Minimally Invasive Image-Guided Surgery in the Surgical Treatment of Deep Endometriosis

Introduction: Deep endometriosis is a severe form of the disease associated with pain, infertility, and impaired quality of life. Minimally invasive surgery has become the preferred treatment, and advances in image-guidance are transforming intraoperative strategies. The integration of imaging technologies enhances lesion identification, surgical precision, and functional preservation. Objective: This review aims to analyze the role of minimally invasive image-guided surgery in the treatment of deep endometriosis. Secondary objectives include evaluating imaging modalities, discussing clinical outcomes, and exploring limitations and future perspectives. Methods: A narrative review was conducted using PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. Studies published in the last five years addressing minimally invasive surgery and imaging techniques in deep endometriosis were analyzed. Clinical trials, systematic reviews, and observational studies were included. Results and Discussion: Image-guided surgery provides enhanced visualization of deep infiltrating lesions, supporting conservative approaches while maintaining efficacy. Technologies such as intraoperative ultrasound, fluorescence imaging, and MRI integration improve surgical safety and outcomes. Multidisciplinary collaboration is essential to optimize patient management. Conclusion: Minimally invasive image-guided surgery represents a promising advancement in the management of deep endometriosis. The evidence suggests that it improves diagnostic accuracy, facilitates radical excision when required, and preserves organ function. Standardization of protocols and further studies are needed to validate these approaches across diverse clinical settings.