New Published Study Highlights ABCt™ Technique for Detecting Hidden Peritoneal Endometriosis

A newly published study demonstrates that the Aqua Blue Contrast Technique (ABCt™), may improve the identification of subtle and occult peritoneal endometriosis lesions during laparoscopic excision surgery. This publication is especially meaningful because it represents one of the first independent clinical experiences using ABCt™ .

For us, this is more than a technique — it is the beginning of wider recognition. ABCt™ was developed from our surgical experience to make invisible or easily missed peritoneal disease more visible. Now, seeing other surgeons apply this method and publish their own findings shows that the concept is expanding beyond our center and beginning to gain international acceptance.

The reality is clear: peritoneal endometriosis is often underestimated, and improved visualization may change how surgeons detect, document, and excise disease. ABCt™ is no longer only our experience; it is becoming part of a broader conversation in endometriosis surgery worldwide.

What Is ABCt™?

ABCt™, or Aqua Blue Contrast Technique, is a laparoscopic visualization method that uses diluted methylene blue solution infused into the retroperitoneal space. This creates a blue contrast beneath the peritoneum, helping surgeons better distinguish abnormal peritoneal areas from normal tissue.

The technique is designed to reveal subtle findings such as:

• occult endometriosis lesions
• nonpigmented peritoneal implants
• peritoneal pores and microdefects
• fibrosis and textural abnormalities
• irregular lesion borders
• early or visually hidden disease

Rather than relying only on standard white-light visualization, ABCt™ enhances the contrast between normal and abnormal peritoneal surfaces.

Key Findings From the Published Study

The study analyzed 126 specimens from 14 women undergoing laparoscopic surgery for peritoneal endometriosis. Lesions were evaluated sequentially by a gynecology resident, an experienced surgeon, and then after ABCt™ application.

Among the 126 excised specimens, 78 were histologically confirmed as endometriosis. The study found that ABCt™ improved detection compared with standard visual inspection. 

Before ABCt™:

After ABCt™:

• ABCt™ identified 78 of 78 confirmed lesions within the excised specimen set

Overall, ABCt™ detected 24.4% more lesions than the experienced surgeon and 44.9% more lesions than the resident. 

Why This Publication Matters

This publication highlights an important challenge in endometriosis surgery: many clinically relevant lesions may be difficult to see with standard laparoscopic visualization alone.

If subtle peritoneal lesions are missed, patients may continue to experience symptoms after surgery. This may contribute to persistent pelvic pain, repeat procedures, or incomplete treatment.

ABCt™ was developed to address this problem by improving the surgeon’s ability to identify occult disease and perform more complete excision.

How ABCt™ Works: The Role of Color Spectrum and Contrast

The ABCt™, works by changing the visual background beneath the peritoneal surface. During standard laparoscopy, the peritoneum is often bright, reflective, and influenced by the reddish tones of the underlying retroperitoneal tissue.

ABCt™ addresses this limitation by introducing a diluted methylene blue solution into the retroperitoneal space. This creates a blue contrast behind the peritoneum and separates the peritoneal surface from the underlying tissue. As a result, the whiteness and glare of the peritoneum are reduced, and small abnormalities become more visible.

From a color-spectrum perspective, the technique shifts visualization away from the dominant red-light range, approximately 620–700 nm, toward the blue-light range, approximately 400–490 nm. Blue wavelengths have higher scattering properties and improve surface-level visualization. This makes subtle changes in texture, fibrosis, peritoneal pores, microdefects, and lesion borders easier to distinguish from normal peritoneum.

In simple terms, ABCt™ improves contrast by placing a blue background behind the peritoneal surface. Lesions that were previously hidden by brightness, reflection, or poor color separation may become lighter, more irregular, and more clearly defined. This enhanced contrast helps surgeons identify occult peritoneal endometriosis and perform more precise excision.

From Surgical Innovation to Published Evidence

The publication of this study represents an important step in moving ABCt™ from surgical observation and technique development into peer-reviewed scientific evidence.

The findings support the potential role of ABCt™ as a practical, cost-effective, and accessible tool for improving peritoneal endometriosis detection during laparoscopic surgery. Further studies are needed to evaluate how improved visualization may affect long-term outcomes such as pain relief, fertility, recurrence, and quality of life.

The Message for Patients

For patients, this study reinforces an important point:

Endometriosis is not always obvious. A normal-looking peritoneum does not always mean the absence of disease.

Occult and hidden lesions require experience, careful inspection, and advanced surgical visualization techniques. ABCt™ was developed to help reveal these difficult-to-detect lesions and support more complete excision surgery.

At Seckin Endometriosis Center, innovation in endometriosis surgery is driven by one goal: to improve disease recognition, remove lesions more completely, and advance care for patients who continue to suffer from this complex disease.