The uterus is lined by a tissue called endometrium, which thickens in preparation for a prospective pregnancy, and breaks down and bleeds as menstrual fluid in the absence of conception. This tissue can become displaced and line other pelvic organs, such as the bowels or ovaries, leading to a painful disorder called endometriosis. Endometriosis can be classified into four stages. The moderate to severe stages III and IV are characterized by many deep implants, which irritate the surrounding tissue causing the formation of scars, adhesions (tissues that abnormally connect organs) and fluid-filled cysts called endometriomas in the ovaries. Stages III and IV endometriosis can be treated by surgical excision.
Excision of stage III and IV endometriosis is a surgery indicated for the treatment of recurrent endometriosis where the aim is to preserve fertility. It can be performed minimally invasively through 2 to 3 tiny incisions and a laparoscope, a thin long fiber-optic tube with a camera and light source, which is inserted to provide a clear view of the surgical site. Other surgical instruments carefully cut and remove the implanted endometrial tissue, adhesions and ovarian cysts.