Identification of Clear Vesicular Lesions of Atypical Endometriosis: A New Technique

Abstract

Background For patients with chronic pelvic pain, a definitive laparoscopic diagnosis can be made by visual inspection and identification of endometriosis or by obtaining biopsies of tissue that reveal endometriosis. It has been shown that there is no clinical correlation between the amount of pelvic pain and the extent of endometriosis identified upon laparoscopic inspection of the pelvis. Atypical (clear, grainy, red, flame) lesions of endometriosis have been shown to be more common than the “classic” dark blue/black lesions in the adolescent population with pelvic pain. Clear lesions of endometriosis can be difficult to identify due to the vesicular nature of the lesions and the subtle appearance of these “grainy” lesions. At times the lesions may not be appreciated due to light reflection from the laparoscope. Methods In order to improve the ability to identify clear vesicles of endometriosis irrigation fluid (lactated ringers or nonnal saline) is introduced into the pelvis and the laparoscope is then submerged so that the optical distention media is now liquid as opposed to carbon dioxide. The magnification focal length of the laparoscope is then adjusted for the new refractory index. Clear vesicles of endometriosis that are viewed through the liquid distention media can be appreciated in three dimension and thus increase ease of identification. The once difficult to appreciate “grainy” and clear lesions are no longer falsely identified as “light reflection” and can be clearly identified as either vesicles or “ballooning” of transparent tissue arising from the peritoneum. These areas can then be biopsied to confinn the diagnosis, resected, or laser vaporized. Results Improved visualization of clear lesions of atypical endometriosis can be facilitated with the use of the three dimensional effects of liquid introduced into the pelvis. Laparoscopic pictures are presented to show the view with and without the liquid to demonstrate the improved visualization and identification of the atypical endometriosis. Conclusions The presented method for assistance in identifying subtle lesions of endometriosis will hopefully aid in the establishment of the definitive treatable diagnosis for adolescents with chronic pelvic pain, and decrease the number of cases of unrecognized atypical endometriosis. For patients with chronic pelvic pain, a definitive laparoscopic diagnosis can be made by visual inspection and identification of endometriosis or by obtaining biopsies of tissue that reveal endometriosis. It has been shown that there is no clinical correlation between the amount of pelvic pain and the extent of endometriosis identified upon laparoscopic inspection of the pelvis. Atypical (clear, grainy, red, flame) lesions of endometriosis have been shown to be more common than the “classic” dark blue/black lesions in the adolescent population with pelvic pain. Clear lesions of endometriosis can be difficult to identify due to the vesicular nature of the lesions and the subtle appearance of these “grainy” lesions. At times the lesions may not be appreciated due to light reflection from the laparoscope. In order to improve the ability to identify clear vesicles of endometriosis irrigation fluid (lactated ringers or nonnal saline) is introduced into the pelvis and the laparoscope is then submerged so that the optical distention media is now liquid as opposed to carbon dioxide. The magnification focal length of the laparoscope is then adjusted for the new refractory index. Clear vesicles of endometriosis that are viewed through the liquid distention media can be appreciated in three dimension and thus increase ease of identification. The once difficult to appreciate “grainy” and clear lesions are no longer falsely identified as “light reflection” and can be clearly identified as either vesicles or “ballooning” of transparent tissue arising from the peritoneum. These areas can then be biopsied to confinn the diagnosis, resected, or laser vaporized. Improved visualization of clear lesions of atypical endometriosis can be facilitated with the use of the three dimensional effects of liquid introduced into the pelvis. Laparoscopic pictures are presented to show the view with and without the liquid to demonstrate the improved visualization and identification of the atypical endometriosis. The presented method for assistance in identifying subtle lesions of endometriosis will hopefully aid in the establishment of the definitive treatable diagnosis for adolescents with chronic pelvic pain, and decrease the number of cases of unrecognized atypical endometriosis.