Laparoscopic Excision of Pericardial and Diaphragmatic Endometriosis

Abstract

Study Objective To present a five-step approach to the excision of pericardial and diaphragmatic endometriosis by laparoscopy. Design Surgical video. Setting Academic tertiary care hospital. Patients or Participants 35-year-old nulliparous woman followed for chronic pelvic pain and infertility with a diagnosis of diaphragmatic endometriosis at a prior laparoscopy. Symptoms included severe chest and right shoulder tip pain, refractory to multiple medical therapies. Interventions Excision of pericardial and diaphragmatic endometriosis by laparoscopy. Measurements and Main Results This videos presents the relevant anatomy, the literature surrounding pericardial and diaphragmatic endometriosis, and the approach to the surgical intervention. The laparoscopic excision of the full-thickness pericardial and diaphragmatic endometriotic lesions was successfully completed following five reproducible steps: (1) upper abdominal survey; (2) liver mobilization; (3) excision of diaphragmatic endometriosis; (4) intra-thoracic laparoscopic exploration; and (5) closure of the diaphragmatic defect. Conclusion While rare and challenging to diagnose and treat, pericardial and diaphragmatic endometriosis and its potentially debilitating symptomatology can be successfully managed through a multidisciplinary and step-wise surgical intervention.