I specialize in laparoscopic excision of endometriosis. If there is endometriosis/fibrosis into the pelvic sidewalls, by the vessels and ureters, or deep in the pelvis near the bladder or rectal wall, then that is no problem since that is what I do every week and it is what people travel here for. Depending on the situation there are times I will excise rectal or bladder endometriosis and laparoscopically suture repair the rectum or bladder. For partial-thickness excision and full-thickness Disk excision of the bowel wall, I will suture repair the bowel wall myself.
In selected cases where the need for segmental bowel resection is known ahead of time, I can coordinate with a general surgeon, but in most cases it is better and I prefer to excise the disease off the bowel and repair the bowel, as necessary. When entire segments of bowel are removed, there is a chance that bowel function could be altered long-term, and this acceptable in the case of conditions such as Colon cancer, Crohn's, and Diverticulitis. With a benign condition such as Endometriosis, I try to excise the disease and not do anything that might alter your bowel function.
In cases where there is diffuse invasive Endometriosis involving the bowel wall, Endometriosis nodules larger than 3cm, it is appropriate and necessary to perform segmental bowel resection. When cases require segmental resection and primary anastomosis of bowel, a surgeon that I work with will be scheduled to come in and perform the bowel resection portion of the surgery. There is added complexity and risk to segmental bowel resection, so the patient will need to make an added visit to Maine to meet me and the surgeon on the same day. I feel this is worthwhile to get this done right.