Figure 2.

Laparoscopic views of pelvic endometriosis. (a) A raised superficial endometriotic implant on bowel serosa [visceral peritoneum]. (b) Deep-infiltrating endometriosis. A laparoscopic image sometimes described as “frozen pelvis” because of extensive endometriosis and diffuse tissue remodeling causing dense adhesions between the ovary, bowel (rectum), and the uterine peritoneum. White vesicular endometriotic lesions are visible in the delineated area that represents the upper tip of diffuse adhesions caused by endometriosis. A challenging dissection into this plane will eventually take the surgeon into the previously existing rectovaginal (RV) space now harboring a nodule composed of endometriotic tissue and surrounding fibrosis and allow the removal of this RV nodule [see Fig. 4b]. (c) Enlarged left ovary because of a large endometrioma buried in the normal tissue [see (d) and Fig. 4c]. (d) Dissection into the overly stretched normal white-tan ovarian cortical tissue. The fibrotic endometrioma cyst wall is grasped by a forceps. The suction apparatus was inserted into the cyst lumen to remove the thick chocolaty fluid composed of blood products. The surgeon will develop a plane between the normal ovarian tissue and cyst wall in an attempt to remove the cyst in its entirety.