Endometriosis Excision Surgery at PRM: The PRM Center of Excellence

What to Expect During Excision Surgery

The PRM Center of Excellence provides lifetime care for endometriosis patients, including before and after their excision surgery. With a team of pelvic pain and endometriosis specialists, we are improving overall surgical outcomes and reducing the overall total number of surgeries patients undergo in their lifetime.

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Understanding Laparoscopy for Endometriosis

What to Expect During Excision Surgery

Excision surgery involves excising endometriosis lesions in the body. These lesions cause pain and inflammation, so removing them is a vital step in managing the disease. We use the latest in excision technology, such as our robotic-assisted da Vinci surgerical system. PRM is proud to have endometriosis excision surgeons on staff, out of only 100 available in the world. Each is fellowship-trained and have worked on complex excision cases.

The PRM Center of Excellence is here to care for you every step of the way. Not only are we experts in excision surgery, but our surgeons work hand-in-hand with our pelvic pain specialists to help you prepare and recover through the PRM Protocol™.

Most of our surgeries are outpatient, meaning that patients can go home on the same day.

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Lifetime Care and Management of Endometriosis

PRM's Approach to Endometriosis

At PRM, our goal is to reduce the total number of surgeries endometriosis patients must underdog in their lifetime. With endometriosis being a systemic, inflammatory disease process, it is crucial that patients are educated about how the disease affects their body and the importance of pain and symptom management.

Working with both pelvic pain specialists and endometriosis excision surgeons through the PRM Center of Excellence means endometriosis patients will not only experience enhanced surgical outcomes, but better understand their condition, how it affects their pelvic floor, and receive the treatment and guidance needed to manage it.

PRE-HAB: Pre-habilitation refers to preparing the body to undergo endometriosis excision surgery with the goal of reducing inflammation in the pelvic floor, addressing comorbidities such as bladder pain and chronic constipation, and optimizing surgical outcomes. At PRM, endometriosis patients receive treatment through the PRM Protocol™ which reduces inflammation in the pelvic floor, resulting in overall increased pelvic floor function and decreased pelvic pain.
EXCISION SURGERY: Endometriosis excision surgery is a laparoscopic procedure that removes endometriosis lesions from the body. Excision surgery is the gold standard in the treatment of endometriosis and through the PRM Center of Excellence, patients find comfort in knowing that each excision surgeon has experience in complex cases and is fellowship-trained, emphasizing their expertise in treating endometriosis.
POST-HAB: Post-habilitation refers to addressing residual inflammation and comorbidities from endometriosis following a patient’s surgery. Because of the inflammatory nature of endometriosis, it is important for endometriosis patients to receive treatment through the PRM Protocol™ not only in the weeks following their surgery, but as needed in the years to come.

How Does It Work?

PRM's Surgical Process

Step One: The surgical procedure begins with approximately 3-4 tiny incisions on your abdomen below the umbilicus and a 10 mm incision inside the umbilicus. Carbon dioxide is used to inflate your abdomen, and the tiny camera and other surgical instruments will be placed through the incisions.

Step Two: The surgeon will then explore the abdomen and pelvis, looking for any endometriosis. If endometriosis is found, the lesions will be carefully excised with tiny surgical scissors and removed from the body to be sent to pathology.
The surgery may last 1-6 hours, depending on the extensiveness of the endometriosis and the amount to be excised.

Step Three: Upon completion of the procedure, the carbon dioxide and all instruments will be removed. The incisions on your abdomen will be closed with dissolvable stitches, the tube will be removed from your mouth, and you will wake up.

Step Four: In the recovery room and post-operative observation room. You will be carefully monitored for several hours. Typically, you will be discharged with instructions the same day or the next day after the surgery.

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How is Endometriosis Treated?

Two Types of Endometriosis Surgery

It’s important for patients to understand that there are two different types of surgery relating to endometriosis. AT PRM Centers of Excellence nationwnide, our experts specialize in laparoscopic excision surgery, coupled with the PRM Protocol™ to optimize surgical outcomes prior to excision and management inflammatio and comorbidities following surgery.

Ablation Surgery: Ablation surgery applies heat, such as laser or electrosurgery in an effort to destroy the endometriosis lesions and embedded tissue. The disadvantage of ablation for endometriosis is that the heat either does not fully destroy the lesions, or the heat penetrates and spreads too much and causes thermal damage to the surrounding non-diseased tissue. Furthermore, there is no surgical specimen for pathological identification and confirmation. Ablation treatment for endometriosis does not require advanced surgical skill, and all research studies indicate inferior outcomes and higher complication rates. This is NOT the preferred treatment and PRM does not offer this type of surgery.
Excision Surgery: Excision surgery, on the other hand, involves cutting out the lesions, implants, or fibrosis (scar tissue) caused by endometriosis. Although excision surgery is more effective, the procedure is more technically difficult and time-consuming. Complete removal of all visible diseased tissue makes this the best treatment currently available. Furthermore, with this type of surgery, the specimen removed from surgery can be sent to the pathology department where confirmation can be made that it is indeed endometriosis and not a different type of disease. Our Endometriosis Excision Surgeons have completed extensive Mayo Clinic fellowships and are experts in their field of diagnosis and treatment.

Surgery FAQs

What to Expect Following Surgery

Recovering From Excision Surgery

Your recovery process depends on your baseline of health and fitness, severity of the disease, and any pre-habilitation treatment you have undergone. In general, for the first couple of days after your surgery, you may experience bloating and discomfort from the gas that was used to distend your abdominal cavity for the laporoscopy.

You will also have some cramping and post-operative soreness/tenderness. This should improve by the third day, after which you should be feeling better. It is very important that you call us after surgery if you don’t feel better each day compared to the previous day
Within two weeks, you should be feeling almost 90% back to normal. At this time, you will have a follow-up office visit to ensure all is well and to check your abdominal incisions, which by this time should be almost completely healed. Your surgeon will discuss with you the surgical findings and the follow-up treatment plans.
We recommend following up with your pelvic pain specialist to begin post-habilitation treatment to continue to address any residual inflammation and comorbidities as a result of the disease.

Contact Us To Learn More About Endometriosis Surgery

At the PRM Center of Excellence, we take pride in our team fellowship-trained endometriosis excision surgeons. Their extensive training and experience in handling complex excision cases have equipped them with expertise not commonly found in treating endometriosis. Having met with hundreds of patients suffering from this debilitating condition, our surgeons possess the knowledge and skill necessary to provide optimal healing and care.

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