The microcirculation in gynaecological disease

The microcirculation consists of the smallest blood vessels in the human body. These small blood vessels are essential for proper organ functioning and in processes such as wound healing and the development of cancer. The microcirculation can be visualized with handheld vital microscopes, allowing assessment of microcirculatory function and whether certain diseases or therapies affect this function. This thesis describes literature reviews and translational studies of different aspects of the microcirculation in patients with benign and malignant gynaecological diseases. We demonstrated that incident dark field (IDF) imaging is a suitable method to assess the microcirculation in these patients. The first part consists of four chapters that focus on the vaginal microcirculation, in the context of pelvic organ prolapse and vaginal surgery, vulvovaginal atrophy and estrogen therapy. The second part of this thesis consists of three chapters that focus on the peritoneal microcirculation and its role in peritoneal carcinomatosis of epithelial ovarian cancer. We showed that in addition to the more common sublingual microcirculatory assessment, IDF imaging of the microcirculation can also be used for a myriad of purposes in gynaecology: assessment of vascular damage after vaginal surgery, assessment of angioarchitecture to measure the effect of estrogens, focal depth to measure epithelial thickness and to improve understanding of metastatic disease.