Endometriosis of the diaphragm: four cases treated with a combination of laparoscopy and thoracoscopy.
OBJECTIVE
We aim to describe the clinical characteristics and the principles of combined laparoscopic and thoracoscopic management of women with diaphragmatic endometriosis at our institution.


METHODS
Case series (Canadian Task Force Classification II2).


METHODS
Tertiary care referral center.


METHODS
Four women with diaphragmatic endometriosis.


METHODS
Laparoscopy and thoracoscopy.


METHODS
We retrospectively reviewed the charts of 4 consecutive women with diaphragmatic endometriosis who underwent laparoscopy and thoracoscopy from June 2008 through September 2008.


RESULTS
Four patients underwent a combination of laparoscopy for treatment of abdominopelvic endometriosis and thoracoscopy for treatment of diaphragmatic endometriosis. All patients had a history of chest pain. Three had a history of pelvic pain. Two had a history of catamenial hemothorax or pneumothorax. Two had been previously diagnosed with endometriosis, and three had a history of hormonal pharmacotherapy. All underwent laparoscopy and thoracoscopy without complications. All had uneventful recoveries. At nine-month follow-up, all patients were free of chest pain, and one patient had recurring pelvic pain.


CONCLUSIONS
To the best of our knowledge, this constitutes the only reported series of patients with endometriosis who underwent a procedure systematically combining both laparoscopy and thoracoscopy for treatment of abdominopelvic and thoracic disease. It confirms that combined laparoscopic and thoracoscopic diagnosis and management of diaphragmatic endometriosis is reasonable. The inferior aspect of the diaphragm should be evaluated in all patients undergoing laparoscopy for endometriosis. Concomitant thoracoscopy should be considered for all patients with history of catamenial hemopneumothorax, cyclic chest or shoulder pain, or cyclic dyspnea. The aim of treatment should be to remove endometriotic lesions, to provide symptomatic relief, and to avoid recurrence. The use of these minimally invasive techniques may reduce the need for laparotomy or thoracotomy in affected patients.
Nezhat
Camran
C
Center for Special Minimally Invasive Surgery, Stanford University Medical Center, Palo Alto, California 94304, USA. Cnezhat@stanford.edu
Nicoll
Linda M
LM
Bhagan
Lisa
L
Huang
Jian Qun
JQ
Bosev
Dorian
D
Hajhosseini
Babak
B
Beygui
Ramin E
RE
D000328:Adult; D002637:Chest Pain / Q000209:etiology; D003964:Diaphragm; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006491:Hemothorax / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D053685:Laser Therapy; D009135:Muscular Diseases / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology; D010388:Pelvis; D012189:Retrospective Studies; D013906:Thoracoscopy