The camera systems, monitors, operative techniques, and skills developed with minimally invasive surgery provide tissue images and magnification with exceptional clarity. The abdomen and individual organs can be examined in situ with ease, without disturbing the anatomic features or the pathologic condition before treatment. In addition, video images can be used intra- and postoperatively to re-evaluate the pathologic condition and operative technique and for teaching purposes. They provide the surgeon with excellent quality real-time video, assessing cavities and areas of the human body impossible to observe with the naked eye. The easy access to tissue images facilitates, encourage, and accelerate the application of bioinformatics using different algorithms, which are correlated with the histopathological findings [1,10].

Dual-working channel endoscopes can enable an image-guided punch biopsy by using OCT. Matched OCT images obtained in vivo corresponding to histological biopsies can improve the accuracy and reliability of the technique [21]. An improvement in image resolution and the development of more specific imaging technology, such as polarization sensitive OCT, may also improve the accuracy of detecting buried pathologic features [21]. However, dual-working channel endoscopes increase the tip diameter of the scope, which is a big disadvantage when small cavities are observed, as in hysteroscopy. OCT is frequently used in ophthalmology and can provide information about cell architecture and morphology up to 15 nano microns below epithelial cells [14].

Tissue visual signs, image texture analysis, and selected features by electronic neural network systems can serve as biomarkers distinguishing abnormal from normal tissue. Precancerous as well as cancerous conditions are characterized as images with a complex set of attributes. Colour, texture, and relative geometry are predominately useful, while region shape is significantly less so. Regions are frequently amorphous, or, for a few region classes, exhibit a shape which may be only approximately modelled, and even in these cases, the model may be image dependent. The overall region of interest in the images may in general correlate with the histopathologic cancerous characteristics, such as abnormal tissue architecture, neo-angiogenesis, oedema, and cellular dysfunction. Images from a histopathologic section produced by microscopy may be interpreted by visual signs and tissue image features by computer-assisted diagnosis [22]. Such translation from microscopy tissue section characteristics to tissue image textures demand an allocation of data and computer system training [23]. CAD may have the potential to diagnose early disease, including cancer [1]. The loading of data with digital features of normal and abnormal tissue, with both visual and histopathologic characteristics, is essential in building the primary level of bioinformatics. The functionality and efficiency of CAD depends on network capacity, speed of data processing, and technological support [1].

The texture discrimination of capsule endoscopy (CE) video frames can be improved by modelling classical texture descriptors in the colour scale plane instead of the colour plane, as usually assumed by classical approaches [4]. Higher order statistics applied to the joint distribution of classical texture descriptors appear effective for texture characterization. Future work will include introducing different classification schemes [4]; augmenting the database, which is important in generalizing the results, especially when higher order statistics’ modelling is involved; exploring the temporal dynamics of texture information, since taking information from neighbour frames may improve classification performance [4].

Optical coherence tomography (OCT) is widely considered a real-time intraoperative tumour margin assessment because of its high-resolution (HR) images, rapid scanning, and optical properties [24]. However, although OCT provides HR images, the combination of OCTSS and spectral domain (SD) is still insufficient to effectively classify different types of internal organs [24]. The main reason is that OCT images are simply composed of the reflectivity of light (elastic scattering property), which can only reflect the texture information instead of molecular information [25]. OCT is a minimally invasive method to evaluate buried glands or other subsurface features and may be used to evaluate the efficacy of other endoscopic therapies, such as cryoablation and photodynamic therapies, not only in the GIT but also in the skin and abdominal cavity [26].

Raman spectrum is aimed at improving the accuracy of tissue margins’ delineation by detecting the margin of tumour surrounded by normal tissues, e.g., muscle. Based on the integrated system, OCT and RS can acquire the measurement with similar experimental conditions [27]. This allows for real-time review and assessment of the margins. Tumour margin detection can be evaluated with different algorithms and tissue types. 3D optical coaxial tomography and Raman spectroscopy were the two additional modalities used in combination with the tissue texture analysis to augment CATIA diagnostic ability. Coaxial tomography seems to provide extra information regarding the tissue cell layers below the superficial layer and can be used as an added tool to the optic system. Raman spectroscopy provides highly specific 3D spectra with intensity and time axes mainly used during microscopy for histopathologic sections.

Although many ENT articles have been published on CAD, research on tissue texture analysis was missing. No studies using CAD for endometriosis were found. The intensity, density, and variety of tissue hue found in cases of pelvic and abdominal endometriosis would facilitate CATIA research in clinical practice. CATIA could probably contribute to the identification and quantification of endometriosis, especially the depth and extent of the disease on one tissue, the epithelium, and could probably assist in surgical treatment and the depth of destruction by laser and other modalities. Prospective and randomized studies are needed before CATIA is implemented in clinical practice.