Further studies are required to assess the role of laparoscopic surgery for managing stage III-IV endometriosis, in particular for the control of pain and for both pain and subfertility in women with severe disease. We found no direct, high quality evidence about the effects of laparoscopic ablation or destruction of deposits among women with stage III or IV disease. Both case series suggested benefits of improved fertility, quality of life and sexual function and reduced pain. As, however, the series lacked control groups and therefore must be regarded as a very weak form of evidence, neither study can be regarded as conclusive. The sole trial that included women with stage III endometriosis combined both laparoscopic ablation and uterine nerve transection. This study found that combined laparoscopic intervention led to a reduction in pain. We found limited evidence from single-centre case series to suggest that, in general, gynaecological laparoscopy is associated with few complications.