From Vision to Precision: A Systematic Review of Intraoperative Navigation Techniques in Endometriosis Surgery

To systematically evaluate the clinical evidence on intraoperative navigation techniques in endometriosis surgery.

In accordance with the PRISMA guidelines, a systematic literature search was conducted in the databases PubMed/MEDLINE, Embase, and Scopus covering the period from 2015 to 2025, with the final search performed on September 10th, 2025. In addition, an AI-assisted platform was used as a complementary search tool to identify further relevant literature.

Eligible studies comprised surgical studies in humans reporting intraoperative navigation techniques. Preclinical and cadaveric studies, reports without intraoperative applications, and interventions lacking a navigation component were excluded. Abstracts were excluded unless intraoperative data were extractable. Only English-language publications were included, with no restrictions on study design. Study selection was conducted by two independent reviewers followed by full-text assessment, with discrepancies resolved by consensus.

A standardized template captured design, sample size, navigation modality, technical parameters, approach, workflow integration, and outcomes; quality appraisal used design-specific tools. From 800 records, 54 studies (1,002 patients) met inclusion criteria: 41 intraoperative optical imaging studies (IOI) (976 patients), 12 intraoperative ultrasound studies (IOUS) (24 patients), and 1 augmented/virtual reality (AR/VR) case series (2 patients). IOI mainly supported anatomic orientation, lesion assessment, and perfusion-related decisions; IOUS supported lesion localization and landmark definition; AR/VR supported preoperative 3D planning which was used intraoperatively.

In endometriosis surgery, IOI, particularly indocyanine green-guided surgery, and IOUS currently constitute the predominant reported navigation modalities, supporting real-time anatomical orientation and informed intraoperative decision-making in complex pelvic disease, while AR/VR applications remain at an early stage of clinical translation. Despite the challenging pelvic anatomy and heterogenous disease manifestations that could benefit from intraoperative navigation, current evidence remains limited. Prospective comparative studies are needed to define clinical indications and to determine the added value of these technologies.