Multidisciplinary treatment for thoracic and abdominopelvic endometriosis.
OBJECTIVE
Thoracic endometriosis is a rare form of extragenital endometriosis with important clinical ramifications. Up to 80% of women with thoracic endometriosis have concomitant abdominopelvic endometriosis, yet the surgical treatment is usually performed with separate procedures. This is the largest published series of the combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic and thoracic endometriosis. The objectives of this series are to further evaluate the manifestations of thoracic endometriosis, assess the multidisciplinary surgical approach, and discuss our institution's protocols.


METHODS
This is a retrospective, institutional review board-approved case series of 25 consecutive women who underwent combined video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic, diaphragmatic, and thoracic endometriosis from January 1, 2008, to September 30, 2013. All surgeries were performed at a tertiary referral center by the same primary surgeons. Data were collected by chart review.


RESULTS
Twenty-five patients were included, with a mean age of 37.7 years. Eighty percent of patients had catamenial chest pain, and in 40% this was their only chest complaint. Shoulder pain was noted in 40% of patients, catamenial pneumothorax in 24%, and hemoptysis in 12%. One hundred percent of patients were found to have endometriosis in the pelvis, 100% in the diaphragm, 64% in the chest wall, and 40% in the parenchyma. There were 2 major postoperative complications: 1 diaphragmatic hernia and 1 vaginal cuff hematoma.


CONCLUSIONS
Clinical suspicion and preoperative assessment are crucial in the diagnosis of thoracic endometriosis and allow for a multidisciplinary approach. The combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of endometriosis optimally addresses the pelvis, diaphragm, and thoracic cavity in a single operation.
Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
Camran
C
Nezhat
Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
Jillian
J
Main
Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
Chandhana
C
Paka
Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
Azadeh
A
Nezhat
Department of Cardiothoracic Surgery, Stanford University Medical Center and Clinics, Palo Alto, CA, USA.
Ramin E
RE
Beygui
D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery*; D012189:Retrospective Studies; D013896:Thoracic Diseases / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
Endometriosis; Laproscopy; TES(Thoracic endometriosis syndrome); Thoracoscopy