Information alert

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The information provided aims to address the questions you may have about surgical management of endometriosis. It is intended to supplement advice already provided by your healthcare professionals. It explains what surgery may involve, the possible risks of surgery, and what you can expect during your recovery after surgery. Further information on endometriosis and non-surgical management options.

If you have any further questions or concerns after reading this, please speak to your doctor or clinical nurse specialist.

Endometriosis is a common condition affecting one in every 10 women, where tissue like the tissue which lines the womb (endometrium) is found elsewhere in the body. Usually it occurs in the pelvis: around the womb, ovaries (forming the cysts called “endometriomas” or “chocolate cysts”), fallopian tubes, in the area between the vagina and the rectum, bowel or bladder.

Sometimes other areas may be also affected, such as the diaphragm (the muscle separating your chest from your abdomen), chest and lungs, belly button, nerves, and scars from previous operations.

Endometriosis can be a long- term condition. In some women it has a significant impact on day- to-day life and emotional wellbeing.

Common symptoms include lower abdominal and back pain (often worse just before and during your period), pain during or after sex, pain related to opening your bowels or passing urine, and tiredness.

In some women, it may be associated with difficulty becoming pregnant. However, symptoms are very variable, and some women even with extensive endometriosis do not have any symptoms or problems.

Anatomy of the female pelvis with examples of which organs may be affected by endometriosis. Image courtesy of endometriosis team UCLH.


Laparoscopy, also known as ‘key-hole surgery”, is carried out under a general anaesthetic and involves making small (five to 12mm) cuts in your abdomen (usually one in/below the bellybutton and a few more (usually one to three) cuts in other positions on the abdomen). A thin telescope (laparoscope) is then used to look inside your pelvis.

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Figure 2. Diagram representing key-hole surgery. Image courtesy of endometriosis team UCLH.


If a small amount of endometriosis is found, then it is usually treated at your first operation.

However, if a large amount of endometriosis is found at your initial laparoscopy, and especially if it includes large endometriomas, or if it is affecting your bowel, bladder, ureters, or major blood vessels, it may be felt appropriate to plan a second procedure for more extensive surgery at a later date. This allows time for us to discuss with you in more detail what is involved, time to receive additional hormonal treatment as a preparation for second procedure, and time to do further investigations and plan the safest way to carry out the procedure (this may require other surgeons being available, such as a bowel surgeon or bladder surgeon).

Diagnostic Laparoscopy

A diagnostic laparoscopy is an investigation for endometriosis. It is the initial step of every laparoscopy, and allows us to ‘map’ where endometriosis is, and the organs that are affected.

Some women have a diagnostic laparoscopy because initial tests such as a scan or MRI have not shown any definite endometriosis, but their symptoms are very suggestive of it. In these situations, we would usually suggest treating with medicine or other options rather than putting you through risks of surgery.

However, some women, especially if they have not tolerated medical treatment or didn’t find other options enough effective, prefer to have the laparoscopy despite being aware that the cause of their symptoms/pain may not be found.

Operative Laparoscopy

If during the diagnostic laparoscopy superficial endometriosis is found, the following procedures can be performed:

  • Burning (ablation) or removal (excision) of endometriosis deposits
  • Removal of scar tissue (adhesiolysis) which often forms web-like bands from one organ to another, restricting their movement.
  • Tissue biopsy
  • Treatment to ovarian endometriomas (by opening and draining, followed by energy treatment (ablation), to try and stop them re- collecting. Alternatively, they may be removed completely (cystectomy) depending on the findings)
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Figure 3. Diagram showing scar tissue (adhesions) affecting ovaries, uterus, fallopian tubes, and their ligaments (suspensory bands supporting the organs in the pelvis). Image courtesy of endometriosis team UCLH.

Although we are very careful, surgery may cause a damage to healthy ovarian tissue, especially treatment to endometriomas can have an effect on the rest of the ovary, which may then have implications for your fertility (especially if fertility treatment is required). For this reason, endometriomas may often be treated in two stages: cysts are drained at the first operation, followed by medical treatment to for three to six months, before a second operation is performed. It is important that you consider and discuss your fertility wishes with your surgical team.

In cases of more severe endometriosis, surgery may involve other specialists such as bowel surgeons and/or bladder surgeons (urologists). Again, this may be done as a single or, more often, a two-stage procedure.

Procedures include:

  • Releasing ovaries that are firmly attached to each other, to the womb, bowel, or the side walls of your pelvis.
  • Cutting away endometriosis-affected tissue from the bowel, bladder or ureters (the tubes that carry urine from the kidneys to the bladder).
  • Placing thin tubes (stents) in the ureters to make the surgery safer. Depending on the operation, these may be either be removed at the end of the operation, or six to 12 weeks later.

