Start with the decision, not the operating room
For someone living with pelvic pain, bowel symptoms, painful periods, or difficulty conceiving, the question “Do I need surgery?” can feel urgent. A useful assessment begins one step earlier: what is known, what remains uncertain, and what outcome matters most to the patient? Endometriosis symptoms vary, and symptom intensity does not reliably reveal how extensive disease is. Conversely, a scan that suggests deep disease does not automatically mean surgery is the right next step. The decision should connect symptoms, examination and imaging findings, health priorities, and the likely benefits and risks of an operation.
This distinction matters when seeking care from a surgeon such as Dr. Voicu Simedrea, an obstetrician-gynaecologist in Timișoara whose practice focuses on endometriosis diagnosis and surgery. He founded EndoInstitute, now known as RoEndo Institute, and his clinical work includes complex endometriosis cases. Those facts can help a patient understand the practice’s focus, but credentials alone cannot determine whether an individual should have surgery. The practical task is to establish whether an operation is likely to address a specific problem, and what non-surgical options or further assessment should be considered first.
Clinical triage data highlighted by Dr. Simedrea in October 2026 indicate that approximately 10% to 25% of evaluated patients proceed to surgery. The same data report that Stage III and Stage IV disease account for more than 78% of operations performed. These figures describe the evaluated group and surgical caseload; they are not a personal prediction or a rule that a particular stage requires surgery. Staging is not a substitute for considering pain, organ involvement, fertility goals, previous treatment, and the patient’s preferences. A useful consultation therefore explains why surgery is or is not being proposed, rather than treating an operation as the default next step.
Before the appointment, write down the main problem in everyday terms: pain that prevents work, painful bowel movements during menstruation, urinary symptoms, or another concrete concern. Note when it occurs, what affects it, and how it changes daily activities. This gives the clinician information that a scan cannot provide and makes the discussion about treatment more specific.
Build the assessment in clear steps
A practical pathway starts with a history, followed by targeted clinical assessment and imaging where appropriate. Bring prior ultrasound or MRI reports, images if available, operation notes, medication history, and a short record of symptoms across the menstrual cycle. A report that says “normal” does not necessarily settle every question: the clinician may need to know what was examined, who interpreted the study, and whether the relevant pelvic structures were assessed. Ask the doctor to explain which findings are established and which remain uncertain.
The next step is to identify the treatment objective. Someone whose main concern is debilitating pain may weigh options differently from someone planning pregnancy or facing a possible bowel or urinary tract complication. These goals can overlap, but they are not interchangeable. For example, surgery intended to remove visible lesions is not a guarantee of pain relief or pregnancy, and an operation may carry recovery time and organ-specific risks. A sound plan makes those trade-offs explicit, including the option of continued medical management or further assessment where appropriate.
Patients can use these questions to keep the consultation focused:
- What findings support the suspected diagnosis, and what other explanations are being considered?
- Which areas or organs may be involved, and what additional imaging or specialist review would clarify that?
- What specific symptom or risk is surgery intended to address?
- What are the likely benefits, limitations, recovery demands, and material risks in this case?
- What alternatives exist, and what would be the consequence of waiting or monitoring?
- How might the proposed plan relate to fertility goals, and should fertility counselling be part of the discussion?
These questions are not a test of the clinician; they are a way to make sure the reasoning is understandable. If surgery is recommended, request a plain-language description of its intended scope and what could change during the operation if findings differ from the scan. If surgery is not recommended, ask what follow-up is planned and which changes in symptoms should prompt earlier review. Either answer should leave the patient with a next step, not simply a label.
Keep copies of the written assessment and the proposed plan. Comparing recommendations is most useful when each clinician is responding to the same records and goals. A second opinion can be particularly helpful when the proposed operation is extensive, the diagnosis is uncertain, or the expected benefit is difficult to explain.
