Newest scholarly works
Camera trocar lifting in office gasless laparoscopic sterilization under local anesthesia Acta obstetricia et gynecologica Scandinavica · 2010 Systematic review and metaanalysis of intraperitoneal instillation of local anesthetics for reduction of pain after gynecologic laparoscopy Journal of minimally invasive gynecology · 2012 Ultrasound Visceral Slide Assessment to Evaluate for Intra-abdominal Adhesions in Patients Undergoing Abdominal Surgery - A Systematic Review and Meta-analysis Journal of minimally invasive gynecology · 2021
All works
Original research
Systematic Mapping of the Abdomen and Pelvis (S-MAP) IIRRM 2026 · poster A three-axis framework for reproductive impairment IIRRM 2026 · poster The ART Reporting Completeness (ARC) Framework IIRRM 2026 · poster
All original research
Get a free library card
Save papers, follow topics, and connect the library to Claude or ChatGPT.
Sign up free
Commentary
Where Did the Vitamin A Go? What Changed in Cereal, Milk and the American Plate Naomi Whittaker, MD and Pam Schoenfeld, MS, RD, LDN · Oct 20
All 22 guides Plain-language guides to the methods, the conditions, and what the evidence shows.
All commentary
Breaking Up with IVF Free for membersMidwife and former front-line IVF clinician Dr. Jennifer Mercier joins Dr. Naomi Whittaker for a candid Save the Uterus Club conversation. Masterclass in Endometriosis & Surgery 9 sectionsComprehensive guide for patients preparing for endometriosis surgery. Hormones Through the Lifespan Free for membersA comprehensive overview of hormonal health across a woman's life, menstrual cycles, common conditions, and the transition to menopause, presented by Dr. Ana Garcia, OB/GYN.
All 20 courses Endometriosis For clinicians
Member courses and live calls
Join Save the Uterus Club: live calls with Dr. Whittaker, member courses, discussion.
Become a member
Save the Uterus Club
Save the Uterus Club The community and collaboration arm of RRM Academy: live calls, new research, advocacy taking shape. Become a member

Chapter 63: Diagnostic Laparoscopy: "Near Contact" Approach

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 845-854, 2004

RRM Academy Synopsis

Repeat laparoscopy found endometriosis in 41 of 46 first normal exams

A repeat laparoscopy found endometriosis in 41 of 46 cases first called normal. This 2004 textbook chapter describes a close-up, magnified way of looking at the pelvis. The author also gives his own case series of repeat operations.

Key Findings

  • In 46 cases where an earlier laparoscopy had been considered normal, the repeat laparoscopy found endometriosis in 41 (89.1%). The first laparoscopy was performed elsewhere.
  • The repeat laparoscopy identified adhesive disease in 2 cases and normal pelvic anatomy in 3 cases (6.5%). The author performed every repeat procedure.
  • The chapter states that a laparoscope held at a distance from the pelvic tissues will routinely miss significant pathology, and that magnification can improve detection.
  • The chapter states that experience with laparoscopic sterilization in residency is inadequate preparation for diagnostic laparoscopy, because the two skills are quite different.
  • The chapter says a fixed, routine order for viewing the pelvis and nearby bowel significantly reduces the chance of missing important findings.

RRM Context

Endometriosis is diagnosed by looking, and a laparoscopy that skips the close view can return a normal report for a woman who has disease. Pelvic pain or infertility with a normal first report remains undiagnosed. Finding the cause comes before treatment. The chapter sits in the NaProTechnology textbook literature. Excision is the surgical standard once endometriosis is found.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes the "near-contact" approach to diagnostic laparoscopy (NCL), in which the laparoscope is brought closer to the pelvic tissues to magnify them. Hilgers reports 46 cases in which a laparoscopy performed elsewhere had been considered normal; on repeat laparoscopy, endometriosis was found in 41 (89.1%). The technical considerations include a uterine manipulator, elevation of the anterior abdominal wall with Kocher clamps on the anterior rectus fascia for trocar entry, transillumination before suprapubic trocar placement, and a probe with irrigation and suction. The chapter calls for a systematic, routine sequence that evaluates all of the pelvic tissues along with the appendix, cecum, terminal ileum and rectosigmoid colon.

By this author

Related research

Thomas W Hilgers
Tom Hilgers, T Hilgers
Hilgers et al. 2004, Hilgers 2004

Learn

Resources

Tools

Help

Candid Platinum Transparency 2026

RRM Academy is a 501(c)(3) nonprofit providing free and low-cost education in restorative reproductive medicine for patients and healthcare professionals.

This site is an educational resource and does not provide medical advice. Inclusion of a study does not imply endorsement of its findings. Always consult a qualified healthcare provider for diagnosis and treatment.

© 2026 RRM Academy · All Rights Reserved

Restorative Reproductive Medicine Foundation · 3401 Hartzdale Dr, Ste 103B PMB 3518, Camp Hill, PA 17011 · EIN: 93-4594315
Sitemap AI Instructions Developers Terms of Use Medical Disclaimer Privacy Policy