Endomapping and Surgical Planning

Why pre-surgical mapping matters

Endometriosis frequently extends beyond the reproductive organs. Without accurate mapping, a surgeon may discover bowel, bladder, ureter, sidewall, or diaphragmatic disease only after the operation has begun — often without the multidisciplinary team required to treat it safely. Endomapping is designed to make that outcome less likely by identifying disease locations in advance, so the right specialists are booked and the right techniques are planned.

What Endomapping includes

• Specialized transvaginal ultrasound with bowel preparation, performed and interpreted by an operator experienced with endometriosis.
• MRI with endometriosis-specific protocol (thin slices, dedicated sequences, appropriate contrast use).
• Expert radiology interpretation by a reader who regularly evaluates endometriosis.
• Correlation with symptoms, prior operative reports, and pathology when available.
• A written map of expected disease locations shared with the surgical team.

How mapping shapes the surgical plan

• If bowel involvement is present, a colorectal surgeon is booked and the correct technique (shaving, disc, or segmental resection) is anticipated.
• If ureter or bladder disease is present, urology or urogynecology is booked and ureteral stents or reconstruction may be planned.
• If sidewall or nerve involvement is suspected, nerve-preserving technique or neuropelveology support is planned.
• If diaphragmatic disease is present, upper abdominal access and appropriate positioning are prepared.
• If fertility organs need protection, ovarian-preserving technique is prioritized.

Limitations of imaging

No imaging technique detects all endometriosis. Small superficial lesions may not be visible, and some deep disease can be missed depending on protocol and operator experience. Laparoscopy and pathology remain the reference standard for definitive diagnosis of many lesions. A negative or "normal" scan does not rule out disease — especially if it was not performed with an endometriosis-specific protocol.

Who should have Endomapping

• Patients with suspected deep or complex endometriosis
• Patients with cyclic bowel or urinary symptoms
• Patients with prior failed surgery or persistent pain after surgery
• Patients considering fertility treatment with pelvic symptoms
• Patients preparing for cross-border or specialist surgery who need a clear plan in advance

Bringing outside imaging

If you already have MRI or ultrasound, bring the images (not only the report) on CD/DVD or via portal access. Expert re-read of prior imaging can sometimes identify disease missed on the original report.