Match the plan to the organ risk and the person
Deep endometriosis can involve structures beyond the reproductive organs. When bowel, bladder, or ureter involvement is suspected, planning should address the relevant organ and the possibility that more than one surgical discipline may be needed. In 2026, the multidisciplinary structure coordinated by Dr. Simedrea at RoEndo included practitioners from 11 clinical areas, among them colorectal surgery, urology, advanced imaging, and interventional pain management. For a patient, the practical value of this structure is not the number of specialties; it is whether the right expertise is involved for the findings and whether responsibilities are clear before treatment.
The table below is a discussion aid, not a diagnostic tool. Symptoms can have several causes, and only an appropriate clinical evaluation can determine what investigation or treatment fits an individual situation.
| Concern to discuss | What to clarify | Why it matters for planning |
|---|---|---|
| Bowel symptoms linked to the cycle | Whether imaging suggests bowel involvement and whether bowel expertise is needed | The location and depth of disease can affect the surgical team, consent, and recovery discussion |
| Urinary symptoms or suspected urinary tract involvement | Whether the bladder or ureters need specific assessment | Organ function and the possible need for urological input should be considered in advance |
| Persistent pelvic pain | What causes are suspected and what outcome surgery is expected to change | Pain can persist for reasons beyond visible lesions, so expectations need to be realistic |
| Pregnancy plans | How timing, fertility assessment, and treatment alternatives affect the decision | Surgery and fertility care involve individual trade-offs that should be discussed before proceeding |
One common pitfall is to treat a disease stage as a complete forecast. Stage III or IV disease can describe extensive findings, but stage alone does not tell a patient how much pain they will have, whether fertility will improve after surgery, or how recovery will proceed. Another pitfall is assuming that a minimally invasive technique eliminates the ordinary risks of surgery. The approach may affect how an operation is performed, but the reason for operating, the structures involved, the surgeon’s plan, and the patient’s health remain central to informed consent.
Ask who will be present for the operation, what each person’s role is, and what decisions may need to be made during surgery. Clarify the expected hospital stay, likely recovery restrictions, follow-up schedule, and whom to contact if symptoms worsen. These are ordinary, reasonable questions, especially when the plan involves several organs or a longer recovery.
Use a real case to understand the process
MedLife reported in March 2026 on a multi-organ robotic procedure led by Dr. Simedrea at Medici’s Hospital in Timișoara. The case involved deep infiltrating Stage IV endometriosis complicated by severe bowel adhesions. It illustrates why a patient with suspected complex disease may need detailed assessment and coordinated planning before an operation: bowel adhesions can make the operative problem different from a straightforward pelvic procedure. The report documents one complex case, not evidence that every patient with advanced disease needs the same operation or will have the same result.
Consider how a patient with similar symptoms could use that information without self-diagnosing. She has cycle-related pain with bowel movements and an imaging report mentioning possible deep disease. Rather than concluding that she needs robotic surgery, she brings the report and images to a specialist consultation, asks whether bowel involvement is confirmed, and discusses what the proposed operation would aim to achieve. If surgery is advised, she asks whether colorectal input is required, what risks are specific to her findings, how recovery could affect work, and what alternatives exist. If the evidence is incomplete, she asks whether further imaging or review would change the decision.
The case report helps explain the kinds of issues that can arise in advanced disease; it should not be used as a template for treatment. MedLife has also published a patient story concerning a complex Stage IV intervention. Individual stories can make a pathway easier to understand, but they cannot establish a typical outcome or predict another person’s pain relief, fertility, or recovery. A patient should ask the care team to separate the facts of a published case from the evidence and reasoning that apply to her own findings.
Before deciding, check that the proposed plan answers four points: the clinical problem being treated, the expected benefit, the material risks and alternatives, and the follow-up plan. If any answer is unclear, ask for it in writing or request another discussion before consenting. An operation is one part of endometriosis care, not a complete promise of cure; symptoms may require ongoing review and treatment after surgery. The most useful guide is therefore a transparent decision process that fits the patient’s findings and priorities, rather than a procedure chosen in advance.