Endometriosis Surgery

Endometriosis surgery is a “keyhole” operation that lets doctors see and treat endometriosis—tissue similar to the uterine lining that grows where it shouldn’t (like on the ovaries, fallopian tubes, or pelvic walls). Through a few tiny belly incisions, the surgeon slides in a camera (laparoscope) that shows a magnified view on a screen. Slim instruments are used to carefully remove (excision) or destroy (ablation) endometriosis spots, release scar tissue (adhesions) that tethers organs, and drain or remove endometriomas (ovarian cysts caused by endometriosis). If needed, they can also treat deep lesions that burrow into ligaments or the bowel surface.

Why do it? The goal is to reduce pain (period pain, pelvic pain, pain with sex), improve organ function, and, for some, support fertility by freeing stuck structures and clearing disease. Surgeons may map lesions with imaging and plan a targeted approach, often focusing on excision for precise removal. Some people also have supportive procedures at the same time (for example, addressing a blocked tube or straightening adhesions) to help the pelvis work more normally. It’s primarily a function‑focused surgery: clean up the problem tissue and restore normal anatomy.

Shorter wait times

• Endometriosis is painful and unfortunately common, impacting 1 in 10 Canadian women. Though common, it can take years to receive a diagnosis, and 1-3 years for surgical care.
• Private centres often line up assessment and surgery within weeks—cutting months of pelvic pain, missed school/work, and repeated ER/clinic visits.

Choice and control

• Pick a high‑volume endometriosis surgeon who focuses on laparoscopic excision (and deep disease when relevant).
• Choose clinic location (including out‑of‑province) and schedule around exams, jobs, athletics, or fertility timelines.
• Discuss a tailored plan: excision vs ablation, management of endometriomas, and whether to coordinate with colorectal/urology if needed.

Peace of mind

• Clear dates, a named surgeon, and a detailed plan (anaesthesia, approach, expected findings) reduce uncertainty.
• Direct messaging and rapid result sharing help organize time off, childcare, and pelvic floor physio.

Preventing further decline

• Ongoing inflammation can fuel pain flares, adhesions (organs sticking), bowel/bladder irritation, and sexual pain.
• Earlier excision can restore anatomy, support fertility goals, and reduce cycles of urgent care visits and strong pain meds.

Integrated care

• Access to multidisciplinary teams (gyn + colorectal/urology + pelvic physio), high‑definition laparoscopy, and advanced energy tools.
• Option to bundle necessary procedures in one surgery (e.g., endometrioma management, adhesion release).

1. ‍Confirm the need. Most patients start with a family doctor or specialist who confirms that endometriosis surgery is advisable, but your gynecologist can also confirm if needed.
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2. Research. Explore gynecologists who specialize endometriosis surgery.
   
   • You can find gynecologists in Vancouver, British Columbia; Calgary, Alberta; Toronto, Ontario; and Montréal, Québec on our app, and review qualifications, as well as pricing.
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3. ‍Schedule an initial consultation. Most gynecologists offer in-clinic and online consults.
   
   • Consultations are usually booked within days or a few weeks.
   • Note: expect a consultation fee between $150 - $350.
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4. ‍Consultation. The gynecologist will review your condition, symptoms, and any previous treatments or diagnostics, such as x-rays or MRIs.
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5. ‍Post consultation. The surgeon will then review your case and provide surgical options based on your needs; review the risks and expected outcomes; and present pricing and scheduling options.
   
   • Because the procedure is not covered by your provincial health plan when done privately, you’ll need to review the quoted cost and consider payment options (out-of-pocket, private insurance, or financing).
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6. ‍Schedule your surgery date. Once you confirm the procedure and payment, the clinic will schedule your surgery—generally within a few weeks.
   
   • Plan for travel and accommodation, since the surgery will likely take place outside your home province.
   • Expect pre-surgery preparation, and possibly some pre-surgery tests.

Diagnostic laparoscopy only (look and map) takes about 45–90 minutes. Laparoscopic excision/ablation of mild–moderate endometriosis takes about 1–2.5 hours. Deep endometriosis or endometriomas, possible bowel/bladder work: 3–5+ hours, sometimes with a second specialist. Expect extra hours at the centre for check‑in, anaesthesia, and recovery. Many cases are same‑day; complex cases may stay overnight.

Basic steps (what actually happens)

Check‑in and plan

• You meet the team, review symptoms and goals (pain relief, fertility, organ function), and confirm what might be treated (adhesions, endometriomas, deep lesions).

