Trina Mansour, MD, highlights surgical strategies for managing endometriosis

At the 2025 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, Trina Mansour, MD, a gynecologic surgeon from the Phoenix VA Healthcare System, presented on the surgical management of endometriosis. Her session focused on identifying and safely excising endometriosis and offered guidance on improving surgical outcomes through a structured approach.

Trina Mansour, MD

Developing a structured surgical strategy

“Our presentation is about the safe excision and identification of endometriosis, essentially just the surgical management of endometriosis,” said Mansour. She emphasized the importance of taking audience members “on a journey from how patients present to how surgery or different types of surgery modalities [are] available, platforms available, and then tips and tricks at the time of surgery to help efficiently and safely excise disease.”

According to Mansour, success in endometriosis surgery requires a methodical technique. “It needs to be a systematic approach. Having to do the same thing for every single case really helps identify those atypical lesions, especially in those areas that we don't usually go and evaluate,” she said.

She recommended beginning with a comprehensive survey of the upper abdomen and working in a clockwise fashion—“to the left side, then the bowel, then going to the pelvis”—rather than immediately focusing on the pelvic region. This ensures no atypical lesions are overlooked.

Recognizing atypical presentations of endometriosis

Endometriosis may not always appear in typical forms, which makes surgical identification more challenging. Mansour advised clinicians to “really familiarize themselves through surgical libraries, through research,” as “there's more and more research about atypical appearances of endometriosis.” She added, “I always recommend excising any suspicious lesions, even though it might not be the typical powder burn, because that will help increase confidence in identifying those atypical appearances and making sure that we're fully excising disease.”

Limitations in noninvasive diagnosis

“There’s no noninvasive testing right now for endometriosis,” Mansour noted, reaffirming that “the gold standard is to do surgery with excision and have pathology confirm the diagnosis.” While the ReceptivaDx test is a laboratory tool, it is primarily used in patients undergoing infertility evaluation and is not broadly applicable.

Instead, imaging advancements offer promise. “The most emerging tool is really advanced imaging and targeted imaging,” said Mansour. For example, she suggested that when a patient reports right upper quadrant pain consistent with endometriosis, a targeted ultrasound or MRI with endometriosis-specific protocols may help in identifying deep infiltrating disease. However, she acknowledged, “There still needs to be a lot of studies and research, but that is an emerging tool for patients right now.”

Surgical platform choice depends on context

Mansour explained that “it really depends on the extent of the disease, what platform is available, and surgeon expertise” when selecting between robotic and laparoscopic approaches. “In the right hands, both robotic and laparoscopic surgery provide patients with relief of their symptoms,” she said.

While research indicates similar complication rates and perioperative outcomes between platforms, robotic surgery may offer enhanced visualization and improved ergonomics for managing deep-infiltrating endometriosis. “Laparoscopic surgery is more cost-effective, so in the right hands, it might be a better option,” she said.

In more complex cases—such as those involving the kidney, ureter, or bowel—a multidisciplinary approach is required. Platform selection in such cases is shared among the surgical teams involved.

Disclosure:

Mansour reports no relevant disclosures.

Reference:

Wasson M, Mansour T. Increasing Skill and Safety in the Identification and Excision of Endometriosis. Presentation. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.