Advanced Endometriosis Excision Surgery in Princeton, New Jersey
If you have been living with endometriosis pain for years, you may already know how difficult it can be to find answers and effective treatment. Some patients come to Dr. Gina Ranieri after years of pelvic pain, multiple treatments, or previous endometriosis surgery that did not provide the relief they hoped for.
Dr. Gina Ranieri is a Mayo Clinic fellowship-trained minimally invasive gynecologic surgeon specializing in the surgical treatment of endometriosis. Her advanced training includes both robotic and laparoscopic surgery, allowing her to treat a broad range of endometriosis, from superficial disease to complex cases involving deep endometriosis, the bowel, bladder, and other pelvic structures.
Her surgical approach emphasizes careful visualization and thorough identification and excision of endometriosis. When appropriate, Dr. Ranieri uses a technique called peritonectomy to help expose the underlying pelvic anatomy and identify areas of disease that may otherwise be difficult to see.
If you are considering endometriosis surgery or seeking another opinion after previous treatment, learning about your surgical options can be an important first step.
What Is Endometriosis?
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. This tissue can cause inflammation, scarring, adhesions, and changes to the surrounding pelvic anatomy.
Endometriosis can occur in many areas of the pelvis, including the ovaries, pelvic peritoneum, fallopian tubes, uterosacral ligaments, bowel, bladder, and other structures.
Symptoms can vary significantly from patient to patient.
Common symptoms may include:
Severe menstrual or pelvic pain
Chronic pelvic pain
Pain during or after intercourse
Pain with bowel movements
Pain with urination, particularly during menstruation
Bloating and gastrointestinal symptoms
Lower back or pelvic pain
Heavy or painful periods
Difficulty becoming pregnant
Ovarian endometriomas
Persistent symptoms despite hormonal treatment
The severity of symptoms does not always correspond to the extent of disease. Some patients with extensive endometriosis may have relatively mild symptoms, while others may experience significant pain with less extensive disease.
What Is Endometriosis Excision Surgery?
Endometriosis excision surgery involves surgically removing areas of endometriosis rather than simply treating the surface of the lesion.
The exact surgical approach depends on where the disease is located, how extensive it is, and how it affects the surrounding anatomy.
Endometriosis can sometimes involve structures deep within the pelvis or be associated with dense scar tissue and adhesions. For these cases, surgery requires careful identification of the disease and an understanding of the surrounding anatomy.
Dr. Ranieri's fellowship training in minimally invasive gynecologic surgery provides specialized training in advanced laparoscopic and robotic approaches to gynecologic surgery and the treatment of endometriosis.
A Thorough Approach to Endometriosis Excision
One of the challenges of endometriosis surgery is that disease is not always limited to the areas that are easiest to see.
Endometriosis can occur on or beneath the pelvic peritoneum and can be associated with adhesions that distort normal anatomy.
Dr. Ranieri uses a meticulous surgical approach designed to improve visualization of the pelvis and carefully identify areas of endometriosis.
What Is Peritonectomy?
Peritonectomy is a surgical technique in which portions of the pelvic peritoneum—the thin tissue lining the pelvic cavity—are carefully removed.
When appropriate for a patient's disease, peritonectomy can help expose the underlying anatomy and provide improved visualization of areas where endometriosis may be present.
Dr. Ranieri incorporates peritonectomy techniques when appropriate as part of her approach to endometriosis excision.
The goal is to carefully identify and excise visible endometriosis while preserving healthy surrounding tissue and important pelvic structures whenever possible.
If you are considering endometriosis surgery, it can be helpful to ask your surgeon how they approach disease involving the peritoneum and whether techniques such as peritonectomy may be appropriate for your individual case.
Treating Complex Endometriosis
Endometriosis is not the same for every patient.
Some patients have relatively superficial disease, while others have endometriosis that is deeper in the pelvis or involves critical structures.
Dr. Ranieri's advanced minimally invasive surgical training allows her to evaluate and treat a broad range of endometriosis presentations, including complex disease.
Deep Endometriosis
Deep endometriosis can extend beneath the surface of the pelvic peritoneum and may involve structures such as the uterosacral ligaments, rectum, bowel, bladder, or ureters.
Treatment requires careful surgical planning and a detailed understanding of pelvic anatomy.
Bowel Endometriosis
Endometriosis can affect the bowel, particularly the rectum and lower portions of the colon.
Patients may experience symptoms such as painful bowel movements, constipation, diarrhea, bloating, or cyclical gastrointestinal symptoms.
When bowel involvement is suspected, surgical planning must take into account both the endometriosis and the surrounding bowel anatomy.
Bladder and Urinary Tract Endometriosis
Endometriosis can also involve the bladder or, less commonly, other portions of the urinary tract.
Symptoms may include pelvic pain, painful urination, urinary urgency, or symptoms that worsen around menstruation.
When endometriosis involves the bladder or other pelvic structures, treatment requires careful attention to the anatomy and the potential involvement of other specialists when appropriate.
When Previous Endometriosis Surgery Has Not Relieved Your Symptoms
Some patients seek consultation after having already undergone surgery for endometriosis.
If pain or other symptoms persist after surgery, there may be several possible explanations. Endometriosis may remain, disease may recur, scar tissue or adhesions may contribute to symptoms, or another condition may be contributing to the pain.
A previous surgery does not necessarily mean that another surgery is the right answer.
