Surgery may be indicated in women who suffer severe disease, do not respond to medical therapy, or desire fertility. The indications for surgical intervention are summarized in Table 12.2. Endometriosis can be challenging to manage surgically because of the peculiarities of the disease. Because it is adhesive, widespread, infiltrative, and recurrent, the objective of surgical management is to safely resect or ablate all visible disease. To date there are four primary surgical options. Traditional laparotomy is associated with longer recovery and hospital stay but may be necessary for advanced disease with extensive adhesions or involvement of the ureter, bladder, uterine arteries, and/or bowel. Laparoscopy is an alternative minimally invasive approach that has been shown to be equally effective in resecting endometriomas. Robotic-assisted laparoscopy is another new modality that has been reported.

Most recently, laparoendoscopic single-port surgery (LESS) has emerged as a minimally invasive approach. Compared to traditional laparoscopy, it is associated with better cosmetic results, a shorter hospital stay, and less postoperative pain. It has been used extensively for a wide variety of gynecologic indications. More recently, LESS was used in an attempt to treat endometriosis requiring a single incision [3–6].