Near Contact Laparoscopy

Near-contact laparoscopy is a method of examining the pelvis with the camera held very close to the tissue. The close view magnifies the image and makes it sharper than a view from across the pelvis. Gynecologic surgeon Dr. David Redwine introduced the technique and the name near-contact laparoscopy to detect subtle endometriosis. Those lesions can be early, clear, or unusually colored. They are easy to miss when the camera stays at a distance.¹ Published descriptions of the close-approach view date from the 1980s.² A distant view shows the layout of the pelvis well. It does not always show the fine detail needed to assess a small area of tissue.

Many lesions resemble normal peritoneum, the lining of the pelvis, from a distance. Up close, they do not. Color, texture, blood vessels, and surface irregularities all appear more clearly. This difference affects care. Endometriosis that is staged or treated from a poor view will be underestimated and undertreated. It is also more likely to recur. NaProTechnology and IIRRM-trained surgeons use the close view as part of a systematic examination of the whole pelvis, so that less disease is missed.

Near-contact laparoscopy is not an operation in itself. It is a method of viewing, used during diagnostic and operative laparoscopy. It works best with a defined mapping plan such as S-MAP. Mapping ensures that every area of the pelvis receives a close examination before the surgeon removes any tissue. Together, mapping and the close view address a real problem in endometriosis surgery. The lesions that cause the most lasting pain and the most harm to fertility are often the hardest to see.

Excision of every lesion the close view finds is the appropriate response. Ablation, which burns only the surface of a precisely located lesion, discards that advantage. Complete removal, with the close view used to check the margins, is consistent with the evidence favoring excision over ablation.