Dr. Ranieri begins by reviewing the patient's symptoms, previous treatments, operative reports, pathology, imaging, and individual goals.
For patients considering another procedure, understanding what was found and treated during previous surgery can be particularly important in developing an appropriate treatment plan.
Do I Need Endometriosis Surgery?
Not every patient with endometriosis needs surgery.
Depending on your symptoms and goals, treatment may include:
Hormonal therapy
Pain management
Pelvic floor physical therapy
Fertility treatment
Observation and monitoring
Minimally invasive surgery
A combination of treatments
Surgery may be considered when symptoms remain significant despite medical treatment, when there is an ovarian endometrioma or other anatomical concern, when deep or extensive disease is suspected, or when surgery may help address a patient's individual goals.
The decision to undergo surgery should be individualized.
A consultation can help you understand your options and determine whether surgery makes sense for you.
What Makes an Endometriosis Surgeon Different?
Endometriosis surgery requires more than general experience with gynecologic surgery.
When choosing a surgeon, patients may want to ask about:
Fellowship training in minimally invasive gynecologic surgery
Experience performing endometriosis excision
Experience with complex and deep endometriosis
Experience with laparoscopic and robotic surgery
How the surgeon evaluates the extent of disease
How the surgeon approaches peritoneal disease
Experience with bowel and bladder involvement
How previous surgical findings are incorporated into treatment planning
How the surgeon balances removal of disease with preservation of healthy tissue
It is appropriate to ask detailed questions about the surgical approach before deciding whether surgery is right for you.
Why Patients Choose Dr. Gina Ranieri for Endometriosis Surgery
Dr. Ranieri's approach is built on specialized training, advanced minimally invasive surgical techniques, and careful attention to the individual patient's disease and goals.
She completed fellowship training in minimally invasive gynecologic surgery at Mayo Clinic, one of the world's leading medical centers.
Her training includes both laparoscopic and robotic surgery, allowing her to approach a wide range of gynecologic surgical conditions and complex endometriosis cases.
Her experience includes treatment of patients with:
Deep endometriosis
Complex endometriosis
Bowel involvement
Bladder involvement
Ovarian endometriomas
Recurrent or persistent symptoms
Previous endometriosis surgery
For patients who have struggled with endometriosis for years or who continue to experience symptoms after previous treatment, Dr. Ranieri provides an opportunity for a detailed evaluation and discussion of additional treatment options.
Endometriosis Excision Surgery in Princeton, NJ
Dr. Ranieri provides specialized minimally invasive gynecologic surgical care in the Princeton, New Jersey area.
Her practice is accessible to patients throughout Central New Jersey and surrounding communities, as well as patients who are willing to travel for specialized endometriosis care.
Patients may seek consultation from communities throughout:
Princeton
Plainsboro
West Windsor
Lawrenceville
Hamilton
Trenton
New Brunswick
Somerset County
Bucks County and the Philadelphia suburbs
Other areas of New Jersey and the surrounding region
For patients traveling from outside the immediate Princeton area, the decision to travel for an endometriosis specialist may be worthwhile when seeking specialized surgical expertise.
Questions to Ask Before Endometriosis Surgery
Choosing an endometriosis surgeon is an important decision.
Consider asking:
1. What specialized training do you have in endometriosis surgery?
Ask specifically about fellowship training and advanced minimally invasive gynecologic surgery training.
2. Do you perform excision of endometriosis?
Ask your surgeon to explain their surgical approach and how they treat different types of disease.
3. How do you evaluate the peritoneum for endometriosis?
Understanding how your surgeon identifies and evaluates peritoneal disease can help you understand their surgical philosophy.
4. Do you use peritonectomy when appropriate?
Ask whether peritonectomy is part of the surgeon's approach when disease involves the pelvic peritoneum.
5. Do you treat deep endometriosis?
If deep disease is suspected, ask about the surgeon's experience with complex endometriosis.
6. How do you approach bowel or bladder endometriosis?
If your imaging or symptoms suggest involvement of these organs, ask how the surgical team plans for that possibility.
7. What happens if I have had previous endometriosis surgery?
Ask the surgeon to review your previous operative reports and explain how they affect your treatment plan.
Take the Next Step
If you have been living with endometriosis pain, have been diagnosed with complex endometriosis, or continue to experience symptoms after previous treatment, you do not have to navigate your options alone.
A consultation with Dr. Gina Ranieri can provide an opportunity to review your history, imaging, previous surgical findings, symptoms, and treatment goals and discuss whether endometriosis excision surgery may be appropriate for you.
Learn more about endometriosis excision surgery or schedule a consultation in Princeton, NJ.
About Dr. Gina Ranieri
Dr. Gina Ranieri is a fellowship-trained minimally invasive gynecologic surgeon specializing in advanced minimally invasive gynecologic surgery and the surgical treatment of endometriosis.
She completed her fellowship training at Mayo Clinic and has advanced training in both laparoscopic and robotic surgery.
Her practice focuses on providing individualized care for patients with endometriosis and other complex gynecologic conditions.
Medical Disclaimer
The information provided on this website is for general educational purposes only and should not be considered medical advice or a substitute for evaluation by a qualified healthcare professional. Every patient and surgical situation is different. Treatment recommendations should be individualized based on a patient's medical history, examination, imaging, goals, and other clinical factors.