Imaging and Surgery in Endometriosis—Recent Advances

Dear Colleagues,

Transvaginal ultrasound and MR imaging are the key diagnostic tools to stage and classify endometriosis lesions before starting individualized surgical treatment. According to the presurgical staging results, the surgical approach technique, duration of surgery, instrumentation, possible multidisciplinarity, and the respective preparation of the patient including detailed informed consent can be determined. Although this optimal comprehensive approach in the hands of skilled and experienced sonographers, radiologists, and surgeons allows for a high-precision excision of endometriosis and represents a huge change compared to the situation some years ago, there are many open questions that require answers. The evaluation of pelvic sidewalls and pelvic nerves and the description of multiple rectal nodules represent the current challenges in transvaginal sonography. Extrapelvic endometriosis lesions of the sigmoid colon, the coecum, the small bowel, the diaphragm, and the inguinal region are still underdiagnosed or even missed during the presurgical examination. Broadly available training concepts and standards for sonographers and radiologists are still missing and require further well-designed concepts. On the other hand, as precision in imaging is increasing, the currently available classification systems require a more detailed process of lesion description. Especially in adenomyosis, a globally accepted wording and classification system is not available. Endometriosis surgery has come a long way. Currently, the surgical approach has started to shift from standard conventional laparoscopy to robotic-assisted surgery (RAS), although clear results showing the perceived benefits of RAS are still missing. Considering the advanced RAS and CLS systems with 3D techniques, higher resolution, and the possibilities of ICG applications in endometriosis surgery, the complication rates should decrease and the results should become more favourable. However, the impact of deep endometriosis surgery on fertility outcomes is still under discussion. In both imaging and surgery fields, AI will play a major role in the near future and the impact of these advancements needs to be the subject of further studies. You are welcome to contribute your research in order to answer some of the raised questions.

Dr. Harald Krentel
Prof. Dr. Rudy Leon De Wilde
Guest Editors

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• robotic-assisted surgery
• MR imaging
• radiomics
• transvaginal ultrasound
• deep endometriosis
• ovarian endometriosis
• fluorescence-guided surgery
• artificial intelligence
• adhesions in endometriosis
• infertility
• classification systems