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Endometriosis Surgery: The Difference Between Ablation and Excision

For women with endometriosis, surgery is most often a choice medication and other therapies do not work. Your doctor may also suggest surgery based on your childbearing intentions (whether or not you are hoping to get pregnant). There are two main types of surgery for endometriosis treatment:

Laparoscopic surgery happens when a surgeon inserts a tiny camera and surgical instruments through a small incision, usually through the belly button.1

Recently, some physicians have also offered robot-assisted laparoscopic surgery, where the instruments are attached to a surgical robot. However, currently, there is no evidence that robotic surgery works better than normal laparoscopic surgery for endometriosis.2 This research is still ongoing.

In more extensive cases, doctors may treat patients with regular abdominal surgery, although that is much less common.3

The difference between surgical ablation and excision

There are two main techniques for removing the endometriosis patches inside the body:

  • Ablation burns the tissue using heat or lasers.
  • Excision cuts away the tissue using sharp instruments or lasers.

Which is better?

There are a few known disadvantages to ablation:2

  • Ablation does not allow the surgeon to collect tissue for a pathologist to examine, in case there are other problems that need to be identified.
  • Ablation does not allow the surgeon to see the line between healthy and unhealthy tissue as easily as with excision, so only the surface tissue is removed. This can leave deeper endometriosis patches untreated, allowing the condition to recur more easily.
  • With ablation, there can be complications, and the heat can affect other tissues and organs, since it is less precise than excision.

Studies comparing ablation and excision

In one study comparing ablation and excision via robot-assisted laparoscopic surgery, women who had experienced painful intercourse had better results with ablation compared to excision 6 months post-surgery. However, after 12 months, there was no longer a difference.4

In another, more complete analysis that looked at multiple studies together, researchers saw that excision led to more improvements than ablation for patients in the following areas 12 months after surgery:5

  • Painful periods
  • Ongoing pain in the pelvis
  • Constipation because of disrupted bowels

Talk to your doctor

It is important to know that many women experience a recurrence of endometriosis by 5 years after surgery (20-40%, according to some studies).6 Be sure to discuss your treatment options carefully with your healthcare provider and decide what is right for you before moving forward.

  1. Endometriosis. Office on Women’s Health. U.S. Department of Health and Human Services. Updated March 16, 2018. https://www.womenshealth.gov/a-z-topics/endometriosis Accessed July 26, 2018.
  2. Dr. Erin Nesbitt-Hawes. Endometriosis Australia. Published September 19, 2016. https://www.endometriosisaustralia.org/single-post/2016/09/19/What-does-it-all-mean-Excision-ablation-and-robotic-assistance-for-removal-of-endometriosis---Tools-of-the-Trade Accessed July 27, 2018.
  3. Endometriosis: Diagnosis & treatment. The Mayo Clinic. Updated July 24, 2018. https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661 Accessed July 26, 2018.
  4. KA Riley, AS Benton, TA Deimling et. al. Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial. J Minim Invasive Gynecol. 2018 Mar 30. pii: S1553-4650(18)30180-8. doi: 10.1016/j.jmig.2018.03.023. [Epub ahead of print] Accessed July 27, 2018.
  5. J. Pundir, K. Omanwa, E. Kovoor, et. al. Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2017 Jul - Aug;24(5):747-756. doi: 10.1016/j.jmig.2017.04.008. Epub 2017 Apr 26. Accessed July 27, 2018.
  6. Endometriosis: Recurrence & Surgical Management. The Cleveland Clinic Foundation. Updated August 1, 2014. https://my.clevelandclinic.org/health/diseases/4551-endometriosis-recurrence--surgical-management Accessed July 26, 2018.

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