Removing part of the bowel affected by endometriosis and joining the healthy bowel parts together (anastomosis). Sometimes it is necessary to allow this joined area time to heal, and for this reason you may need a stoma (where a section of bowel is brought to the surface or your abdomen, and your bowel contents empty into a bag). This stoma is usually reversed after three to six months in an additional procedure by the bowel surgeons.

Increasingly, we are recommending the use of “Robotic assistance” in surgery for deeply infiltrating endometriosis. A 3D high-definition camera is used for a clear, magnified view of your uterus and pelvis, and the surgeon then sits at a console next to you. Every hand movement your surgeon makes is translated in real time by the robotic system which bends and rotates the instruments so your surgeon can treat the endometriosis.

Advantages of robotic-assisted laparoscopy, compared to standard laparoscopy, are:

  • Fewer complications.
  • Less blood loss.
  • Enhanced surgical 3D vision and dexterity of instruments – gives the surgeons high levels of control within the abdomen.
  • Lower risk of conversion to open surgery.

The gynaecology cancer team at UCLH have carried out robotic laparoscopic surgery for several years with excellent results. Since July 2023 we have introduced this technique for our non-cancer patients who need an operation for other reasons, because we believe it will improve the outcomes and reduce complications for patients. The surgical team have been trained to use the device and the robot technical team are available to support every procedure.

Pelvic clearance

This is complete removal of the womb with the cervix, both fallopian tubes and both ovaries and excision of endometriosis. It may be considered for women who have completed their families, and if other treatment options for endometriosis have not been successful.

Removal of your ovaries immediately leads to the menopause. This means you will need Hormone Replacement Therapy (HRT) until the age of the natural menopause (approximately 52 years). This protects you from the effects of an early menopause, including thinning of your bones, and a higher risk of stroke and heart attacks, and will also treat the hot flushes and night sweats you may experience without HRT.

Overall, serious complications at laparoscopy are uncommon – affecting approximately two in every 1000 women. Complications can occur immediately during or after the surgery, or they can develop later (after a couple of days or weeks). Risks are higher in women who have had surgery before, and in women who are significantly underweight or overweight.

There is also a ‘risk’ that the procedure does not make you better. In some women laparoscopy may not find endometriosis or any other cause of the symptoms or pain. This can be very disappointing.

In those in whom endometriosis is treated, it can recur. Studies show that symptoms return in two to four out of every 10 women within five years of surgery. The use of suppressive hormone therapy (e.g. the combined oral contraceptive pill, progesterone-only pill, or a progesterone coil) after surgery may reduce the chances of your symptoms returning

Common risks and complications


It is normal to have vaginal bleeding during the first 24-48 hours after surgery, and for up to 14-21 days after a more extensive procedure.

If you bleed heavily during or after the procedure, you may require a blood transfusion. You may also need iron.

Blood can collect internally around the site of the operation: this is called a “haematoma”. Haematomas often resolve spontaneously, but sometimes can become infected and require treatment with antibiotics. Occasionally a further operation may be required to treat a haematoma.


All women will experience a degree of pain as they recover from their surgery. Some women may not have improvement in pain after surgery or may even experience a worsening and/or new long-term pain caused by scarring.


Infection can occur around the wound sites or deeper in the pelvis, and may require the use of intravenous or oral antibiotics.

Bruising, wound gaping, or painful abdominal swelling may occur after surgery.

Uncommon risks and complications

  • Hernia at the site of entry.
  • Blood clots in the legs and pelvis (deep vein thrombosis - DVT) or lungs (pulmonary embolism – PE). To help prevent this you will be given special compression stockings to promote the blood circulation in your legs while you are in hospital. If an overnight (or longer) stay is required after your procedure you may also be given injections to prevent blood clots. Sometimes these are required to be taken at home for the next seven to 10 days.
  • Damage to the surrounding organs and structures, such as bladder, bowel, ureters, major blood vessels, nerves. If we identify this at the time, this will be repaired during your procedure. This may include involvement of other teams such as bowel surgeons and/or urologists. Sometimes damage is discovered after the procedure, when your recovery is complicated by increasing pain, or evidence of infection. You may then need an additional operation.
  • Reduction in egg (ovarian) reserve. Surgery to the ovaries may have an impact on the function of your ovaries. This can have implications on future fertility. If you are near to the menopause at the time of surgery, then your menopause may occur earlier (even if your ovaries are not removed).
  • Fistula development. This is abnormal communication between vagina and bladder and/or bowel resulting in urine/stool containing discharge from vagina.
  • Uncertain effect on bowel, bladder, and sexual function. Many women find that endometriosis already causes problems with one or more of these areas. Although the aim of surgery is to improve the symptoms, unfortunately in some women these may deteriorate.

Additional procedures which may become necessary during the surgery

  • Conversion to open surgery (laparotomy).
  • Repair of any surgical damage – to the bowel (including the possibility of a stoma), bladder, ureters, blood vessels, and also uterus, tubes, ovaries.
  • Unplanned removal of the ovary (oophorectomy).
  • Blood transfusion.

You should talk to your specialist doctor to decide if surgery is right for you. You should have the opportunity to discuss all the available information on surgical and non-surgical options, and their risks and benefits, to help you make an informed decision.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with surgery, we will ask you to sign a consent form. This confirms that you would like to have the procedure and understand what it involves.

The medical team will explain all the risks, benefits, and alternatives, and invite you to ask any questions, before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak with a senior member of the medical or nursing team again.


It is important that there is no possibility of pregnancy when you have this operation. For this reason, we ask you to either abstain from having sex, or use reliable contraception, in the month before your surgery (from the first day of your last period before your operation).

Combined oral contraceptive pills slightly increase your risk of blood clots on the legs or lungs (DVTs or PEs) after surgery. For this reason, you will usually be advised to change to an alternative e.g., condoms or the progesterone only pill, four weeks before the procedure.

Preparing your body for surgery

Some changes can have a really big impact on your recovery, for example:

  • Increasing your exercise: try to do 30 minutes of activity which makes you feel out of breath, at least three times each week.
  • Eating a healthy, balanced diet before surgery and planning easy to cook meals for your recovery.
  • Stopping smoking and alcohol can be hard, but quitting or cutting down before surgery can reduce your hospital stay and improve wound healing.

More information is available under “Gynaecology Enhanced Recovery Pathway”.

Preoperative Assessment Clinic

A few weeks before your surgery you will be asked to attend a preoperative assessment appointment. This can be by telephone, or in person in the hospital.

You will be asked questions about your health, medical history and home circumstances. Some tests may also be required, for example blood tests, or an ECG (a tracing of your heart rhythm).

You will be given information about the morning of your surgery: when to stop eating and drinking, and if you need to stop taking any of your regular medications.

Bowel preparation

You may be given a medication to take the day before your procedure to empty your bowels. This can make surgery safer, especially when endometriosis is close to, or involves, the bowel. You will be given clear instructions about how to take this.

The day of your surgery

You will receive instructions about the time of your admission, and where to go.

You will receive instructions about the time of your admission, and where to go. If you do not receive these, please contact your team using the contact details below.

More information about what to bring to hospital, and what to expect once you arrive, can be found in the “Gynaecology Enhanced Recovery Pathway”.

Detailed information about what to expect in hospital after an operation, and about your longer-term recovery, can be found under “Gynaecology Enhanced Recovery Pathway”.

When you wake up from the operation, you will have a drip in your arm and a catheter in your bladder. These will usually stay in for about 24 hours. You may also have a drain placed in your tummy to allow additional body fluids (e.g., blood) to drain out, but this is not common.

You may feel drowsy and nauseous from the anaesthesia. Your abdomen may feel painful and bloated. You may also have pain around the shoulders from the gas that is used within the abdomen for the procedure. This will settle within a few days, and can be improved by moving around and taking pain killers.

You will be discharged once you are eating, drinking, passing urine and moving around safely, and when your pain is well-controlled with tablets. This is usually after one to three nights. Occasionally your surgeon may recommend that you stay in hospital a little longer, especially if your surgery was difficult, or if there were complications.

It is important that someone is available to help you get home when you are discharged (e.g., to help carry your bag). You will need to plan in advance for the fact that you won’t immediately be able to do things you usually would do at home, including driving. Our section “Gynaecology Enhanced Recovery Pathway” explains in more detail about what to expect, and what plans you may need to make.

We would suggest that you plan to be off work for two to six weeks, depending on the planned extent of your surgery. You may feel able to go back sooner, or you may need longer if your job is very active, or if surgery was extensive or there were complications. Please discuss this further with your doctor.

If you develop the following symptoms once you get home, you should go to your nearest Accident and Emergency Department. They can be signs of complications, for which you may need urgent treatment.

  • High fever.
  • Pain in the abdomen that is getting worse.
  • Swelling of the abdomen that is getting worse.
  • Being unable to pass urine, or passing very little.
  • Swelling, redness, or tenderness in the lower legs.
  • Difficulty breathing, or chest pain.

Please contact us in case of any further queries throughout your care. Email:

Alternatively, you may reach us via MyChart UCLH application using direct message. Please allow at least 72 hours for a reply.

Ward T7 South (if your next of kin wants an update on how you are immediately after the operation, or if you have non-urgent queries when you go home)

Tel: 020 3447 7828 or 020 3447 0712

Pre-operative assessment clinic (PAC) (if you have questions about how to prepare for the operation)

Tel: 020 3347 2504

Surgical reception (if you are running late on the day of your operation) Tel: 020 3447 3184 or 07939 135323

For additional information and support please visit:

University College Hospital

235 Euston Road, London NW1 2BU Switchboard: 020 3456 7890


Page last updated: 23 May 2024

Review due: 30 November 2025