Laparoscopic Surgery for Endometriosis
Laparoscopic Surgery for Endometriosis in Pune
Laparoscopic surgery for endometriosis is a keyhole procedure in which a thin camera is inserted through a small navel incision to visualise the inside of the pelvis, confirm the diagnosis of endometriosis, and remove or destroy the abnormal tissue in the same sitting. It is the only method that can both diagnose endometriosis definitively and treat it at the same time — without the need for a large abdominal cut.
Dr. Ammbalal Gurram performs laparoscopic endometriosis surgery in Pune at Manipal Hospital Baner and Ashwinii Nursing Home Thergaon (PCMC). MBBS, DGO, DNB. Fellowship in advanced laparoscopic surgery. 26 years experience. 98% surgical success rate.
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I Have Been Told I Might Have Endometriosis. What Does That Mean for Me?
Endometriosis is one of the most underdiagnosed conditions in gynaecology. Women in Pune, Baner, Thergaon, Pimpri-Chinchwad and across PCMC often spend 6 to 8 years with symptoms — painful periods, pelvic pain, difficulty getting pregnant — before getting a clear diagnosis. That is not unusual. Endometriosis cannot be seen on a blood test or confirmed reliably on ultrasound. The only way to know for certain is to look inside.
Laparoscopic surgery does exactly that. It finds the disease, stages it, and removes it in a single procedure under general anaesthesia. Most patients go home the next day.
I Have Been Told I Might Have Endometriosis. What Does That Mean for Me?
Endometriosis is one of the most underdiagnosed conditions in gynaecology. Women in Pune, Baner, Thergaon, Pimpri-Chinchwad and across PCMC often spend 6 to 8 years with symptoms — painful periods, pelvic pain, difficulty getting pregnant — before getting a clear diagnosis. That is not unusual. Endometriosis cannot be seen on a blood test or confirmed reliably on ultrasound. The only way to know for certain is to look inside.
Laparoscopic surgery does exactly that. It finds the disease, stages it, and removes it in a single procedure under general anaesthesia. Most patients go home the next day.
What Is Endometriosis?
The uterus has an inner lining called the endometrium. In endometriosis, tissue very similar to this lining grows outside the uterus — on the ovaries, fallopian tubes, the outer surface of the uterus, the pelvic lining, and in more severe cases the bowel, bladder, or ureters.
Every month during the menstrual cycle, this misplaced tissue responds to hormones the same way the uterine lining does — it thickens, breaks down, and bleeds. But unlike normal uterine lining, this blood cannot leave the body. It accumulates, causes inflammation, forms scar tissue, and over time creates adhesions that can stick pelvic organs together. On the ovaries it forms blood-filled cysts called endometriomas.
Why Endometriosis Gets Missed for So Long
- Painful periods are often dismissed as "normal" — they are not, when they are severe enough to stop daily activity
- Ultrasound can detect endometriomas but misses superficial and deep infiltrating lesions entirely
- Blood markers (CA-125) are unreliable for diagnosis — elevated in many other conditions
- MRI can suggest deep disease but still does not replace surgical confirmation
- The only definitive diagnosis is direct visualisation at laparoscopy — with biopsy confirmation
Symptoms That Bring Women to Dr. Gurram's Clinic in Baner & Thergaon
Not everyone with endometriosis has the same picture. Some women have severe Stage I disease that causes unbearable pain. Others have Stage IV disease with minimal pain but significant fertility problems. The symptom does not always match the stage.
| Symptom | What Endometriosis May Be Doing | How Common? |
|---|---|---|
| Severe period pain (Dysmenorrhoea) | Inflammatory chemicals from endometriosis lesions can trigger intense uterine cramping. | Very common — one of the most frequent presenting symptoms. |
| Pelvic pain between periods | Ongoing inflammation and adhesions may pull on pelvic structures. | Common in moderate to severe disease. |
| Pain during sex (Dyspareunia) | Deep infiltrating disease or uterosacral ligament involvement. | Common, especially with deep endometriosis. |
| Heavy or prolonged bleeding | Adenomyosis may coexist, leading to increased uterine bleeding. | Moderately common. |
| Painful bowel movements or urination during periods | Bowel or bladder endometriosis may be present. | Less common, but suggests deeper disease involvement. |
| Difficulty getting pregnant | Blocked tubes, distorted pelvic anatomy, ovarian endometriomas, or impaired implantation. | Approximately 30–50% of women with infertility have endometriosis. |
| Bloating or abdominal swelling | Inflammation and large endometriomas may contribute. | Variable from person to person. |
Why Laparoscopic Surgery — Not Just Medicines?
Medicines for endometriosis — hormonal pills, GnRH injections, progesterone — manage symptoms by suppressing the menstrual cycle. They reduce pain while you take them. They do not remove the disease. When the medication stops, endometriosis returns to its pre-treatment state, often within a few months.
