Endometriosis, a disease affecting approximately 10% of the female population, requires laparoscopy and histologic  confirmation for diagnosis. Laparoscopic recognition of endometriosis lesions can be extremely challenging even for the experienced surgeon due to the protean appearances of  endometriosis. Visual appearance of what is classically described as pigmented, dark lesions are easily spotted while the non-pigmented, more prevalent white lesions, also known as "subtle" lesions, pose difficulty for recognition. This is due to a wide unrestricted light spectrum, light reflection, and  gas pressure used in laparoscopic surgery. Eliminating these optical illusions, Aqua Blue Contrast Technique (ABCT)®is  a novel  revolutionary method that aids the surgeon's eye to recognize subtle peritoneal abnormalities. Distinct morphological features detected with Aqua Blue Contrast Technique is eventually confirmed as inflammation and endometriosis with pathological samples stained with Hemotoxylin and eosin (HE) and by using immunohistochemical staining of CD-10, for which it is often positive for both, with stromal cells alone more commonly found than glands/stroma.

The ABCT® identifies normal peritoneum and its texture is easily identified. This method assists the surgeon to target the lesion by clear recognition of subtle peritoneal changes in endometriosis. Assisted by enhancing contrast and eliminating the yellow and red spectrums, the surgeon is now more easily able to perform tedious and precisely accurate excision surgery without unnecessary removal of normal peritoneum. Aqua Blue Contrast Technique® not only will improve results for excision surgery, but also opens a future window of understanding and likely will bring a new definition to our aged concepts about endometriosis.