title: Laparoscopic Imaging Techniques in Endometriosis Therapy: A Systematic Review.
abstract: Endometriosis is a common disease associated with pelvic pain and subfertility. Laparoscopic surgical treatment has proven effective in endometriosis, but is hampered by a high rate of recurrence. The aim of this systematic review was to evaluate the intraoperative identification of endometriosis by enhanced laparoscopic imaging techniques, focusing on sensitivity and specificity. A systematic review was conducted according to PRISMA guidelines in PubMed, Embase, Cochrane Library, and Web of Science. Published prospective studies reporting on enhanced laparoscopic imaging techniques during endometriosis surgery were included. General study characteristics and reported outcomes, including sensitivity and specificity, were extracted. Nine studies were eligible for inclusion. Three techniques were described: 5-ALA fluorescence (5-ALA), autofluorescence (AFI), and narrow-band imaging (NBI). The reported sensitivity of 5-ALA and AFI for identifying endometriosis ranged from 91% to 100%, compared with 48% to 69% for conventional white light laparoscopy (WL). A randomized controlled trial comparing NBI + WL with WL alone reported better sensitivity of NBI (100% vs 79%; p < .001). All 9 studies reported an enhanced detection rate of endometriotic lesions with enhanced imaging techniques. Enhanced imaging techniques are a promising additive for laparoscopic detection and treatment of endometriosis. The 5-ALA, AFI, and NBI intraoperative imaging techniques had a better detection rate for peritoneal endometriosis compared with conventional WL laparoscopy. None of the studies reported clinical data regarding outcomes. Future studies should address long-term results, such as quality of life, recurrence, and need for reoperation.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: s.vlek@vumc.nl.
authors.forename: Stijn L
authors.initials: SL
authors.lastname: Vlek
authors.affiliation: Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M C I
authors.initials: MC
authors.lastname: Lier
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ankersmit
authors.affiliation: Medical Library, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes C F
authors.initials: JC
authors.lastname: Ket
authors.affiliation: Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J J M L
authors.initials: JJ
authors.lastname: Dekker
authors.affiliation: Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Mijatovic
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Tuynman
mesh_terms: D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D062048:Narrow Band Imaging; D061848:Optical Imaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: Endometriosis; Fluorescence; Imaging; Laparoscopy