Our findings suggest that fluorescence diagnosis using 5-aminolevulinic acid is feasible and can improve the diagnosis of endometriosis in nonpigmented and occult endometrial lesions. Fluorescence diagnosis is a promising new tool in the diagnosis of endometriosis.

Elevated IL-6 levels subsequent to AH may reflect significantly greater tissue damage in these patients than in patients who undergo VH or LAVH. LAVH should therefore be considered in cases that cannot be managed by the vaginal route alone.

The chorioallantoic membrane (CAM) is a useful model for the fluorescence diagnosis of experimentally induced endometriosis. In our experimental setup 75.7% of the histologically examined tissue preparations were viable and only 24.3% showed signs of necrosis on the CAM after various periods of incubation. Best results were obtained when grafting to the CAM was performed between days 7 and 9 and when implants were left on the CAM for 3-5 days (P < 0.05). We were able to demonstrate that 5-aminolaevulinic acid (ALA) is stored selectively in ectopic endometrium. The subsequent fluorescence of the endometrium shows a rapid increase that reaches a peak after 10-14 h which can be clearly differentiated from the weaker fluorescence of grafted normal peritoneum and fimbriae (P < 0.01).

According to the transplantation theory, endometriosis develops from endometrial fragments that are retrogradely menstruated into the peritoneal cavity. In order to develop into endometriotic lesions, they have to connect to the vascular system by angiogenesis, probably involving matrix metalloproteinases (MMP) as key enzymes in extracellular matrix remodelling. A model of endometriosis using the chorioallantoic membrane (CAM) of chick embryos was established. Eutopic endometrium from healthy women was transferred to the CAM and cultivated ectopically for up to 3 days. Before transplantation and after 24, 48 and 72 h of culture on the CAM, total RNA was extracted and reverse transcribed. Human MMP-1 (interstitial collagenase) and MMP-2 (gelatinase A) mRNA expression was assessed by competitive PCR. Results were normalized to the content of human glyceraldehyde 3-phosphate dehydrogenase (GAPDH) mRNA. In eutopic endometrium, 0.29 amol MMP-1 mRNA and 0.42 fmol MMP-2 mRNA per fmol GAPDH mRNA were found. Relative MMP-1 mRNA concentrations increased strongly after culture on the CAM, while MMP-2 mRNA levels were nearly unaltered. This differential regulation suggests different roles of these enzymes in the angiogenesis of ectopic endometrial fragments and during the development of endometriosis.

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It appears that laparoscopic adhesiolysis is an effective therapeutic measure to relieve chronic pelvic pain. Therefore, adhesiolysis should be performed in all patients with chronic or intermittent pain, and a complete lysis of adhesions should be planned. However, since pelvic pain may have organic or functional causes other than adhesions, complete adhesiolysis in patients with persistent pelvic pain may be of only limited importance.

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