How to Choose the Right Endometriosis Surgeon (Episode 495)

Full Transcript: Episode 495

LISA: Today’s episode is one that you won’t want to miss. I’m sharing my interview with a world-renowned endometriosis surgeon who really gets into a fascinating level of detail on the complexity of the condition itself, and really breaks down what I would say are essential practical tips that you need to know if you find yourself in a position where you’re thinking about surgery — whether for diagnosis, treatment, or both.

LISA: I found today’s episode to be the perfect combination of informative and mind-blowing. So buckle up your seatbelts, as they say. But before we jump in, let me tell you a little bit about our guest. Dr. Sinervo is the Medical Director of the Center for Endometriosis Care and an award-winning, internationally renowned gynecologic expert specializing in laparoendoscopic excision of endometriosis and advanced minimally invasive gynecologic surgery. A native of Ontario, Dr. Sinervo is a fellow of the Royal College of Physicians and Surgeons of Canada, a member of the Canadian Society of Obstetrics and Gynecology, and many other professional and medical societies. He is frequently sought after for his expert opinion by various biotechnology, device, and medical institutions. A noted author and speaker who lectures globally, he has countless abstracts, publications, and presentations to his credit and is routinely called upon by the international media for his expertise. He remains extensively involved in both the patient and professional sectors, contributing his compassionate expertise to countless endeavors to advance endometriosis advocacy, awareness, collaborative care, and disease education.

DR. SINERVO: Thank you very much. I’m glad to be here.

LISA: Thanks for being here. I’d love to start by giving you the opportunity to share your background — what prompted you to go into the medical field and then to further specialize in endometriosis?

DR. SINERVO: When I was in undergrad, a few of my friends encouraged me to go into medicine. They thought I had a good disposition and would make a good physician. So I switched my major and eventually went to medical school in Toronto, followed by a residency in Calgary. Early in my residency, I was introduced to advanced laparoscopic surgery and was fascinated by what could be done minimally invasively — things I’d never seen in standard training. That experience really opened my eyes. Later, during my fellowship in Atlanta — at the Center for Endometriosis Care — about half the surgeries I was involved in were for endometriosis. I saw the dramatic impact of properly excising the disease, especially on pain and fertility outcomes. That was the turning point for me.

LISA: That’s so interesting. And I think a good place to go next is: can you give us a bit of an overview of endometriosis itself? What is it, and how well is it understood by the average GP?

DR. SINERVO: Endometriosis is very common — it affects about 10% of women and can present even before menarche. Some of my youngest patients have had symptoms as early as age 8 or 9, though we often don’t see them until later. It’s a complex disease that can affect people throughout their reproductive lives and even after menopause.

DR. SINERVO: The disease involves tissue that’s similar to, but not the same as, the endometrial lining — and it grows outside the uterus. These lesions behave differently and don’t respond the same way as uterine tissue. That’s why retrograde menstruation doesn’t fully explain it. Endometriosis can show up anywhere — the pelvic area, bowels, bladder, even the diaphragm and lungs. Symptoms vary widely, from painful periods and intercourse to bowel and bladder issues, and even cyclical chest pain. This is why misdiagnosis is so common — people are often treated for other conditions like IBS or interstitial cystitis for years before endometriosis is even considered.

LISA: That diagnostic delay is something we hear a lot about. Can you speak to why that happens and what could help improve it?

DR. SINERVO: The average time to diagnosis ranges from 7 to 12 years. Many GPs — and even some gynecologists — aren’t adequately trained to recognize it. There’s often a focus on symptom suppression with hormonal therapy rather than pursuing a diagnosis. Even the ACOG guidelines lean heavily on medical management. The reality is that surgery — specifically excision — is the only way to confirm the diagnosis and effectively treat the disease in many cases. If guidelines were followed more closely and providers referred sooner, many women could be diagnosed within two years. But it requires a shift in mindset and better education at every level of care.

LISA: You mentioned excision. Can you break down the difference between ablation and excision for our listeners?

DR. SINERVO: Absolutely. Ablation destroys lesions on the surface using heat or energy — but it leaves the root of the disease behind. Think of it like cutting down a tree at the base without removing the roots. Those roots can regrow. Excision, on the other hand, removes the entire lesion, root and all. We carefully dissect under the affected tissue to fully remove it. Recurrence rates after excision are significantly lower — 5–10%, compared to 40–60% with ablation. And for deep disease or involvement of organs like the bowel or diaphragm, excision is really the only option.

LISA: That makes a lot of sense. For women considering surgery, how can they know whether a surgeon is truly qualified to perform excision?

DR. SINERVO: It’s critical to ask the right questions. How many endometriosis surgeries does the surgeon perform? Do they do excision — not ablation? Do they have a multidisciplinary team for bowel, bladder, or thoracic involvement? If a surgeon says they’ll “see what’s there” and decide during surgery whether to treat it — that’s a red flag. You want a surgeon who is trained, experienced, and fully prepared to excise disease wherever it may be found.

DR. SINERVO: At our center, we review each patient’s history, imaging, and past records before surgery. We go in with a plan and the right team. That’s how we reduce the risk of missed diagnosis and unnecessary repeat procedures.

LISA: Thank you for sharing that. I think this will be incredibly helpful to listeners who are trying to navigate their options.

DR. SINERVO: I hope so. It’s such a challenging journey for many. But with the right care, things can improve. Our goal is always to get to the root of the issue — not just manage symptoms.

LISA: For those interested in learning more about your clinic or accessing the resources you mentioned, where should they go?

DR. SINERVO: They can visit our website at centerforendo.com. There are hundreds of pages of educational material, including a helpful article on what questions to ask your doctor when seeking care for endometriosis. We’re here to help, whether someone is looking for a surgeon or just trying to understand their options.

LISA: Thank you again for being here and for the important work you do. This conversation has been so informative and eye-opening.

DR. SINERVO: Thank you for having me.