Patients of a Minimally Invasive Gynecological Surgery practice who underwent laparoscopic surgery for symptoms of pelvic pain between 2018 and 2023. Participants were chosen based on intraoperative findings of lesions with an atypical appearance, which were later confirmed endometriosis on pathology.

These dense adhesions are commonly associated with advanced endometriosis. They can be treated with laparoscopy techniques, but are more likely to reform after surgery.

At laparoscopy, the goal was to remove all visible implants that might be endometriosis. All lesions suspicious for endometriosis were excised by using a contact neodymium:yttrium-aluminum-garnet laser (Surgical Laser Technologies, The Oaks, PA) after careful, systematic inspection of the peritoneal surfaces throughout the pelvis and the abdomen.

The typical appearance of endometriosis is described as a superficial, so-called powder-burn or gunshot lesion that is black, dark-brown, or blue; but subtle lesions that are red or clear, small cysts with hemorrhage or white areas of fibrosis may also be endometriosis (1).

Our study objective was to describe the appearance, stage, and treatment of endometriosis in adolescents undergoing laparoscopic treatment of severe dysmenorrhea and endometriosis.