Anaesthesia

• General anaesthesia (you’re asleep).

Position and prep

• You’re positioned safely on a padded table. The belly is cleaned; sterile drapes are placed. A catheter may be used to keep the bladder empty.

Tiny incisions (ports)

• The surgeon makes 3–5 small cuts on the abdomen. Carbon dioxide gently inflates the belly so organs are easier to see.

Camera in

• A thin camera (laparoscope) shows a magnified view of the pelvis on a screen. The surgeon inspects the uterus, ovaries, tubes, bowel surface, bladder area, and ligaments.

Treat the disease

• Excision (careful cutting out) or ablation (destroying spots) of endometriosis.
• Release of adhesions (scar bands) so organs move freely again.
• Management of endometriomas (drain and remove the cyst wall).
• If deep lesions involve bowel or bladder, a collaborating surgeon may assist.

Rinse and check

• The area is washed; bleeding points are sealed. The team re‑checks organ mobility and looks for any remaining disease.

Close up

• Ports are closed with dissolving stitches or small sutures and covered with dressings.

Wake‑up and instructions

• You recover in PACU, get simple home instructions (walking, meds, wound care), and usually go home the same day unless your case was complex.

Everyone heals differently—follow your surgeon’s plan. Gentle, steady progress beats rushing.

In general, what to expect

Week 1

• Reality check: belly/pelvic soreness, shoulder tip pain from gas used in laparoscopy, bloating, and fatigue. Naps are normal.
• Goals: control pain and swelling, protect the incisions, get moving safely.
• Activities: short walks every few hours, deep breathing, sip fluids, protein‑rich snacks. Keep dressings clean/dry; use stool softener and fibre to avoid straining. No heavy lifting.

Weeks 2–4

• Still annoying but improving.
• Goals: steady energy, easier standing/walking, gentler bowel/bladder routine.
• Activities: increase walking distance, light chores, gentle stretching/mobility. Most return to school/desk work in this window (ask your surgeon). Avoid core‑straining moves, high‑impact exercise, and heavy lifting.

Weeks 5–8

• The rhythm phase.
• Goals: rebuild basic strength and endurance without flaring pelvic pain.
• Activities: add low‑impact cardio (bike, brisk walks), light resistance (bands/bodyweight), and posture/core control work (no heavy ab work yet). If recommended, start or resume pelvic floor physiotherapy.

Weeks 9–12

• The work phase.
• Goals: confident daily activity; targeted strength and flexibility.
• Activities: progress resistance and duration; introduce more dynamic movements as cleared. Some return to non‑contact sports/training in this period.

Months 3–6

• Getting back to “normal‑ish.”
• Goals: full daily function and fitness; tailored plan for sport or fertility goals.
• Activities: resume higher‑impact exercise and heavier lifting only when cleared.

Red flags—call your care team

• Fever, worsening pain, spreading redness, or foul‑smelling discharge from incisions
• Heavy vaginal bleeding (soaking pads), vomiting with inability to keep fluids down
• Painful, swollen calf; chest pain or shortness of breath
• Can’t pass urine or severe constipation despite meds

Exact prices vary drastically, depending on how complex your case is (mild spots vs deep disease), whether endometriomas or bowel/bladder lesions are treated, the surgeon’s expertise, clinic location, and OR time. Always ask for a written, itemized quote.

In Canada, private clinics charge:

• Diagnostic laparoscopy only: $4,000–$10,000
• Laparoscopic excision/ablation for mild–moderate disease:  $9,000–$18,000
• Complex excision (deep endometriosis, endometriomas, possible bowel/bladder work with a second specialist): CAD$15,000–$35,000+
• Overnight hospital stays, extra OR time, and multidisciplinary teams increase costs.

In the United States, endometriosis surgery ranges between CA$15,000 - CA$60,000+.

