A Case of Pelvic Peritoneal Damage by Laparoscopy Instruments Revealed Under Scanning Electron Microscope (SEM)

Document Type : Case report


1 Professor, Department of Obstetrics and Gynecology, Endometriosis Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

2 Assistant Professor, Endometriosis Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

3 Gynecologist, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Associate Professor, Department of Obstetrics and Gynecology, Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.

5 Medical student, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.

6 M.Sc. of Biomedical Engineering, Department of Biomaterials, Materials and Biomaterials Research Center, Tehran, Iran.


Introduction: The role of peritoneal membrane in human has been known in transport of fluids and electrolytes, host defense and reduce friction between bowels and other organs for a long time. This serosal layer consists of a single layer of mesothelial cells resting on basement membrane and submesothelial connective tissue with cell populations and structural proteins. In last decades, human pelvic peritoneum has been studied by using scanning electron microscopy in many conditions to diagnose the diseases especially in endometriosis, chronic pelvic pain and etc. In this study, microstructural changes caused by the surgeon due to unintentionally technical problems in tissue dissections is reported. This article presents unintentionally ultrastructural changes on the pelvic peritoneum during laparoscopic surgery by instruments that can lead to errors in diagnosis and understanding of the disease process for pathologist
Case presentation: Two pieces of involved peritoneal tissues with size of 7×7 mm and two pieces of apparently normal peritoneum were evaluated by scanning electron microscopy in a patient with chronic pelvic pain and suspected to endometriosis.
Conclusion: According to inadvertent damage of laparoscopic instruments to evaluate fine tissues such as peritoneum, this very simple but important tip should be noted during laparoscopic peritoneal tissue dissections for diagnostic and ultrastructural investigations.


  1. Young VJ, Brown JK, Saunders PT, Horne AW. The role of the peritoneum in the pathogenesis of endometriosis. Hum Reprod Update 2013; 19(5):558-69.
  2. Nagy JA, Jackman RW. Anatomy and physiology of the peritoneal membrane. Seminars Dialysis 1998; 11(1):49-56.
  3. Buss H, Hollweg HG. Application of scanning electron microscopy to diagnostic pathology. A critical review. Scan Electron Microsc 1980(3):139-53.
  4. Vonnahme FJ. The scanning electron microscope as a diagnostic tool in liver pathology. Scan Electron Microsc 1984(Pt 1):173-82.
  5. Nakamura K. Scanning electron microscopic study on pathogenesis of peritoneal endometriosis. Nihon Sanka Fujinka Gakkai Zasshi 1994; 46(10):1049-55.
  6. Vasquez G, Cornillie F, Brosens IA. Peritoneal endometriosis: scanning electron microscopy and histology of minimal pelvic endometriotic lesions. Fertil Steril 1984; 42(5):696-703.
  7. Hayata T, Matsu T, Kawano Y, Matsui N, Miyakawa I. Scanning electron microscopy of endometriotic lesions in the pelvic peritoneum and the histogenesis of endometriosis. Int J Gynaecol Obstet 1992; 39(4):311-9.
  8. Kashi AM, Tahemanesh K, Chaichian S, Joghataei MT, Moradi F, Tavanger SM, et al. How to prepare biological samples and live tissues for scanning electron microscopy (SEM). Galen Med J 2014; 3(2):63-80.