Enhanced peroperative imaging of endometriosis and peritoneal carcinomatosis

Stijn L. Vlek
In: Vrije Universiteit Amsterdam · 2024 · doi:10.5463/thesis.585 · W4400574516
dissertation OA: gold CC0
🔓 Open OA copy Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This thesis evaluated preoperative MRI, haptic feedback, and enhanced laparoscopic imaging techniques including NBI, 3D, and ICG, alongside a novel TAMIS procedure, to improve endometriosis and carcinomatosis diagnosis and treatment.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This PhD thesis evaluated imaging and surgical approaches to improve diagnosis and staging of endometriosis and peritoneal carcinomatosis from colorectal cancer, combining analysis of prospective databases, systematic reviews, health technology assessment, and prospective trials. It found that MRI-based measures of bowel-wall endometriosis infiltration correlated strongly with histopathology (89% sensitivity, 97% positive predictive value) and that laparoscopic 3D imaging and narrow-band imaging increased sensitivity for detecting peritoneal endometriosis versus white-light laparoscopy, with a pooled sensitivity of 91.2% when combined, while near-infrared imaging with ICG did not improve detection across tested administration phases. A prospective evaluation for peritoneal metastases reported higher sensitivity with NBI (96.0%) than with white light (80.0%), and a health technology assessment suggested potential cost savings for haptic feedback, while for endometriosis rectal surgery the thesis described a transanal minimally invasive approach that appeared safe and feasible in selected cases but not in randomized comparisons. This paper is centrally about endometriosis—enhanced peroperative imaging (MRI, NBI, 3D laparoscopy) and a transanal surgical technique for rectal resection in endometriosis—while also addressing peritoneal carcinomatosis from colorectal cancer.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

This thesis explores new methods to improve the diagnosis and staging of endometriosis and peritoneal carcinomatosis from colorectal cancer. The studies focus on preoperative planning, laparoscopic fluorescence techniques, and a novel surgical procedure for rectal resection in endometriosis patients, aiming to enhance patient outcomes. Preoperative Techniques An existing preoperative technique for measuring the depth of endometriosis infiltration in the bowel wall was re-evaluated. Analysis of a prospective database showed an 89% sensitivity and 97% positive predictive value correlation between MRI and histopathology. This helps in selecting the surgical strategy and patient counseling. Health Technology Assessment A health technology assessment evaluated the potential benefits of haptic feedback in laparoscopic instruments for deep endometriosis. The analysis suggested a potential cost saving of €687 per patient, indicating that haptic feedback could be cost-effective. Enhanced Laparoscopic Imaging Endometriosis lesions are difficult to identify, and recurrence rates are high. A systematic review examined the potential of narrow-band imaging (NBI), autofluorescence imaging (AFI), and 5-ALA fluorescence imaging. All techniques improved sensitivity for detecting peritoneal endometriosis compared to conventional white light laparoscopy. The LITE-study directly compared NBI, near-infrared imaging with ICG, and 3D imaging with conventional white light laparoscopy. 3D imaging showed improved sensitivity of 83.5% compared to 75.8% for white light laparoscopy. Combining 3D imaging and NBI resulted in a sensitivity of 91.2%. A more complete resection of endometriosis might be achieved by combining 3D imaging with NBI, though further studies are needed to evaluate clinical benefits. Detection of Peritoneal Metastases A prospective trial similar to the LITE-study evaluated the best detection technique for peritoneal metastases from colorectal carcinoma. NBI showed a significantly increased sensitivity of 96.0% compared to 80.0% for white light imaging. This suggests NBI could be a safe and effective method for assessing the need for HIPEC treatment and the extent of cytoreduction. Near-Infrared Imaging with ICG Near-infrared imaging with ICG did not show improved sensitivity for detecting endometriosis and peritoneal carcinomatosis. Different phases of ICG administration were evaluated, including the direct post-administration phase and the prolonged phase up to 24 hours after administration, with no significant improvements in detection. Biliary Structure Identification A systematic review and meta-analysis evaluated the visualization of biliary structures using near-infrared imaging with ICG during laparoscopic cholecystectomy. Visualization was 86.5% before dissection of Calot's triangle and 96.5% after, comparable to intraoperative cholangiography but less invasive. Transanal Minimally Invasive Surgery (TAMIS) Transanal total mesorectal excision has gained significant interest over the past decade. For rectal resection in endometriosis, mesorectal excision is not needed, but the anterior approach can be complicated by adhesions in stage IV endometriosis. The TAMIS technique, described here for the first time in international literature for endometriosis, appears safe and feasible. In selected patients, this technique can avoid open surgery and create an anastomosis in difficult low lesions, which would be more challenging with conventional low anterior resection. In summary, this thesis provides valuable insights and improvements in the diagnosis and surgical treatment of endometriosis and peritoneal carcinomatosis, focusing on preoperative planning, enhanced imaging, and new surgical techniques to improve patient outcomes.
Full text 4,444 characters · extracted from oa-html · 2 sections · click to expand

