Laparoscopic advanced Imaging Techniques in Endometriosis therapy

RATIONALE: Despite it’s proven efficacy, recurrence rates after endometriosis surgery remain a major challenge and a crucial issue in the long-term management of endometriosis. Insufficient treatment due to the polymorphic appearance of endometriosis lesions is common. Remaining untreated lesions are the supposed origins of recurrences and subsequent unsuccessful treatment. So called non-pigmented ‘red’ lesions are hard to distinguish from normal peritoneal tissue. Previous studies have shown that image enhancement modalities such as narrow-band imaging (NBI), near-infrared fluorescent imaging with indocyanin green (ICG) and three-dimensional laparoscopy (3D) may improve endometriosis detection and therefore may also effect treatment outcomes.
OBJECTIVE: The aim of this pilot trial is to examine which advanced image enhanced modality is the most feasible for the detection of endometriosis lesions, with respect to the sensitivity and specificity of the investigated modalities. This in order to set up a larger scale randomised clinical trial.
STUDY POPULATION: Female patients who are planned to undergo laparoscopic treatment of endometriosis.
INTERVENTION: During laparoscopy selected regions will be inspected and photographed with 3D-imaging, NBI and ICG in a systematically randomized different order. Biopsies of suspected endometriosis lesions are taken. Control biopsies of healthy peritoneum will be taken to compare the healthy and affected tissue. Patients will receive ICG through an infuse during surgery.

The use of advanced imaging techniques will result in increased sensitivity of detecting peritoneal endometriosis

Only intra-operative intervention, no follow-up

Intra-operative identification of peritoneal with the following imaging techniques:

- Narrow-band Imaging (NBI)

- Three-dimensional imaging (3D)

- Near-infrared imaging with Indocyanin Green (ICG)
Biopsies of endometriosis lesions and healthy peritoneum will be taken.