Surgical Management of Pelvic Endometriosis and Endometrioma

The vast majority of endometriosis is located in the pelvis and is reported to represent 96.4% of all lesion locations. This can include the ovary with or without posterior cul-de-sac obliteration (1). Surgical management of pelvic endometriosis requires a high index of suspicion, thorough evaluation of the entire pelvis, and a sound understanding of intraperitoneal and retroperitoneal anatomy. Superficial endometriosis, which involves less than 5 mm of invasion, is more prevalent than deep infiltrating endometriosis and is not consistently visible on diagnostic imaging studies. As a result, multiple national obstetrics and gynecology organizations from around the world recommend surgery to be considered in patients with suspected superficial endometriosis (2).