Evan Friedman, MD

Endometriosis excision surgery is an advanced minimally invasive procedure that involves carefully identifying and removing endometriosis lesions from affected areas while preserving healthy tissue. Unlike approaches that only treat visible disease on the surface, excision surgery focuses on removing endometriosis at its root to help reduce symptoms and improve quality of life. At PRM, fellowship-trained minimally invasive gynecologic surgeons use advanced laparoscopic techniques and comprehensive evaluation to develop individualized treatment plans based on each patient’s symptoms, goals, and disease severity.

Endometriosis surgery may be considered for patients whose symptoms are not adequately controlled with medications or hormonal treatments, whose pain significantly impacts daily life, or who are experiencing fertility challenges. Surgery may also be recommended when imaging or evaluation suggests deeper disease, such as endometriosis involving the bowel, bladder, or other pelvic structures. Common reasons to consider an endometriosis surgery consultation include persistent pelvic pain despite medical treatment, painful periods, painful intercourse, gastrointestinal or bladder symptoms, difficulty conceiving, or findings such as endometriomas or deep infiltrating endometriosis. During an evaluation at PRM, providers review your symptoms, medical history, imaging, and treatment goals to determine whether excision surgery is the right option for you and develop a personalized care plan.

PRM cares for patients experiencing a wide range of pelvic health conditions, including endometriosis, chronic pelvic pain, pelvic floor dysfunction, painful periods, dyspareunia, bladder pain, gastrointestinal symptoms related to pelvic disorders, adenomyosis, fibroids, ovarian cysts, and other complex gynecologic conditions. Providers also support patients with symptoms that have previously gone undiagnosed or untreated.

PRM’s endometriosis surgeons specialize in advanced laparoscopic excision surgery and care for patients through a fully integrated, multidisciplinary approach. Unlike a surgery only model, PRM combines surgical expertise with pelvic pain care to address the inflammation, nerve sensitivity, and pelvic floor dysfunction that can contribute to ongoing symptoms. PRM’s fellowship-trained Minimally Invasive Gynecologic Surgeons (MIGS) have specialized training in complex excision surgery and treat advanced endometriosis, including cases involving areas such as the bowel, bladder, and diaphragm. Their approach also includes comprehensive support before and after surgery, including pelvic rehabilitation through the PRM Protocol™ to help reduce pain, support healing, and improve long-term outcomes. PRM focuses on personalized, whole-body care designed to help patients achieve meaningful relief while reducing the need for repeated procedures. Providers also evaluate patients clinically based on symptoms, medical history, and physical examination, allowing treatment planning to begin without waiting for surgical confirmation.

Yes, endometriosis excision surgery can improve fertility for some patients by removing endometriosis lesions, treating scar tissue and adhesions, restoring normal pelvic anatomy, and reducing inflammation that may interfere with conception. The impact of surgery depends on factors such as the severity of endometriosis, age, ovarian reserve, and overall fertility health. For patients with mild to moderate endometriosis, removing visible disease may improve the chances of spontaneous pregnancy. In more advanced cases, surgery may help restore the relationship between the ovaries, fallopian tubes, and surrounding pelvic structures to support reproductive goals. At PRM, providers consider each patient’s fertility goals and individual circumstances when determining whether surgery is the right approach and how it fits into a broader fertility plan.

Recovery after endometriosis excision surgery varies depending on the extent of disease treated and each patient’s healing process. Many patients experience gradual improvement over the first several months rather than immediate relief. The first menstrual cycle after surgery (typically 4–8 weeks post-surgery) may be the most challenging, with some patients experiencing increased cramping, pelvic pain, or heavier bleeding as the body heals. By the second cycle, many patients begin noticing improvements, and within three to six months, patients often report reduced pain, improved energy, and better daily function. At PRM, recovery is supported through a comprehensive approach that combines surgical expertise with individualized follow-up care and additional treatments when needed to support long-term healing and quality of life.