What is the role of laparoscopy in the workup of endometriosis?

Updated: May 10, 2021
  • Author: G Willy Davila, MD; Chief Editor: Michel E Rivlin, MD  more...
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Answer

Laparoscopy is considered the primary diagnostic modality for endometriosis. This is an invasive procedure with an overall sensitivity of 97% and a specificity of only 77%.

Endometriosis has been described as protean in appearance. The classic lesions are blue-black or have a powder-burned appearance (see the first 2 images). However, the lesions can be red, white, or nonpigmented. Peritoneal defects and adhesions are also indicative (see the second 2 images). Bear in mind that microscopic evidence of endometriosis may be found in normal-appearing peritoneum.

Powder-burn lesions of endometriosis. Powder-burn lesions of endometriosis.
Active endometriosis with red and powder-burn lesi Active endometriosis with red and powder-burn lesions and adhesions from old scarring.
Peritoneal erosions and adhesions in the posterior Peritoneal erosions and adhesions in the posterior cul-de-sac. These are typical of more severe endometriosis.
Adhesions due to endometriosis. Adhesions due to endometriosis.

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