a Novel Surgical Approach for Endometriosis Surgery
Condition: Endometriosis; Laparoscopy
MeSH terms: Endometriosis
Study type: Interventional

Summary: 
      Endometriosis is a chronic disease defined as the existence of endometrium like lesions
      outside of the uterine cavity. The diagnosis is based on examination of lesions under the
      microscope and capturing endometrial gland and stroma. The mostly used surgical technique to
      diagnose and treat endometriosis is laparoscopic surgery. In our novel technique for
      endometriosis surgery, we used methylene blue for its natural blue color to make
      endometriotic lesions more visible and to filter red, yellow and white colors reflecting from
      the peritoneal surface.
    

Detailed description: 
      Endometriosis is a chronic disease defined as existence of endometrium like lesions outside
      of the uterine cavity. The diagnosis is based on examination of lesions under microscope and
      capturing endometrial gland and stroma. The prevalence of endometriosis upon women on their
      reproductive ages, all over the world is at least 10%. This prevalence depends on surgically
      proven lesions that are excised, according to the this the real prevalence is still unknown
      because of underdiagnosis and being unable to capture endometriotic lesions.

      Endometriosis is usually described as having three subtypes, which are peritoneal, ovarian
      endometriomas and deep infiltrative endometriosis (DIE). Peritoneal endometriosis is the most
      undiagnosed type according to lack of diagnostic tests and being unrecognizable on imaging
      modalities while ovarian endometriomas and deep infiltrative endometriosis lesions can be
      realized by ultrasound or MRI imaging. Also, these three subtypes are mostly existing
      together and even with uterine endometriosis which is named as adenomyosis. Considering the
      difficulties of capturing an endometriotic lesion most of the surgeries done for deep
      endometriosis or ovarian endometriomas usually fail upon insufficient excision of the
      disease.

      The main presentations of endometriosis are pain and infertility. Whether it can be thought
      the most devastating anatomical lesion may cause more pain, the pain of endometriosis is
      usually unrelated with the characteristics of pathology or severity of the disease.
      Therefore, a small lesion even not visible to the naked eye may cause more pain than a large
      DIE nodule. This knowledge arises the importance of threating all lesions on a symptomatic
      patient with pain.

      The mostly used surgical technique to diagnose and treat endometriosis is laparoscopic
      surgery. Under laparoscopic scope endometriotic lesions can bee seen in black, red, white
      colors and as flat or polypoid. Human eye can see wave lengths between 400-700 nm. And it is
      not always easy to visualize all pathologies even with the 4 to 40 times magnification of
      usual laparoscopic scopes. Human vision under white-light reflection cannot easily
      discriminate different tissue types. Making color contrasts make objects easy to be catch by
      human eye.

      In our novel technique for endometriosis surgery we used methylene blue for its natural blue
      color to make endometriotic lesions more visible and to filter red, yellow and white colors
      reflecting from peritoneal surface.
    

Intervention name(s): ABC technique
Intervention type(s): Procedure
Intervention description(s): The intraperitoneal use of methylene blue diluted isotonic sodium chloride solution to visualize endometriotic lesions
Intervention model: Single Group Assignment
Intervention model description: patients undergone for laparoscopic surgery for endometriosis had both approaches with either bare eye and with the help of methylene blue contrast agent
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: endometriosis; methylene blue dye