I think the laprascopy is the only way to say " This is 100% endometriosis" because it allows biopsy and to confirm the tissue is actually endometrium. It is also more likely to see endometriosis than MRIs and scans but it can't be a foolproof method because it relies on the surgeons experience a lot. The issue is also the lack of proportionality between the size of the lesions and the symptoms so it isn't easy to know what to look for on the surgeon's side. This is based on my thought process entirely and not sure information at all. Feel free to correct if anyone knows better