of endometriosis fails, then IVF is the next line of treatment. Endometriosis can progress and recurs at a rate of 20-40 percent within five years following conservative surgery. Periodic pelvic exams and sonography can monitor recurrence of endometriosis.
Experience does count in surgery. The more experienced the surgeon, the more likely she will recognize and skillfully remove all disease, reducing the risk of recurrence.