The future of diagnostic laparoscopy – Cons

Abstract

Endometriosis has a large impact on the lives of patients, affecting nearly 90% of women with chronic pelvic pain and infertility. Unfortunately, diagnosis for this condition is often delayed by an average of 7 years, with adolescent patients experiencing disproportionate delays, which can lead to disease progression. This is in part due to the use of an invasive procedure for primary diagnosis and limited access to subspecialty care. While laparoscopy serves an important purpose in the diagnosis and management of endometriosis, it has been found to be less cost effective than empiric medical therapy and puts an emphasis on the lesion as opposed to the patient and the disease process as a whole. As studies emerge, we gain a deeper understanding of the complex nature of this disease. Laparoscopy has been shown to have variable results, with high recurrence rates and varying improvement in symptoms over time. Additionally, studies have shown poor correlation between patient’s pain and the stage and location of lesions, with laparoscopy showing greater benefit for later stage disease and deep infiltrating endometriosis. This article seeks to evaluate the current standards for the management of endometriosis, discuss the place for diagnostic laparoscopy, and review future directions and alternatives.

Molecular Imaging in Gynecology: Beyond Cancer

“…Molecular imaging could also play a key role in surgeries for endometriosis. Indeed, intraoperative imaging tools capable of visualizing endometriosis lesions could reduce operator bias during both laparoscopic diagnoses and surgical resections ( 19 ). Along these lines, a 2021 study by Al-Taher et al.…”

“…The data demonstrated that [ 18 F]FES PET/CT fully agreed with histology and showed greater accuracy than MRI for lesions: PET/CT correctly identified 9 of 9 lesions, whereas MRI produced 3 false negatives and 3 false positives(3).Molecular imaging could also play a key role in surgeries for endometriosis. Indeed, intraoperative imaging tools capable of visualizing endometriosis lesions could reduce operator bias during both laparoscopic diagnoses and surgical resections(19). Along these lines, a 2021 study by Al-Taher et al compared intraoperative near-infrared fluorescence imaging with indocyanine green and conventional whitelight laparoscopy for the delineation of endometriosis lesions in a cohort of 15 patients (20).…”

Surgical Frontiers: A Comparative Review of Robotics Versus Laparoscopy in Gynecological Interventions

“…The procedure enables the identification of abnormalities and provides a means to determine the underlying causes of symptoms such as pelvic pain or infertility. As an alternative to traditional exploratory surgery, diagnostic laparoscopy minimizes invasiveness, accelerates recovery, and plays a pivotal role in the early and precise diagnosis of various gynecological conditions [ 4 ].…”