S-MAP (Systematic Mapping of the Abdomen and Pelvis)
S-MAP (Systematic Mapping of the Abdomen and Pelvis) is an operative protocol developed within NaProTechnology, first described by Dr. Thomas W. Hilgers, that requires a structured, sequential inspection of all abdominal and pelvic regions before any surgical intervention begins. The term S-MAP was coined by Dr. Naomi Whittaker, who presented a case series applying the protocol at the 53rd AAGL Global Congress on Minimally Invasive Gynecologic Surgery in November 2024. The protocol establishes a reproducible examination sequence: every anatomic region is evaluated before excision, lysis, or reconstruction, so that no area of disease is passed over in the urgency of addressing the most visible pathology first.
The clinical rationale is direct. Surgeons who proceed immediately to obvious disease risk missing concurrent pathology in regions not yet examined. Endometriosis is rarely confined to a single location. Adhesions, diaphragmatic implants, appendiceal involvement, and upper abdominal disease are found at laparoscopy in a proportion of patients with pelvic pain or infertility that would surprise a surgeon who only looks where the patient reports pain. Clinical evidence bears this out. In the case series Dr. Whittaker presented at that congress, systematic mapping combined with near-contact technique identified four occult cancers over three years, three neuroendocrine tumors of the appendix and one well-differentiated papillary mesothelioma, none in the region the patient reported as painful. A systematic pre-intervention map changes what gets found. What gets found changes what gets treated.
S-MAP is performed in combination with near-contact laparoscopy, a technique credited to Dr. Redwine. Close-approach visualization at each anatomic region, following the protocol sequence, allows identification of subtle or atypical lesions that standard-distance inspection would miss. The two techniques are complementary: near-contact provides resolution; S-MAP provides coverage. Together they address the two most common sources of surgical failure in endometriosis surgery: missed lesions and skipped regions.
S-MAP is an operative protocol within the NaProTechnology surgical framework and IIRRM training curriculum. It is applied in the context of diagnostic and operative laparoscopy and is part of the broader philosophy of pelvic excision and repair surgery. Couples seeking surgeons familiar with systematic pelvic mapping can look for providers with NaProTechnology surgical fellowship or IIRRM operative training.
This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.