If you have been told you have endometriosis, or if you suspect it, the choice of gynecologist matters more for this condition than for almost any other in women’s health. The reason is simple: endometriosis surgery is technically demanding. The outcome depends almost entirely on the surgeon’s training and experience, not the hospital brand or the number of Google reviews.
This guide explains what to look for, what questions to ask, and why subspecialty training separates surgeons who get patients better from surgeons who leave them cycling through repeat operations.
What endometriosis actually requires from a surgeon
Endometriosis grows on surfaces. In early-stage disease, it appears as superficial deposits on the peritoneum and ovaries. In advanced cases, it infiltrates deep into tissue, involving the bowel, bladder, ureter, and pelvic nerves. Each of these structures requires a different dissection technique.
A general gynecologist can manage Stage I to II disease. Stage III and IV, and particularly deep infiltrating endometriosis (DIE), should be managed by a surgeon with specific fellowship training in endometriosis excision. The distinction matters because incomplete excision is the main reason endometriosis recurs after surgery. When a surgeon removes only the visible lesion without excising the full depth of infiltration, the disease returns, usually within 18 to 24 months.
Fellowship training in endometriosis means a surgeon has spent dedicated time under the supervision of a specialist centre that handles complex, recurrent, and deep disease. There are very few such centres globally. France, Germany, the United Kingdom, and Australia are the primary training destinations for Indian surgeons who pursue this subspecialty.
The nerve question most patients never think to ask
Advanced endometriosis frequently infiltrates pelvic nerves, particularly the hypogastric nerve plexus, the pelvic splanchnic nerves, and the pudendal nerve. When a surgeon dissects in this territory without specific training in pelvic nerve anatomy, the result can be persistent post-surgical bladder dysfunction, bowel dysfunction, or worsening pelvic pain.
A subspecialty area called neuropelveology specifically addresses the diagnosis and surgical management of nerve-infiltrating endometriosis. Surgeons with ISON (International Society of Neuropelveology) training are taught to identify, protect, and in some cases decompress pelvic nerves during endometriosis excision. Fewer than 10 practitioners in India hold this combined training.
When you consult a surgeon for endometriosis, ask directly: do you perform nerve-sparing dissection in endometriosis surgery? The answer tells you immediately whether they have trained in this area.
What fellowship-trained endometriosis care looks like in Kolkata
Dr. Juhi Dhanawat is a female gynecologist practicing in Kolkata with a Fellowship in Endometriosis from France and FMIGS (Fellowship in Minimal Invasive Gynaecology Surgery, Laparoscopy and Robotics) from Germany. She also completed Neuropelveology Parts I and II from ISON, Switzerland. Her MS in Obstetrics and Gynaecology is from Seth GS Medical College and KEM Hospital Mumbai.
This combination is relevant for endometriosis patients specifically because it covers the full range of what complex disease requires: excision technique, minimally invasive approach, and nerve-sparing dissection.
She consults at Neotia Bhagirathi Woman and Child Care Centre (Rawdon Street, Tuesday and Saturday 5 to 7 PM; New Town, Thursday and Sunday 9:30 to 11:30 AM), Motherhood Hospital Kasba (338 Rajdanga Main Road), and R N Tagore International Institute of Cardiac Sciences (EM Bypass, Wednesday 10 AM to 12:30 PM).
Appointment booking: +91 8240886334.
Questions to ask any gynecologist before endometriosis surgery
These six questions separate surgeons with specific training from general practitioners who perform occasional endometriosis cases:
Do you have a fellowship in endometriosis surgery? A fellowship means structured training at a dedicated centre. A CME workshop or course does not qualify.
How many endometriosis excisions do you perform per year? Volume matters. Surgeons who perform fewer than 20 to 30 endometriosis cases annually are unlikely to have the repetition needed for Stage III to IV disease.
Have you managed cases involving bowel, bladder, or ureteric endometriosis? These organs are involved in deep infiltrating disease. If the surgeon has not operated in this territory, they cannot manage it safely.
Do you perform nerve-sparing dissection? This is the question most patients never ask. It directly relates to post-surgical quality of life.
What is your approach to ovarian endometrioma? There is a clinical debate between drainage/ablation and cystectomy. A trained surgeon will explain this accurately, including the implications for ovarian reserve.
What happens if the disease is more extensive than expected at laparoscopy? A surgeon without full excision training may convert an excision case to drainage or ablation intraoperatively. This should be discussed in advance.
Why Kolkata patients are often undertreated for endometriosis
Most gynecologists in Kolkata are general OB-GYNs. They manage normal and high-risk pregnancy, PCOS, fibroids, and the full range of routine gynaecological conditions. They are not trained specifically in endometriosis excision, and many are not comfortable with Stage III to IV disease.
This is not a criticism. It is a specialisation gap, no different from the gap between a general surgeon and a hepatobiliary surgeon. The problem is that patients with endometriosis are often not told this. They are offered hormonal suppression (GnRH agonists, combined pill, mirena) as long-term management, which controls symptoms but does not treat the disease and does not address the fertility implications.
The women who do best are those who find a fellowship-trained excision surgeon early, understand what their stage of disease involves, and make an informed decision about surgery timing relative to fertility goals.
Endometriosis and fertility: the timing question
Endometriosis affects fertility in roughly 30 to 50 percent of women with the condition. The mechanism involves inflammatory cytokines in the peritoneal fluid, distortion of tubal anatomy from adhesions, and in ovarian endometrioma, direct damage to the ovarian cortex.
For women who want to conceive, the decision about surgery timing should be made jointly with a surgeon who understands both the excision technique and the fertility implications. Aggressive surgery on bilateral endometriomas, for example, can reduce ovarian reserve. The right surgeon weighs these trade-offs explicitly.
A useful internal link here: Endometriosis and Infertility: 5 Facts Every Woman Trying to Conceive Must Know
What to expect at a first consultation for endometriosis
A thorough first consultation for suspected endometriosis should include a detailed symptom history (when the pain started, its relationship to the menstrual cycle, whether it affects the bladder or bowel, whether it affects intimacy), a clinical pelvic examination, a transvaginal ultrasound, and in some cases an MRI pelvis.
Blood tests (CA-125, AMH) are part of a complete workup but are not diagnostic on their own. The only definitive diagnosis of endometriosis is laparoscopy with histological confirmation.
If a consultation consists of a 10-minute history and an ultrasound prescription, it is not a specialist endometriosis assessment.
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