Surgeon Submission — Endo Excision for All

Practice information

First Name *

Last Name *

Specialty

Board Certification(s)

Hospital Affiliations

Years in Practice

State(s) Licensed In

Website

Primary Contact Email

Training

Have you completed any advanced training / fellowship? If so, please detail. *

Have you completed formal training specifically in endometriosis excision? *

Yes

No

Surgical volume

Approximate number of endometriosis excision surgeries performed *

Approximate number of deep infiltrating endometriosis (DIE) cases performed

Do you perform multidisciplinary surgeries when indicated? *

Yes

No

Credentials

Do you hold a Focused Practice Designation (FPD) from the American Board of Obstetrics and Gynecology (ABOG)?

Yes

No

Surgical approach

Do you perform complete excision of endometriosis (removal of disease at its origin)?

Yes

No

Do you perform ablation or fulguration as a primary treatment method?

Yes

No

What do you do when bowel endometriosis is present?

What do you do when ureteral involvement is present?

Where do you excise endometriosis?

Do you send excised tissue for pathological confirmation?

Yes

No

Average operative time for a moderate to severe excision case

Do you routinely document excised endometriosis with intraoperative photographic and/or video evidence?

Yes

No

Are patients provided access to these images or recordings?

Yes

No

Philosophy of care

Do you consider endometriosis a chronic inflammatory disease requiring complete excision when surgically treated?

Yes

No

Do you routinely recommend hysterectomy as treatment for endometriosis?

Yes

No

Do you support fertility preservation when appropriate?

Yes

No

Do you counsel patients on recurrence risk after excision?

Yes

No

Do you believe ablation and excision are equivalent treatments?

Yes

No

Outcomes & access

Estimated reoperation rate within 5 years

Do you track surgical outcomes?

Yes

No

Are you willing to provide de-identified outcome data upon request?

Yes

No

Average wait time for new patient consultation

Insurance accepted

Attestation

I attest that the above information accurately reflects my current surgical practice. *

Date *