Hey doc! At a gathering of true endometriosis experts, you would be called a liar if you said peritoneal involvement isn’t common in most cases you see. It’s almost a given—peritoneal endometriosis affects the majority of women with the disease. And yet, dealing with endometriosis over this connective and complex tissue remains one of the most challenging aspects of surgical management. Why? Because peritoneal lesions are often microscopic, invisible on MRI, and easily missed even by experienced surgeons. If endometriosis cells were hitchhikers trying to get around the pelvis, the peritoneum would be their Uber Pool—providing direct access to the ovaries, bladder, bowel, and even the diaphragm. In today’s edition, we break down what makes peritoneal endometriosis so complex, why it spreads so effectively, how to identify it surgically, and the precise dissection techniques needed to manage it. For patients reading this: understanding peritoneal involvement explains why your pain might be widespread, why imaging can miss your disease, and why expert surgical excision is essential for complete treatment. Read more