Refining minimally invasive surgery for endometriosis: illumination of various perspectives

Abstract

This thesis illuminates various perspectives towards refining minimally invasive surgery for endometriosis. A critical node was made regarding the development and updating of evidence-based clinical practice guidelines, which are important to create optimal performance. Updating is an onerous process and does not always lead to additional value, especially in the absence of new surgical techniques or technologies. Furthermore, centralisation of complex endometriosis surgery seems to be the key to increase volumes, quality of care and dedication of subspecialists. Finally, the role of Fluorescence Guided Surgery was explored to enhance intra-operative visualization for endometriosis. A non-targeted fluorescent tracer, Indocyanine Green, was investigated, using fibrotic characteristics of colorectal endometriosis nodules. Additionally, potential endometriosis specific biomarkers, to use as a target for targeted fluorescence guided surgery, were identified using transcriptomic analysis and validated using immunohistochemistry.