Surgical treatment of endometriosis requires precision, extensive expertise, and compassionate care. Our team provides comprehensive and highly specialized treatment led by Dr. Gustavo Pizani and his multidisciplinary team, with a strong commitment to technical excellence and individualized care. In this article, we explain step by step how the surgical pathway we offer to our patients is structured.

Symptoms and Prevalence of Endometriosis

Many women with endometriosis may be asymptomatic. For those who experience symptoms, the most common include chronic pelvic pain — especially around menstruation — heavy menstrual bleeding, pain during intercourse, and fertility challenges. It is estimated that nearly 40% of women experiencing infertility have underlying endometriosis.

What Is Endometriosis Surgery?

Endometriosis surgery is a procedure aimed at excising endometrial-like tissue (tissue normally found inside the uterus) that is growing outside the uterine cavity.

The main types of endometriosis surgery include:

• Excision of endometriotic lesions: Removal of endometriosis implants, fibrosis caused by the disease, and pelvic adhesions.
• Hysterectomy (in selected cases): It is important to note that hysterectomy is not routinely required and should be reserved for individualized cases. This procedure involves removal of the uterus.
• Bowel resection: Indicated when there is superficial or infiltrative involvement of the bowel, using disc excision or segmental resection techniques with advanced endoscopic stapling devices.
• Bladder resection: Necessary when part of the bladder wall is infiltrated, particularly in patients experiencing urinary discomfort, urgency, or symptoms suggestive of urinary dysfunction. These resections are typically limited to the affected area.
• Diaphragmatic resection: Approximately 15–20% of patients with infiltrative disease may present diaphragmatic involvement. Resection is generally limited to the affected area and is often of small extension.

When it comes to endometriosis, surgical intervention remains the only definitive way to confirm that the disease is responsible for the symptoms experienced.

If you have been diagnosed with endometriosis, it is essential to discuss all available treatment options during your consultation, including clarifying any questions regarding surgical risks and potential complications.

If you are a candidate for surgery, you may undergo:

• Robotic surgery using the da Vinci system
• Conventional laparoscopic surgery

Endometriosis Surgery Can Restore Quality of Life

Endometriosis is a chronic inflammatory condition characterized by the presence of endometrial-like tissue outside the uterus. It may affect the ovaries, fallopian tubes, peritoneum, bowel, and bladder, leading to pain and infertility. When clinical management is not effective, surgery becomes an important therapeutic option.

When Is Endometriosis Surgery Indicated?

Surgery is recommended in specific cases where medical treatment does not provide satisfactory results, such as:

• Chronic pelvic pain that does not improve with hormonal therapy or analgesics.
• Infertility in women with endometriosis who wish to conceive.
• Organ involvement affecting the bowel, bladder, or ureters, with risk of obstruction or functional impairment.

How Is Endometriosis Surgery Performed?

The procedure is predominantly performed via laparoscopy, a minimally invasive technique using small abdominal incisions to introduce surgical instruments and a high-definition camera.

Main steps include:

• Lesion mapping: Visual identification of endometriotic implants.
• Excision or ablation: Complete removal or thermal destruction of lesions.
• Ovarian cystectomy: Removal of endometriomas (ovarian cysts).
• Adhesiolysis: Release of adhesions causing pain or organ dysfunction.
• Complex surgery: In advanced cases, collaboration with a colorectal surgeon or urologist may be required.

In severe situations, a laparotomy (open surgery) approach may be necessary, particularly when multiple organs are involved.

Postoperative Care and Recovery

Recovery depends on case complexity. After laparoscopic procedures, patients may return to daily activities within days to weeks. Ongoing medical follow-up, hormonal therapy when indicated, and comprehensive health care are essential to reduce recurrence risk.

How Can You Prepare?

One of the best ways to understand your surgical options is by asking detailed questions during your consultation. Consider discussing:

• What medical and surgical options are available to me?
• Which approach is most appropriate for my case?
• What are the differences between open, laparoscopic, and robotic surgery?
• Should I seek a second opinion?
• What symptoms should I expect after surgery?
• How should I prepare for surgery?
• What is your surgical training and experience?
• What is your experience with robotic surgery?
• What outcomes have your patients achieved?

How Does Robotic Endometriosis Surgery Work?

• The surgeon uses a high-definition 3D camera providing crystal-clear magnified visualization inside the body.
• The surgeon operates from a nearby console through small incisions using precise micro-instruments.
• All hand movements are translated in real time by the da Vinci system, allowing refined articulation and precise excision of endometriosis lesions.

Specialized Care Plan

We provide a structured care pathway for patients with endometriosis, focusing on safety, meticulous surgical planning, and comprehensive postoperative support.

Important: all payments must be completed prior to surgery, with proof of payment sent via our WhatsApp contact.

Hospital selection will be made in coordination with Dr. Gustavo Pizani, prioritizing safety, infrastructure, and patient comfort.

Important Safety Information

Patients should discuss all questions during consultation to determine whether robotic surgery on the da Vinci platform is appropriate. Physician and patient must carefully review all available surgical and non-surgical options and associated risks to make an informed decision.

Serious complications may occur with any surgical procedure, including robotic surgery. For important safety information, including risks, indications, considerations, and contraindications, please consult:

• www.davincisurgery.com/safety
• www.intuitivesurgical.com/safety

Individual results may vary depending on multiple factors, including but not limited to patient characteristics, disease severity, and surgeon experience.

References

1. Patient FAQs: Endometriosis – American College of Obstetricians and Gynecologists (ACOG) . Accessed April 27, 2025.
2. Health Topics: Endometriosis – Office on Women’s Health, U.S. Department of Health & Human Services . Accessed April 27, 2025.
3. Brazilian Ministry of Health – gov.br . Updated 2025.
4. FEBRASGO – Brazilian Federation of Gynecology and Obstetrics Associations . Updated 2025.

To understand how surgical care is structured for patients traveling from other cities, states, or countries to undergo surgery with Dr. Gustavo Pizani in Belo Horizonte, please visit: Surgery with Dr. Gustavo Pizani in Belo Horizonte .