Correlation of laparoscopic identification Correlation of laparoscopic identification and subsequent histological confirmation of endometriotic lesions J.T. Wright. Woking Nuffield Hospital. In the United Kingdom the majority of diagnostic laparoscopies for pelvic pain will be undertaken by physicians in training and are usually poor. If endometriosis is diagnosed at all it will be so on the basis of dark powder burn lesions, more subtle lesions such as white scarring or sago grains being missed.
Biopsy confirmation is rare.
In patients who have had previous laparoscopic fulgaration or laser ablation carbon deposition makes the diagnosis more difficult. Such patients will often have had infiltrating or nodular lesions inadequately treated and thus be symptomatic but with no clear surface lesions, obscuring the correct diagnosis even further. A policy of excision biopsy with lesion mapping, the data being entered onto a palm top computer immediately after the operation, together with the reports of the subsequent histological examination, allows for accurate assessment of the presence, extent and histological grading of endometriotic lesions. Allowing for heat artefact following laser or diathermy excision it is possible to assess the false positive rate for individual surgeons. At follow up relief in terms of areas of pelvic tenderness associated with possible areas of inadequate excision can be assessed and further surgical intervention planned on the basis of clearly mapped and identified areas of disease.