Endometriosis Excision

Endometriosis is a chronic inflammatory disorder in which endometrial tissue grows outside the uterus in the pelvic cavity. The condition is relatively common among women with infertility and pelvic pain. While medications may lessen endometriosis symptoms, the condition is best treated surgically via a minimally invasive laparoscopic surgery in which endometriosis is removed.

The most common kind of endometriosis surgery uses a method called fulguration, in which the endometriosis lesions are burned with a cautery device. This method of treatment could be compared to melting the tip of an iceberg, since much of the time, endometriosis is left under the surface of pelvic tissues. As a result, women who have an endometriosis fulguration procedure have a much higher chance of their endometriosis returning within 1-2 years after surgery.

A much more effective way of treating endometriosis is using a technique called excision, in which all endometriosis implants (and associated scar tissue and inflammation) are completely removed. This method of treating endometriosis results in a much lower chance of endometriosis returning after surgery (about 10-20%) and also results in better pain resolution compared with fulguration.

Endometriosis Excision at Veritas Fertility and Surgery

Technique Matters
While endometriosis excision and fulguration are both considered “endometriosis surgery,” they are not equivalent. Technique matters. Fulguration only partially treats the disease and often leaves pelvic tissues burned or damaged; excision seeks to completely eliminate the disease and provides women with a better chance of being restored to optimal reproductive health. Far fewer surgeons have the training and expertise to perform endometriosis excision, which is why many women aren’t aware of the different methods of treating endometriosis.

The doctors at Veritas Fertility and Surgery only perform excision when treating endometriosis, and this helps his patients have better outcomes and lower chances of recurrence.

As reproductive surgeons, we use advanced laparoscopic surgery with a CO2 laser to completely excise endometriosis. The CO2 laser is a very precise instrument that allows for the safe removal of endometriosis lesions, even when growing on or near vital structures like the fallopian tubes, ovaries, ureters, blood vessels, nerves, or the bowel.

In order to excise all endometriosis during surgery, it is important first to confidently identify all endometriosis lesions upon careful inspection. To do this, the doctors at Veritas Fertility and Surgery use a method called near-contact laparoscopy to magnify and systematically evaluate every area of the pelvic cavity for endometriosis before starting the process of removing all visible disease. Additionally, excision techniques allow the surgeon to remove even deep infiltrating endometriosis (where the endometriosis grows deeper into the pelvic tissues than normal).

Laparoscopic excision of endometriosis is an outpatient procedure, meaning that patients go home the same day as their surgery. While each patient’s experience may be unique, most women recover quickly after laparoscopic surgery. The first 1-2 days after surgery, most women feel crampy/sore, tired and sometimes bloated. With each passing day, recovery becomes easier, and by 5-7 days after surgery, most women feel like they’re 100% back to normal.


“Dr. Puthoff is amazing! He is compassionate, patient, and very intelligent. He seems to really care, and it feels like you’re in good hands. It is reassuring that he is so good at what he does and still allows you to make your own choices.”

“I am very blessed that the Lord brought Dr. Puthoff and his team into my life. His work and the treatment I received made it possible for us to have another child. That is a priceless joy and we couldn’t say thank you enough to Dr. Puthoff.”

“The friendly and welcoming attitude of Dr. Puthoff put me right at ease. He thoroughly explained the procedure and answered all of my questions. I felt extremely confident that he is the right surgeon for my procedure.”

“My husband and I were very pleased with how approachable and comforting Dr. Puthoff was. He took time to listen and to care. We never felt rushed. He gave us hope. That’s what we needed. Thank you Dr. Puthoff for what you do. Your job truly has a lasting impression and gift on your patients.”

“Because of my first visit and the attentive phone calls I have received since, I am confident I am in caring hands for my upcoming surgery. I feel extremely grateful to be getting such amazing care.”

“I always feel involved in my care. Dr. Puthoff has an excellent bedside manner and demonstrates a high level of professionalism.”

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