title: An advanced flexible laparoscope with wide optic angle for observing diaphragmatic lesions associated with catamenial pneumothorax.
abstract: OBJECTIVE
  To explore diaphragmatic lesions that are potentially associated with catamenial pneumothorax by using an advanced flexible laparoscope with wide optic angle.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 30-year-old woman who was scheduled for thoracoscopic surgery because of recurrent right-sided catamenial pneumothorax.
  
  
  METHODS
  The peritoneal surface of the diaphragm was explored with an advanced flexible laparoscope that was equipped with a charge-coupled device on the tip, concurrently with thoracoscopic surgery.
  
  
  METHODS
  Lesions associated with endometriosis on the peritoneal surface of the posterior diaphragm abutting the posterior abdominal wall and liver.
  
  
  RESULTS
  When the flexible laparoscope was inserted via an umbilical trocar and the peritoneal surface of the right-sided diaphragm was explored, guided by illumination from the thoracoscope, scattered specific lattice lesions and fenestrations were identified in the central tendon of the posterior diaphragm, a region that cannot be visualized with the conventional rigid laparoscope.
  
  
  CONCLUSIONS
  By using the flexible laparoscope, endometriotic lesions potentially related to catamenial pneumothorax were identified on the posterior diaphragm.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. kumakiri@med.juntendo.ac.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shimanuki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Keiji
authors.initials: K
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000473:pathology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D020706:Laparoscopes; D011030:Pneumothorax / Q000473:pathology*; D013577:Syndrome; D013906:Thoracoscopy / Q000379:methods*