Editing Endometriosis (section)

===Laparoscopy===
[[File:Endometrioma.jpg|thumb|[[Transvaginal ultrasonography]] showing a 67 x 40 mm [[endometrioma]] as distinguished from other types of [[ovarian cyst]]s by a somewhat grainy and not completely [[anechoic]] content]]
Laparoscopy, a surgical procedure where a camera is used to look inside the abdominal cavity, is the only way to accurately diagnose the extent and severity of pelvic/abdominal endometriosis.<ref name="Imaging">{{cite journal | vauthors = Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML | title = Imaging modalities for the non-invasive diagnosis of endometriosis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD009591 | date = February 2016 | issue = 2 | pmid = 26919512 | doi = 10.1002/14651858.cd009591.pub2 | pmc = 7100540 }}</ref> Laparoscopy is not an applicable test for extrapelvic sites such as umbilicus, hernia sacs, abdominal wall, lung, or kidneys.<ref name="Imaging"/>

Reviews in 2019 and 2020 concluded that 1) with advances in imaging, endometriosis diagnosis should no longer be considered synonymous with immediate laparoscopy for diagnosis, and 2) endometriosis should be classified as a syndrome that requires confirmation of visible lesions seen at laparoscopy in addition to characteristic symptoms.<ref>{{cite journal |vauthors=Chapron C, Marcellin L, Borghese B, Santulli P |title=Rethinking mechanisms, diagnosis and management of endometriosis |journal=Nat Rev Endocrinol |volume=15 |issue=11 |pages=666–682 |date=November 2019 |pmid=31488888 |doi=10.1038/s41574-019-0245-z |s2cid=201838966 }}</ref><ref>{{cite web |url=https://blogs.bmj.com/bmj/2020/08/11/reclassifying-endometriosis-as-a-syndrome-would-benefit-patient-care/ |title=Reclassifying endometriosis as a syndrome would benefit patient care - The BMJ |date=11 August 2020 |access-date=17 August 2020 |archive-date=13 August 2020 |archive-url=https://web.archive.org/web/20200813021150/https://blogs.bmj.com/bmj/2020/08/11/reclassifying-endometriosis-as-a-syndrome-would-benefit-patient-care/ |url-status=live }}</ref>

Laparoscopy permits lesion visualization unless the lesion is visible externally (e.g., an endometriotic nodule in the vagina) or is extra-abdominal.<ref name="Imaging" /> If the growths (lesions) are not visible, a biopsy must be taken to determine the diagnosis.<ref name="John2013"/> Surgery for diagnoses also allows for surgical treatment of endometriosis at the same time.

During a laparoscopic procedure, lesions can appear dark blue, powder-burn black, red, white, yellow, brown, or non-pigmented. Lesions vary in size.<ref name="pmid20436318"/> Some within the pelvic walls may not be visible, as the normal-appearing peritoneum of infertile women reveals endometriosis on biopsy in 6–13% of cases.<ref>{{cite journal | vauthors = Nisolle M, Paindaveine B, Bourdon A, Berlière M, Casanas-Roux F, Donnez J | title = Histologic study of peritoneal endometriosis in infertile women | journal = Fertility and Sterility | volume = 53 | issue = 6 | pages = 984–8 | date = June 1990 | pmid = 2351237 | doi = 10.1016/s0015-0282(16)53571-7 | doi-access = free | title-link = doi }}</ref> Early endometriosis typically occurs on the surfaces of organs in the pelvic and intra-abdominal areas.<ref name="pmid20436318">{{cite journal |vauthors=Hsu AL, Khachikyan I, Stratton P |title=Invasive and noninvasive methods for the diagnosis of endometriosis |journal=Clin Obstet Gynecol |volume=53 |issue=2 |pages=413–9 |date=June 2010 |pmid=20436318 |pmc=2880548 |doi=10.1097/GRF.0b013e3181db7ce8 }}</ref> Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules. Larger lesions may be seen within the ovaries as [[endometrioma]]s or "chocolate cysts"; "chocolate" because they contain a thick brownish fluid, mostly old blood.<ref name="pmid20436318"/>

Frequently, during diagnostic laparoscopy, no lesions are found in individuals with chronic pelvic pain, a symptom common to other disorders including [[adenomyosis]], pelvic adhesions, pelvic inflammatory disease, [[congenital anomalies]] of the [[reproductive tract]], and ovarian or tubal masses.<ref name="committee">{{cite journal |title=Treatment of pelvic pain associated with endometriosis: a committee opinion |journal=Fertility and Sterility |volume=101 |issue=4 |pages=927–35 |date=April 2014 |pmid=24630080 |doi=10.1016/j.fertnstert.2014.02.012 |author1=Practice Committee of the American Society for Reproductive Medicine |doi-access=free |title-link=doi}}</ref>