Surgery removes the actual lesions. Excision surgery cuts out the endometriotic tissue completely. Once removed, that tissue is gone. The body’s inflammatory response to it stops. Pain improves. Fertility improves. And while recurrence is possible — endometriosis is a chronic hormonal condition — the remission after good excision surgery is measured in years, not months.
| Medical Management (Hormones) | Laparoscopic Surgery | |
|---|---|---|
| Removes endometriosis tissue | No — suppresses it temporarily. | Yes — excision removes the disease. |
| Pain relief | Good while taking medication. | Significant and long-lasting for most patients. |
| Fertility improvement | No direct benefit; may suppress ovulation. | Yes — especially in Stage III–IV disease or endometrioma. |
| Confirms diagnosis | No | Yes — biopsy can be taken during surgery. |
| Effect after stopping treatment | Disease commonly returns after stopping medication. | Longer-lasting remission, although recurrence can still occur. |
| Suitable for women planning pregnancy | No — ovulation is usually suppressed. | Yes — surgery may improve fertility prospects. |
| Dr. Gurram's recommendation | First-line treatment for mild symptoms; useful before or after surgery. | Recommended when symptoms are severe, fertility is affected, or advanced disease is present. |
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Endometriosis Stages — What Is Found and What Surgery Involves
| Stage | What Is Present | Surgery Required | Recovery |
|---|---|---|---|
| Stage I — Minimal | Isolated superficial implants on the pelvic peritoneum. | Diagnostic laparoscopy with ablation or small excisions (30–45 minutes). | 1-day hospital stay; 1–2 weeks off work. |
| Stage II — Mild | Small endometriomas (<3 cm) with early adhesions. | Laparoscopic cyst excision with lesion removal (45–75 minutes). | Usually 1 day in hospital; about 2 weeks recovery. |
| Stage III — Moderate | Larger endometriomas, significant adhesions, and fallopian tube involvement. | Laparoscopic excision with adhesiolysis (75–120 minutes). | 1–2 days in hospital; around 3 weeks recovery. |
| Stage IV — Severe | Deep infiltrating disease involving the bowel, bladder, ureter, or frozen pelvis. | Complex laparoscopic excision; may require bowel or urological surgical support (2–4 hours). | 2–3 days in hospital; 4–6 weeks recovery. |
What Happens During Laparoscopic Endometriosis Surgery
Before Surgery — Preparation in Pune
Dr. Gurram reviews your symptom history, menstrual pattern, and prior investigation results. A pelvic ultrasound is standard. If deep infiltrating disease is suspected — bowel symptoms, severe pain, or very high CA-125 — an MRI pelvis with rectal contrast is requested before the operation date. Blood tests and anaesthetic fitness are completed at either the Baner or Thergaon clinic.
For patients coming from Pimpri, Chinchwad, Wakad, Nigdi, Ravet and surrounding PCMC areas, the Thergaon clinic is the closer and more convenient pre-operative assessment point. Patients from Baner, Aundh, Hinjewadi and Pune West typically use the Manipal Baner location.
In the Operating Theatre
General anaesthesia. Three to four small cuts under 1 cm. The laparoscope goes in through the navel. Dr. Gurram examines the entire pelvis systematically — ovaries, tubes, uterus, pelvic sidewalls, bladder peritoneum, bowel surface, and uterosacral ligaments — mapping every lesion before touching anything.
Suspicious areas are biopsied and sent for histopathology. All visible endometriosis is then excised — cut out completely, not just burned. Endometriomas are opened, the inner lining stripped, and the cyst wall removed. Adhesions are divided carefully to restore normal pelvic anatomy. Where the bowel or bladder is involved, Dr. Gurram assesses whether safe excision is possible laparoscopically or whether specialist involvement is needed.
After Surgery
Most patients having Stage I–II surgery go home the next morning. Stage III–IV patients typically stay 1 to 2 additional nights. A urinary catheter is in place overnight and removed the following morning. Pain is managed with standard oral medication — it is noticeably less than open surgery.
Dr. Gurram reviews histopathology results at a follow-up appointment 4 to 6 weeks after surgery. Post-operative hormonal treatment — typically progesterone or a GnRH analogue for 3 to 6 months — is often recommended to reduce recurrence risk, especially in Stage III–IV disease.
