Ask an Endo Surgeon: What is the Difference Between Ablation and Excision Surgery? Dr. Haverland

Dr. Rachael Haverland, MD, MS, FACOG is passionate about helping women feel their best by resolving their infertility and pelvic pain through endometriosis excision surgery. Possessing an extensive educational background—which includes a prominent fellowship at the Mayo Clinic among other subspecialty training tenures—Dr. Haverland is uniquely qualified to provide care in her areas of focus: pelvic pain, endometriosis, uterine fibroids, and pelvic floor dysfunction.

At Pelvic Rehabilitation Medicine, our pelvic pain specialists provide a functional, rehab approach to pelvic pain. When you visit one of our offices, you spend an hour with your doctor reviewing in detail your medical history and symptoms. Then, we perform an internal exam (no speculum) to evaluate your nerves and muscles. Together, we'll discuss an individual treatment plan that gets to the root cause of your pain and helps you to feel better. The best part: you can begin treatment the same day!

At PRM, our mission is to decrease the time patients are suffering from pelvic pain symptoms.


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Hello, I'm Dr. Rachael Haverland. I'm an endometriosis surgeon here in Dallas. And today the question is, please discuss the difference between endometriosis ablation and excision surgery. And this is a, a new topic, endometriosis excision has been around for, you know, the last 10 or so years, and we're learning more.

Most of our data is actually extrapolated from the fertility literature. We learned that by excising endometriosis rather than ablating or burning the disease, we had better pregnancy rates, both with natural pregnancy and with IVF. And we extrapolated from this data that these women who had improved chances of fertility, their pain also improved.

They had a longer pain-free interval, is what we call it. So endometriosis ablation surgery is typically also laparoscopic, but where you burn or cauterize the surface of the disease. Endometriosis excision surgery is where you go in, identify the lesions of endometriosis and dissect around the lesion.

I like to explain this as like an iceberg. You see the ice above the water, and you melt it down to the ocean level and it looks good, but you don't wanna drive your boat there because you don't know what's underneath the water. So when we see endometriosis, it's important to make sure you're excising, especially for deep infiltrating disease, but really for all disease to make sure, you're looking behind the lesion and removing all abnormal tissue.

So typically, I dissect back until I find normal tissue, and then everything in front of that comes out and is sent to pathology, but with excision, we have decreased risk of recurrence, better outcomes for, for pain and also for fertility.