Diaphragmatic Endometriosis: Multidisciplinary Treatment

Abstract

Study ObjectiveTo demonstrate a safe laparoscopic procedure for diaphragmatic infiltrative endometriosis. DesignVideo case SettingTeaching hospital (Canadian Task Force classification III). PatientsOne patient presenting deep and severe diaphragmatic endometriosis. InterventionLaparoscopic cure of diaphragmatic endometriosis. Measurements and Main ResultsThroughout this video, which was approved by the institutional board review, we demonstrate safe and complete surgical treatment of a patient suffering severe pelvic and diaphragmatic endometriosis. The patient complained of menstrual dyspnea and shoulder pain persisting despite hormonal treatment, associated with persistent dyspareunia and pelvic pain despite a previous laparoscopic surgery. Patient positioning and anesthesia were adapted to the special requirements of the surgical technique and the expected risks. The operation consisted of the exposure of the right diaphragm by mobilization of the liver, CO2 laser vaporization of left and right diaphragmatic lesions, nerve-sparing excision of infiltrating nodules, and pleural exploration. Finally, we performed an excision of pelvic endometriosis. Participation of 3 surgical teams to this procedure allowed a safe and complete laparoscopic treatment with resolution of pain symptoms at a 1- and 3-month follow-up. ConclusionLaparoscopic treatment allows a safe and complete treatment of diaphragmatic endometriosis.