Recovery After Laparoscopic Endometriosis Surgery in Pune
| Time | Expect | Activity |
|---|---|---|
| Day 1 (Hospital) | Mild pelvic discomfort; some bloating from gas; catheter in overnight. | Rest; assisted walking in the ward. |
| Day 2 (Discharge) | Noticeably better; mild port-site soreness. | Slow walking at home; stairs are usually fine. |
| Week 1 | Fatigue; mild abdominal tenderness; pain tablets as needed. | Light indoor activity; avoid lifting and driving. |
| Week 2 | Energy returning; soreness settling. | Desk work from home; light daily activities. |
| Week 3–4 | Near-normal recovery; first post-operative period usually lighter. | Return to office (desk jobs); gentle walking. |
| 4–6 Weeks | Full recovery; follow-up with your surgeon. | Resume all normal activities as advised. |
When Will You Notice Symptom Improvement?
- Period pain: most patients notice improvement from the first or second cycle after surgery
- Pelvic pain: improves progressively over 4 to 8 weeks as post-operative inflammation settles
- Pain during sex: often improves significantly once deep lesions are excised and healing is complete (6–8 weeks)
- Fertility: pregnancy attempts are usually recommended from 3 months post-op
- Bloating and pressure symptoms: resolve once endometriomas are removed and adhesions divided
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Endometriosis and Fertility — What Surgery Can and Cannot Do
Around 30 to 50 percent of women who have difficulty getting pregnant have endometriosis as a contributing factor. The mechanism varies by stage and anatomy. Laparoscopic surgery addresses the surgical causes — but it is important to understand what it corrects and what remains beyond the surgery.
| Endometriosis Impact on Fertility | Does Surgery Help? | Notes |
|---|---|---|
| Endometrioma distorting ovarian tissue | Yes — cyst excision preserves the remaining ovarian reserve. | Ovarian reserve may be slightly reduced after cystectomy; Dr. Gurram uses an ovary-preserving technique. |
| Fallopian tube blockage from adhesions | Yes — adhesiolysis restores tubal patency in many cases. | Tube function is assessed; IVF may still be needed if the tube is damaged beyond repair. |
| Distorted pelvic anatomy preventing ovum pickup | Yes — restoring the anatomy improves natural conception prospects. | Improvement in pregnancy rates is well documented in Stage III–IV disease. |
| Inflammatory environment affecting implantation | Partial — excision reduces the inflammatory load. | Some implantation issues may persist; IVF with endometrial preparation may still be needed. |
| Stage I–II minimal disease | Uncertain fertility benefit when no other fertility factors are present. | Dr. Gurram discusses each case individually; surgery is not always recommended for fertility alone in mild disease. |
Ablation vs Excision — Which Does Dr. Gurram Use?
Ablation burns or destroys the surface of endometriosis lesions using heat or laser. Excision cuts out the lesion completely, including its base. Dr. Gurram’s standard approach is excision — not ablation — for all but the most superficial peritoneal spots.
The reason is straightforward: ablation leaves the deeper layers of the lesion behind. For superficial disease this is acceptable. For nodular, deep, or glandular lesions — which most symptomatic patients have — ablation misses the root of the problem. Excision removes the entire lesion and sends it to histopathology, confirming the diagnosis pathologically and reducing recurrence rates.
Frequently Asked Questions
The most reliable indicator is a combination of symptoms — painful periods severe enough to disrupt daily life, pelvic pain outside periods, pain during sex, and unexplained infertility. Ultrasound can detect endometriomas on the ovaries. MRI can suggest deep disease. But a definitive answer requires laparoscopy with tissue biopsy. If your symptoms match, a consultation with Dr. Gurram at Baner or Thergaon is the most direct route to clarity.
Yes — recurrence is possible because endometriosis responds to oestrogen, which the body continues to produce until menopause. However, complete excision surgery has significantly lower recurrence rates than ablation or medical management alone. Post-operative hormonal treatment for 3 to 6 months further reduces the risk. Women who become pregnant after surgery also tend to have longer remission periods.
Surgery becomes the better option when: symptoms break through despite medication, you want to get pregnant, an endometrioma has grown above 4 cm, or you simply want to know the actual extent of your disease rather than suppressing it indefinitely. Many women in Pune who come to Dr. Gurram's clinics have been on hormonal treatment for 3 to 8 years before deciding to investigate surgically — and they consistently report wishing they had done so sooner.
Endometrioma removal does carry a small risk to surrounding ovarian tissue — the cyst wall can be very adherent to healthy ovarian cortex. Dr. Gurram uses an ovary-preserving technique and aims to minimise this risk. Leaving a large endometrioma in place also damages ovarian reserve over time through its inflammatory effect. The decision to operate is made weighing both risks. For women planning IVF, fertility specialist input on timing is often sought before proceeding.
The cost page covers pricing ranges, cost breakdown by stage, and insurance details in full. This page covers the surgery itself — what endometriosis is, why surgery is recommended, what happens in the OT, and what recovery looks like. Both pages are available on Dr. Gurram's website. If cost is your primary question, visit the cost page directly.
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