Deep Infiltrating Endometriosis: Current and Future Treatments
Deep infiltrating endometriosis: symptoms, causes, diagnosis and treatment. Medical therapy, ICG-guided surgery, stenting, pathology, and future outlook.
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Read moreImaging for Surgery
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Pre- and intraoperative imaging to map disease and guide precise excision—ultrasound, MRI, and fluorescence guidance—enhancing surgical planning, protecting vital structures, and lowering recurrence in deep and complex endometriosis.
Overview
Imaging for surgery focuses on mapping endometriosis before and during an operation so the team can plan precise, organ‑sparing treatment. High‑resolution, expert transvaginal or transrectal scans characterize deep nodules, tethering, and the “sliding sign,” while MRI outlines multi‑compartment disease and nearby structures, including bowel, bladder, ureters, and nerves. This planning helps select the right approach, assemble colorectal or urology support when needed, anticipate adhesions, and protect fertility and function. It differs from diagnostic imaging by prioritizing operative decisions and risk reduction rather than simply confirming disease. See Ultrasound and MRI for detection details.
In the operating room, near‑infrared fluorescence with indocyanine green can clarify ureter location and confirm blood flow after bowel or ureter resections, lowering complications like leaks or ischemia. When imaging and surgical strategy align, complete Excision Surgery becomes more feasible, recurrence risk falls, and recovery is safer. Guidance here also clarifies who benefits most—especially those with suspected Deep Infiltrating Endometriosis—and how results influence single versus staged Laparoscopy and specialist involvement.
Which test is best before excision—ultrasound or MRI?
Expert transvaginal/transrectal ultrasound excels at detecting deep lesions, assessing organ mobility, and predicting pouch of Douglas obliteration. MRI complements ultrasound by mapping multi‑compartment disease and relationships to bowel, bladder, and ureters; many centers use both for complex or deep disease. See Ultrasound and MRI for what each modality shows.
Can imaging predict if I’ll need bowel, bladder, or ureter surgery?
Yes. Detailed ultrasound and MRI can estimate depth and circumference of bowel involvement, ureteral deviation or narrowing, and bladder wall invasion, which helps schedule colorectal or urology support and plan conservative versus segmental resections. Final decisions are confirmed in surgery, but good mapping reduces surprises and unplanned ostomies.
What is fluorescence‑guided surgery and does it help find endometriosis?
Fluorescence uses indocyanine green and near‑infrared light to highlight blood flow, helping verify perfusion of bowel or ureter reconstructions and identify critical structures like ureters. It is not a reliable dye to “light up” endometriosis itself, but it can lower complications by guiding safe, well‑vascularized resections. Reactions are rare; disclose iodine/iodide sensitivity and liver disease to your team.
Can imaging be negative and still help my surgery?
Yes. Small, superficial peritoneal lesions may be missed, but imaging still clarifies deep disease, endometriomas, adhesions, and organ involvement to optimize team planning and consent. Surgical expertise remains key when imaging is limited or discordant with symptoms.
How close to surgery should imaging be done, and by whom?
Most surgeons prefer imaging within 3–6 months of the operation, or sooner if symptoms change, so anatomy reflects current disease. Choose a radiologist or sonographer with endometriosis expertise and ensure images and reports are shared directly with your Excision Surgery and Laparoscopy team.
Reducing Your Risk of Endometriosis Recurrence
Learn why endometriosis recurs—incomplete excision, hormonal, immune, toxin and molecular factors—and how precise robotic surgery and 3D optics can reduce risk.
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