Abstract

This thesis explores new methods to improve the diagnosis and staging of endometriosis and peritoneal carcinomatosis from colorectal cancer. The studies focus on preoperative planning, laparoscopic fluorescence techniques, and a novel surgical procedure for rectal resection in endometriosis patients, aiming to enhance patient outcomes. Preoperative Techniques An existing preoperative technique for measuring the depth of endometriosis infiltration in the bowel wall was re-evaluated. Analysis of a prospective database showed an 89% sensitivity and 97% positive predictive value correlation between MRI and histopathology. This helps in selecting the surgical strategy and patient counseling. Health Technology Assessment A health technology assessment evaluated the potential benefits of haptic feedback in laparoscopic instruments for deep endometriosis. The analysis suggested a potential cost saving of €687 per patient, indicating that haptic feedback could be cost-effective. Enhanced Laparoscopic Imaging Endometriosis lesions are difficult to identify, and recurrence rates are high. A systematic review examined the potential of narrow-band imaging (NBI), autofluorescence imaging (AFI), and 5-ALA fluorescence imaging. All techniques improved sensitivity for detecting peritoneal endometriosis compared to conventional white light laparoscopy. The LITE-study directly compared NBI, near-infrared imaging with ICG, and 3D imaging with conventional white light laparoscopy. 3D imaging showed improved sensitivity of 83.5% compared to 75.8% for white light laparoscopy. Combining 3D imaging and NBI resulted in a sensitivity of 91.2%. A more complete resection of endometriosis might be achieved by combining 3D imaging with NBI, though further studies are needed to evaluate clinical benefits. Detection of Peritoneal Metastases A prospective trial similar to the LITE-study evaluated the best detection technique for peritoneal metastases from colorectal carcinoma. NBI showed a significantly increased sensitivity of 96.0% compared to 80.0% for white light imaging. This suggests NBI could be a safe and effective method for assessing the need for HIPEC treatment and the extent of cytoreduction. Near-Infrared Imaging with ICG Near-infrared imaging with ICG did not show improved sensitivity for detecting endometriosis and peritoneal carcinomatosis. Different phases of ICG administration were evaluated, including the direct post-administration phase and the prolonged phase up to 24 hours after administration, with no significant improvements in detection. Biliary Structure Identification A systematic review and meta-analysis evaluated the visualization of biliary structures using near-infrared imaging with ICG during laparoscopic cholecystectomy. Visualization was 86.5% before dissection of Calot's triangle and 96.5% after, comparable to intraoperative cholangiography but less invasive. Transanal Minimally Invasive Surgery (TAMIS) Transanal total mesorectal excision has gained significant interest over the past decade. For rectal resection in endometriosis, mesorectal excision is not needed, but the anterior approach can be complicated by adhesions in stage IV endometriosis. The TAMIS technique, described here for the first time in international literature for endometriosis, appears safe and feasible. In selected patients, this technique can avoid open surgery and create an anastomosis in difficult low lesions, which would be more challenging with conventional low anterior resection. In summary, this thesis provides valuable insights and improvements in the diagnosis and surgical treatment of endometriosis and peritoneal carcinomatosis, focusing on preoperative planning, enhanced imaging, and new surgical techniques to improve patient outcomes. | Original language | English | |---|---| | Qualification | PhD | | Awarding Institution | - Vrije Universiteit Amsterdam | | Supervisors/Advisors | - Tuynman, J.B., Supervisor, - - Mijatovic, Velimir, Supervisor, - | | Award date | 13 Sept 2024 | | DOIs | | | Publication status | Published - 13 Sept 2024 |

Keywords

- Endometriosis - Peritoneal carcinomatosis - Imaging - MRI - Laparoscopy - Haptic feedback Fingerprint Dive into the research topics of 'Enhanced peroperative imaging of endometriosis and peritoneal carcinomatosis'. Together they form a unique fingerprint.Cite this - APA - Author - BIBTEX - Harvard - Standard - RIS - Vancouver

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-html ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK