EndoMapping: endometriosis,
mapped before surgery
A map of your disease, made before anyone operates.
An EndoMapping workup includes
Endometriosis rarely stays where you would expect it.
Deep disease hides outside the uterus
The right specialists, booked in advance
Decisions made with you, not while you are asleep
What happens during the mapping ultrasound.
-
01
Uterus and ovaries
The uterus is assessed for signs of adenomyosis, and both ovaries for endometriomas — the cysts that standard imaging usually does catch. This is where most scans stop; here it is the starting point.
-
02
Soft markers
The sonographer checks whether each ovary still moves freely and where you feel tenderness under the probe. Fixed ovaries and site-specific pain point to adhesions and deeper disease that the images alone may not show.
-
03
The pouch of Douglas
The “sliding sign”: gentle pressure tests whether the bowel still glides against the back of the uterus. When it does not, the space behind the uterus is obliterated — a strong indicator of severe posterior disease, and a finding that changes the whole surgical plan.
-
04
Deep nodules, compartment by compartment
A deliberate search of the anterior and posterior compartments for deep infiltrating nodules: bladder, ureters, uterosacral ligaments, vagina, rectovaginal septum, rectum and sigmoid colon — each one measured and located.
Why the order matters. In published studies of the four-step protocol, sensitivity for deep endometriosis rises from roughly 0.65 when only the first step is performed to roughly 0.94 when all four are completed. The MRI is then read against the same compartments, so the two studies confirm and correct each other rather than sitting in separate reports.
What you actually receive.
Your EndoMapping report sets out
From your first message to your follow-up at home.
Seven steps, one bilingual coordinator throughout, and nothing scheduled until you have seen it in writing.
Start Your Consultation- 01
First contact and records review
You write or call, and a bilingual coordinator responds within one business day. Send whatever you already have — symptom history, prior operative reports, pathology, previous imaging discs and reports. Nothing is a prerequisite; incomplete records are normal at this stage.
- 02
Video consultation with an endometriosis specialist
A specialist from the endometriosis team reviews your history with you over video, in English, and tells you honestly whether mapping is the right next step — and what they expect it will and will not answer. No obligation, and no charge for the review.
- 03
Your mapping day in Tijuana
Round-trip transportation from San Diego is arranged for you. You follow a bowel-preparation protocol the day before, then the ultrasound and the MRI are done in the same visit — usually a single day, with no anesthesia and no incisions. Your coordinator is with you throughout.
- 04
Your map and your surgical plan
The images are read by radiologists who specialize in endometriosis and reviewed with the surgical team — typically about five days. You then get a call to walk through the map, followed by a written surgical plan and an itemized quote: what will be removed, by whom, how long it takes, and what recovery looks like.
- 05
Excision surgery at the partner hospital
Surgery is performed laparoscopically by the endometriosis team at our partner hospital in Tijuana, in a hospital operating room with full anesthesia and intensive-care support on site. Every specialist the map called for is scrubbed in from the start.
- 06
Hospital stay and in-country recovery
Most endometriosis patients stay three to four days in Tijuana, depending on how extensive the surgery was. You are monitored in hospital, then cleared for travel by the surgeon. Discharge instructions, prescriptions and your operative report are given to you in English.
- 07
Home, pathology and follow-up
Pathology results are sent to you once available, and follow-up consultations are held remotely with the surgical team. Full recovery is generally four to six weeks. Your coordinator stays your point of contact — including for anything you need to hand to your doctor at home.
The same operation, two very different days.
| Surgery without mapping | Surgery after EndoMapping | |
|---|---|---|
| What is known going in | Symptoms, a routine pelvic ultrasound, sometimes nothing conclusive | A written map of each lesion, by compartment, with size and depth |
| Who is in the operating room | The gynecologic surgeon and their usual team | The specialists the map calls for — colorectal, urology, thoracic — scheduled in advance |
| Bowel or ureteral disease | Sometimes discovered during the operation | Identified, measured and planned for beforehand |
| Surgical approach | Largely decided in the moment | Decided with you, in writing, before the date is set |
| If unexpected disease appears | The team may have to limit the excision, or close and reschedule | The plan already accounts for it |
| Your consent conversation | General, covering possibilities | Specific to what you have — including bowel resection and fertility questions |
| Time and cost estimate | Approximate until the surgeon is inside | Based on the actual complexity of your case |
Is EndoMapping right for you?
Mapping is usually recommended when you have
Who reads your map and performs your surgery.
Dr. William Kondo
Dr. Kondo specializes in minimally invasive gynecological surgery with a particular focus on endometriosis treatment. With extensive training and experience in laparoscopic techniques, his approach emphasizes personalized care and a treatment plan built around each patient’s specific condition — which is precisely what a mapping-led workup makes possible.
Dr. Jorge Zavala
A key member of the EndoGlobal Group, Dr. Zavala is highly skilled in managing and treating endometriosis through minimally invasive procedures. His approach centers on patient education and involvement, so that patients are fully informed and comfortable with their treatment options before surgery is scheduled.
A note on how we work. AngelesHealth is a medical-travel facilitator, not a hospital. We coordinate your imaging, your surgical team, your transportation and your stay — the surgeons and radiologists are staff at our partner hospitals in Tijuana. See our partner hospitals.
What it costs, and what is included.
The surgery package covers
Mapping is quoted on its own
Getting your quote
Questions patients ask about EndoMapping.
What is EndoMapping, exactly?
EndoMapping is a pre-surgical imaging workup for endometriosis. It combines an expert transvaginal ultrasound performed with bowel preparation and an endometriosis-protocol MRI, both read by radiologists who specialize in the disease. The output is a written map of where your endometriosis is, how deep each lesion goes, and which organs are involved — which the surgical team then uses to plan the operation and assemble the right specialists before you arrive.
Can EndoMapping diagnose endometriosis without surgery?
It can identify deep infiltrating endometriosis, endometriomas and the organs involved without an operation, which is often enough to plan surgery and to explain symptoms that previous imaging could not. It is not a complete substitute for laparoscopy: superficial peritoneal disease can be present without being visible on imaging, so a normal map does not always mean no endometriosis. The specialist will tell you plainly what your map does and does not rule out.
I have already had an MRI. Do I still need mapping?
Often, yes — send it and the team will tell you. A general pelvic MRI is acquired and reported differently from an endometriosis-protocol MRI, and the difference lies mostly in who reads it and what they are looking for. If your existing study was performed to the right protocol and is recent, it may be usable as part of your map, which reduces what has to be repeated.
Is mapping painful, and do I need anesthesia?
No anesthesia and no incisions are involved. The ultrasound is transvaginal and takes roughly 45 to 60 minutes; part of the examination deliberately checks where you feel tenderness, so it can be uncomfortable, particularly if you have deep disease. Tell the sonographer — the examination is paced around you, and it can be paused at any point.
How long until I get my results?
Typically about five days from the scans to the written report, allowing time for both studies to be read together and reviewed with the surgical team. Your coordinator then schedules a call to walk you through the map before any surgical date is discussed.
Do mapping and surgery happen on the same trip?
Both are possible and it depends on how far you are travelling. Patients within driving distance of San Diego usually map on one short trip, review the plan at home, and return for surgery. Patients flying in from farther away often prefer to sequence mapping and surgery into a single longer stay. Your coordinator will confirm which applies to your case before anything is booked.
What happens if my map shows bowel or bladder involvement?
That is precisely what mapping exists to find. A colorectal surgeon or urologist joins the surgical team, the operating time and the hospital stay are planned around the more complex procedure, and the options are discussed with you before you agree to anything — including what removing that lesion involves and what it means for recovery. Finding it now is what allows it to be treated in one operation instead of two.
Will my insurance cover mapping or surgery in Mexico?
Coverage for care abroad varies by insurer and policy — some plans reimburse part of an international procedure, many do not. Check directly with your provider. We can supply itemized billing documentation, your imaging report and your operative report to support a claim, but we cannot bill U.S. insurers directly.
Explore the rest of the women’s health program.
Endometriosis Surgery
Hysterectomy
da Vinci Myomectomy
Pricing & Packages
Send your records. Get a real answer.
will arrange your review with the endometriosis team — pricing,
timeline and plan, with no obligation.