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SERVICES

Comprehensive Laparoscopic Excision Surgery

A Precise, Individualized, and Evidence-Based Approach to Endometriosis

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At EndoGlobalGroup, we specialize in comprehensive laparoscopic excision surgery, currently regarded as the gold standard for the definitive management of endometriosis across all phenotypes and stages. This advanced surgical modality necessitates high-level expertise in pelvic anatomy, refined technical skills, and interdisciplinary coordination to ensure optimal outcomes.
Our surgical team brings together over two decades of cumulative experience, offering an unparalleled standard of care grounded in precision, safety, and long-term effectiveness. Through the integration of cutting-edge technologies, high-definition diagnostic imaging, and microsurgical techniques, we are committed to the complete resection of all endometriotic foci, thereby minimizing recurrence and significantly enhancing patients’ quality of life.

Each surgical plan is developed based on a rigorous, individualized assessment incorporating: -ENZIAN classification system, to stratify deep infiltrating endometriosis (DIE) by anatomical location and depth.
-Advanced diagnostic imaging, including bowel preparation-assisted transvaginal ultrasound, high-resolution pelvic MRI, and three-dimensional endometriosis mapping.
-Patient-specific reproductive and endocrine factors, such as age, ovarian reserve (AMH levels, AFC), and fertility preservation objectives.
-Symptomatology and disease burden, including dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain.
-Prior surgical interventions, assessing for residual or recurrent disease.

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1. Conservative Fertility-Sparing Surgery

Indicated in reproductive-age patients desiring fertility preservation. This approach focuses on meticulous excision of ectopic endometrial tissue while maintaining the integrity of vital reproductive structures.
Surgical components may include:
Cystectomy for endometriomas with preservation of healthy ovarian cortex.
Rectal shaving or discoid excision for superficial or limited bowel wall involvement.
Local excision of focal adenomyosis.
Ureterolysis with preservation of ureteral continuity when feasible.

2. Radical or Definitive Surgery

Reserved for patients with no reproductive plans and those with severe or extensive disease refractory to medical management.
Procedures may encompass:
Total laparoscopic hysterectomy (TLH), with or without bilateral salpingo-oophorectomy.
Segmental bowel resections for transmural or stenotic rectosigmoid lesions.
Multiorgan resections involving urological, gastrointestinal, and diaphragmatic compartments.
These interventions are conducted in conjunction with colorectal, urological, and thoracic surgical subspecialists, as indicated.

3. Reoperation for Residual or Recurrent Disease

Incomplete excision is a major contributor to persistent symptoms. Our center is highly experienced in managing complex reinterventions where fibrosis, adhesions, and distorted anatomy are prevalent. Indications include: Residual DIE in the rectovaginal septum, urinary tract, diaphragm, or bowel. Recurrence of endometriomas or symptomatic nodules. Complications from prior suboptimal procedures.
 

Phenotypes of Endometriosis Managed Surgically

  • Superficial Peritoneal Endometriosis:
    Small lesions on the peritoneal surface are excised in toto, avoiding ablation or fulguration to reduce risk of recurrence.
  • Ovarian Endometriomas:
    Managed with fertility-sparing cystectomy using microsurgical dissection planes under magnified vision.
  • Adenomyosis:
    • Conservative excision of adenomyotic foci in selected cases (e.g., focal adenomyosis).
    • Laparoscopic hysterectomy for diffuse or refractory adenomyosis in women not desiring future fertility.
  • Deep Infiltrating Endometriosis (DIE):
    Rectosigmoid Involvement:
    • Superficial: Rectal shaving.
    • Partial thickness: Discoid excision.
    • Full-thickness: Segmental bowel resection with primary anastomosis.
      Procedures are executed in tandem with colorectal surgeons, maintaining an anastomotic complication rate consistently <5%.
  • Urinary Tract Involvement:
    • Bladder DIE: Partial cystectomy with detrusor muscle preservation.
    • Ureteral Endometriosis: From ureterolysis to ureteral reimplantation or ureteroneocystostomy when required.
  • Vaginal DIE:
    En bloc resection of infiltrative nodules with anatomical and functional reconstruction of the vaginal wall.

Diaphragmatic or Thoracic Endometriosis:
Laparoscopic or thoracoabdominal approach depending on transdiaphragmatic involvement, with or without pleural implants. Procedures are coordinated with thoracic surgeons for optimal outcomes.

 

Surgical Principles and Outcomes at EndoGlobalGroup

  • Exclusive use of advanced laparoscopy and microsurgical instrumentation.
  • Nerve-sparing and fertility-preserving techniques integrated into every surgical plan.
  • Implementation of Enhanced Recovery After Surgery (ERAS) protocols.
  • Low intra- and postoperative complication rates, even in advanced or reoperative cases.
  • Commitment to long-term clinical follow-up, symptom resolution, and recurrence prevention.
Why Patients Worldwide Choose EndoGlobalGroup
  • Multinational patient base from Mexico, the U.S., Canada, and Europe.
  • Over 20 years of subspecialized surgical experience.
  • Diagnostic accuracy enhanced by multidisciplinary collaboration.
  • Proven track record in symptom control, restoration of fertility, and improvement in life quality.
Our team operates under the highest international standards, with formal training in centers of excellence across Europe, North America, and Latin America. We are dedicated not only to surgical excellence but also to ethical, compassionate, and evidence-based care.