Endometriosis: features at transvaginal laparoscopy

Introduction As mentioned in previous chapters of this atlas, the workspace and environment offered by transvaginal hydrolaparoscopy are significantly different from the workspace and working conditions every gynecologist is used to when performing a conventional or standard laparoscopy. First of all, the workspace of transvaginal laparoscopy (TVL) is quite small, meaning that all the organs and tissues, hence all pathologies and lesions, are visualized from a physical distance (i.e. between lens and target) of some millimeters to a couple of centimeters at the most. The images that are obtained in this way can be defined as detailed close-ups that are quite different from the panoramic overview offered by standard laparoscopy. A second difference is the reversed anatomy and topography, not from top to bottom, but exactly the opposite so to speak. The combination of the limited workspace and the reversed approach makes a systematic evaluation of all anatomical regions of the female pelvis very important (Table 8.1). If this systematized way of exploring the pelvis is neglected, then significant lesions of endometriosis may be missed. On the other hand, and