Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

Bruce A Lessey, H Lee Higdon, Sara E Miller, Sara Miller, Thomas A Price
Journal of visualized experiments : JoVE · 2012 · doi:10.3791/4313 · PMID:23288271 · PMC3576419 · W2149360913
article OA: closed CC0 ⤵ 17 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

A pilot study demonstrated methylene blue dye uptake on peritoneal surfaces during laparoscopy can reveal subtle endometriosis not visible to the naked eye by identifying loss of peritoneal integrity.

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Abstract

Endometriosis is a common disease affecting 40 to 70% of reproductive-aged women with chronic pelvic pain (CPP) and/or infertility. The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surfaces during laparoscopy (L/S) to detect the loss of peritoneal integrity in patients with pelvic pain and suspected endometriosis. Forty women with CPP and 5 women without pain were evaluated in this pilot study. During L/S, concentrated dye was sprayed onto peritoneal surfaces, then aspirated and rinsed with Lactated Ringers solution. Areas of localized dye uptake were evaluated for the presence of visible endometriotic lesions. Areas of intense peritoneal staining were resected and some fixed in 2.5% buffered gluteraldehyde and examined by scanning (SEM) electron microscopy. Blue dye uptake was more common in women with endometriosis and chronic pelvic pain than controls (85% vs. 40%). Resection of the blue stained areas revealed endometriosis by SEM and loss of peritoneal cell-cell contact compared to normal, non-staining peritoneum. Affected peritoneum was associated with visible endometriotic implants in most but not all patients. Subjective pain relief was reported in 80% of subjects. Based on scanning electron microscopy, we conclude that endometrial cells extend well beyond visible implants of endometriosis and appear to disrupt the underlying mesothelium. Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity, allowing menstrual or ovulatory blood and associated pain factors access to underlying sensory nerves. Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP. This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at L/S and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy.

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Condition tags

endometriosischronic_pelvic_paininfertility

MeSH descriptors

Endometriosis Methylene Blue Pelvic Pain Staining and Labeling Adult Case-Control Studies Chronic Disease Endometriosis Endometriosis Female Humans Laparoscopy Laparoscopy Microscopy, Electron, Scanning Microscopy, Electron, Scanning Pelvic Pain Pelvic Pain Peritoneal Cavity Peritoneal Cavity Staining and Labeling

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References (53)

Cited by (17)

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