The ESSI TOOLKIT
A multispecialty team in the same operating room
Complex endometriosis may involve the bowel, bladder, ureters, diaphragm, lungs, liver, pelvic nerves, or pelvic vessels.
A multimodal operation requires a team capable of managing those findings in one coordinated setting. When a case requires colorectal, urologic, vascular, or thoracic expertise, the case is staffed accordingly so the patient does not have to navigate multiple staged operations whenever a combined approach is feasible.
DISCOVER
The full toolkit
The ESSI Method draws on the following modalities, each chosen for the specific problem it solves. Not every patient receives every modality — the operative plan is tailored to each patient, based on history, exam, imaging, and intraoperative findings.
- Complete laparoscopic or robotic-assisted excision of visible endometriosis.
- Bowel shaving, disc excision, or segmental resection when bowel disease requires it.
- Bladder excision or partial cystectomy when full-thickness bladder disease is present.
- Ureterolysis, ureteric resection, or reimplantation when the ureter is compressed or invaded.
- Diaphragmatic excision, including full-thickness treatment when required.
- Thoracic excision with thoracic colleagues when thoracic endometriosis is present and same-setting treatment is feasible.
- Re-operative excision for persistent or recurrent disease after prior incomplete treatment.
- Multispecialty surgical support with colorectal, urologic, thoracic, and vascular teams when the case requires it.
- Nerve-sparing dissection to preserve autonomic bladder, bowel, and sexual function during deep excision.
- Neurolysis of the sacral, sciatic, obturator, pudendal, or other involved nerves when disease, fibrosis, or scarring has entrapped them.
- Pelvic floor neuromodulation for high-tone dysfunction, levator myalgia, deep dyspareunia, and refractory myofascial pelvic pain.
- Bladder neuromodulation for selected cases of refractory urgency, frequency, and bladder pain syndrome.
- Uterine neuromodulation for selected cases of severe dysmenorrhea or adenomyosis-related cramping.
- Anorectal neuromodulation for chronic fissure, anismus, sphincter spasm, or rectovaginal pain syndromes.
- Vulvar or vestibular neuromodulation for vulvodynia, vestibulodynia, or refractory vaginismus when the target is clinically mapped.
- Ovary-preserving endometrioma strategy when fertility or ovarian reserve is a priority.
- Ovarian PRP as an investigational adjunct in carefully selected diminished-reserve or poor-response cases.
- Organ-sparing adenomyosis treatment when the uterus is being preserved.
- Tubal reconstruction, including adhesiolysis, fimbrioplasty, and neosalpingostomy when anatomy and goals support it.
- Hysteroscopic cavity evaluation in fertility-focused cases, with treatment of polyps, adhesions, retained tissue, or septum when indicated.
- CD138 endometrial biopsy when chronic endometritis is part of the fertility evaluation.
- Placental or amniotic membrane adhesion-prevention barriers when appropriate.
- Coordination with reproductive endocrinology so surgery supports the next fertility step.
- Laparoscopic ligation of selected dilated ovarian or pelvic vessels for symptomatic pelvic venous disease only after obstructive causes such as Nutcracker syndrome or May-Thurner syndrome have been excluded on appropriate imaging.
- ESSI does not ligate every dilated vein seen at surgery. The target is the vein contributing to the problem, not a vein that is simply a consequence of another obstruction.
DISCOVER
How a typical ESSI case unfolds
We map every potential pain generator, every fertility consideration,
and every anatomical question before we ever pick up an instrument.
One operation - Many Interventions
Single anesthetic
One recovery
Multispecialty surgical team
STEP BY STEP
What happens during a single ESSI case?
Every ESSI patient begins with a comprehensive evaluation
that goes well beyond a standard gynecologic intake.
01. Diagnostic Survey
Map contributors plan the case
02. Complete excision
All visible disease removed
03. Nerve-sparing + neurolysis
Nerves preserved
04. Microwave ablation
Adenomyosis, uterus preserved
05. Argon-beam vaporization
Endometrioma,
ovarian reserve
06. Turbal reconstruction
Restore fertility
07. Vascular ligation
Pelvic congestion
08. Targeted neuromodulation
Botulinum toxin in pain areas
Adhesion barriers
Placental membrane
- Not every patient receives every step. The plan is tailored individually from preoperative mapping.
DISCOVER
The Patient Journey
Every ESSI patient begins with an evaluation that goes well beyond a standard gynecologic intake — mapping every pain generator, every fertility consideration and every anatomical question first.
Before surgery
Mapping every pain generator, fertility consideration and anatomical question — before we ever pick up an instrument.
- Detailed pain history covering menstrual, sexual, urinary, bowel, musculoskeletal, and nerve-related symptoms.
- Detailed fertility history, including prior IVF cycles, ovarian reserve, pregnancy loss, and tubal history.
- Pelvic and pelvic-floor examination to map tenderness, hypertonicity, and trigger points.
- Targeted imaging to evaluate deep infiltrating disease, adenomyosis, endometriomas, adhesions, and pelvic veins.
- A clear conversation about which modalities may apply, why they are being considered, and what alternatives exist.
In the operating room
Complete excision, plus every indicated and appropriately-staffed step — in one coordinated setting.
- Diagnostic survey and complete excision of visible endometriosis.
- Bowel, bladder, ureteral, diaphragmatic, thoracic, nerve, or vascular work when indicated and appropriately staffed.
- Organ-sparing treatment of adenomyosis or endometriomas when appropriate.
- Fertility-focused steps such as tubal reconstruction, hysteroscopy, cavity treatment, CD138 biopsy, and ovarian PRP when indicated.
- Targeted neuromodulation in mapped pain generators when selected before surgery.
- Adhesion-prevention strategy at the close of the case.
After surgery
Recovery, fertility coordination and long-term follow-up — care that continues past the operation.
- Structured pelvic floor physical therapy when appropriate.
- Coordinated reproductive endocrinology follow-up for fertility patients.
- Medical therapy individualized to the patient's goals.
- Long-term follow-up to monitor symptoms, function, fertility plan, and recurrence risk.
