Complete removal of endometriosis improves fecundity.

Endometriosis is one of the causative factors of impaired fecundity. Whatever the mechanisms are of this impairment, surgical removal of endometriosis appears to increase postoperative fecundity. Our strategy in laparoscopic surgery for symptomatic endometriosis is to completely remove endometriosis. However, despite this strategy, laparoscopic surgery nonetheless creates two categories of patients; complete and incomplete surgery groups. We found by comparing the two groups that both were comparable in terms of fecundity during the early postoperative phase, whereas unlike the complete surgery group, fecundity in the incomplete surgery group stayed low during the late postoperative phase. Deep rectal endometriosis and deeply invading pelvic endometriosis are conditions wherein complete removal of endometriosis is difficult. We have developed laparoscopic surgeries for these conditions: laparoscopic anterior rectum slicing (LARS) and laparoscopic pelvic wall slicing (LPWS) operations, respectively. Both operations are effective in alleviating disease-related symptoms with minimal surgical invasiveness.