Nathan Mordel, M.D. »Janet Lefkowitz, D.O. »

Excision of Endometriosis-Frozen Pelvis

Patients undergoing laparoscopic or robotically assisted laparoscopic (minimally invasive) surgery recover faster, enjoy superior cosmetic outcome, have less pain and less blood loss as compared to laparotomy (traditional, open) surgery. This is true for excision of endometriosis as well.

Robotically assisted laparoscopic excision of endometriosis (RALEE) stands for the removal of extra uterine endometrial tissue. RALEE is an outpatient surgery (no need for overnight hospital stay).

What is Endometriosis?

Endometriosis develops when endometrium (uterine lining) starts growing outside of the uterine cavity. Usually, endometriosis spreads in the pelvis, affecting (sometimes invading) tubes, ovaries, uterus, bladder, sigmoid, rectum and ureters. Endometriomas (“chocolate” cysts) may develop as well. In most severe cases, called frozen pelvis, all these organs become adherent to each other (“stuck together”) causing complete distortion of pelvic anatomy.

Choosing a Minimally Invasive Gynecologic Surgeon

Performing RALEE requires a highly skilled minimally invasive gynecologic surgeon. The more severe endometriosis becomes, the more challenging is the RALEE. A very experienced surgeon can safely remove endometriosis still using minimally invasive techniques such as RALEE.

If a surgeon is not experienced enough, then higher blood loss or complications, such as injury to the uterus, tubes, ovaries, sigmoid, rectum or ureters may occur at a higher rate. Alternatively, a less experienced surgeon may decide to convert to laparotomy in the middle of the operation.

Patients in a need for RALEE and are afflicted with severe endometriosis (frozen pelvis) should choose an experienced surgeon.

The key questions to ask a surgeon are:

  • How severe endometriosis has he/she removed?
  • How many of these cases has he/she performed?
  • What is his/her complication rate?
  • What is his/her conversion rate?


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