What’s usually included

• Surgeon fee (gynecology/endometriosis specialist) and anaesthesia services
• Accredited facility/OR time, nursing, standard disposables, and routine laparoscopic instruments
• Immediate recovery care (PACU) and 1–2 early follow‑up visits (varies by clinic)
• Basic pathology fees for specimens in some bundles

What’s often not included

• Initial consults, pre‑op imaging (ultrasound/MRI) and labs if done externally
• Additional specialist fees (colorectal/urology), advanced energy devices, or robotic platform surcharges
• Extra OR time beyond the booked block, unplanned overnight stay/inpatient admission
• Prescriptions after discharge (pain meds, anti‑nausea, stool softeners)
• Pelvic floor physiotherapy and longer‑term follow‑up beyond the “global” period
• Travel and accommodation if you’re out‑of‑province/state

Tips to compare quotes

• Ask if it’s a global bundle (surgeon + facility + anaesthesia + pathology) and request line items.
• Confirm what’s included for complex disease: management of endometriomas, adhesiolysis, potential bowel/bladder work, and whether second‑surgeon fees are bundled.
• Clarify policies on extra OR time, conversion to inpatient, and what triggers additional charges.

Choosing your surgeon is a major benefit of private surgical care, here's how to choose wisely.

What to look for

Experience and volume

• Ask how many laparoscopic endometriosis surgeries they perform per year, and their case mix: superficial vs deep infiltrating disease (bowel/bladder/ureter), endometriomas, adhesiolysis, and revisions.
• Higher volume and routine same‑day pathways usually mean smoother care and fewer complications.

Credentials and training

• Verify licensure with your provincial college (CPSO Ontario, CPSBC BC, CPSA Alberta, CMQ Québec, etc.).
• Look for FRCSC‑certified gynaecologists with advanced training in laparoscopic excision and, for deep disease, involvement in a multidisciplinary team (colorectal/urology).

Outcomes and safety

• Request recent data: unplanned return to the OR within 30–90 days, infection/bleeding rates, readmissions, conversion to open surgery, complication rates for bowel/bladder work.
• Ask for patient‑reported outcomes (pain scores, quality of life, return‑to‑work timelines) and re‑operation rates at 12–24 months.

Indications and alternatives

• Make sure non‑operative options were discussed (targeted hormones, Mirena/IUD, pelvic floor physio, pain strategies). Clear indications = better chance of meeting expectations.

Surgical plan and techniques

• Excision vs ablation (and why), approach to endometriomas (cystectomy vs drainage), adhesion prevention steps, and how deep lesions will be handled.
• If bowel/bladder/ureter may be involved, confirm joint planning with colorectal/urology, and what thresholds prompt resection vs shaving.

Imaging and planning

• Use of targeted pelvic ultrasound and/or MRI for mapping deep disease. Ask how imaging changes the plan and team setup.

Facility accreditation

• Confirm the clinic/hospital is accredited (Accreditation Canada/CAAASF or provincial program), with advanced laparoscopic equipment, anaesthesia coverage, and a hospital transfer agreement.

After‑care integration

• Written, phased recovery plan; early mobilization guidance; pain plan; and coordination with pelvic floor physiotherapy and, if relevant, fertility care.

Pricing transparency (private/self‑pay)

• Itemized quote for surgeon, facility, anaesthesia, equipment (energy devices/robotic platform), pathology, and follow‑ups. Clarify added fees for second surgeons, longer OR time, or overnight stays.

Questions to ask during your endometriosis consultation

Surgeon and plan

• How many endometriosis surgeries do you perform yearly? How many involve deep disease or endometriomas?
• What are your last 12–24 month rates for significant bleeding, infection, readmission, conversion to open surgery, and re‑operation?
• Will you use excision, ablation, or both for my lesions? Why?

Team and logistics

• If you find bowel/bladder/ureter involvement, who assists and how is consent/cost handled in real time?
• What anaesthesia do you recommend? Same‑day discharge or chance of overnight stay?

Recovery and after‑care

• What’s the expected timeline to normal walking, desk work, exercise, and lifting?
• What’s the pain‑control plan and bowel routine? When should I start pelvic floor physio?
• What red flags should trigger a call/ER visit? Who is my direct post‑op contact? How many follow‑ups are included?

Costs and documentation

• What exactly is included in my quote (surgeon, facility, anaesthesia, equipment, pathology, first follow‑ups)?
• What could add cost (second surgeon, robotic platform, longer OR time, hospital admission)?
• Will I receive the operative note, photos, and a summary for my family doctor/fertility specialist/physio?

Signals of a high‑quality program

• Shares outcomes and complication rates openly, including deep disease results.
• Provides a clear, written after‑care plan and accessible post‑op support.
• Uses accredited facilities with advanced laparoscopic tools and multidisciplinary backup.
• Offers transparent, itemized pricing with clear inclusions/exclusions.