Laparoscopic management of diaphragmatic endometriosis by three different approaches.
OBJECTIVE
To report our three surgical approaches in the management of diaphragmatic endometriosis.


METHODS
Video article presenting laparoscopic surgical techniques, with and without robotic assistance.


METHODS
University hospital.


METHODS
Nulliparas with deep endometriosis associated with multiple endometriosis lesions of the diaphragm.


METHODS
Laparoscopic approach in women who present with small black-pigmented diaphragmatic lesions, with or without infiltration of the diaphragm, which are ablated using plasma energy. Robotic-assisted laparoscopic route in larger deep infiltrating implants, which are resected. To avoid phrenic nerve injury, robotic-assisted thoracoscopy is preferred in large lesions involving the central tendon of the diaphragm.


METHODS
The steps of each technique are emphasized. Surgical technique reports in anonymous patients are exempted from ethical approval by the Institutional Review Board.


RESULTS
Seven patients have been managed by these procedures from July 2015 to March 2016. Patients' functional outcomes were uneventful, with no phrenic nerve palsy or residual chest and right shoulder pain.


CONCLUSIONS
By combining resection and ablation techniques, the laparoscopy and thoracoscopy route, conventional and robotic-assisted minimally invasive approach, we offer a surgical strategy that is as conservative as possible, with an aim to limit postoperative adhesions between the liver and the diaphragm, and avoid diaphragmatic paralysis.
Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group 4308 "Spermatogenesis and Gamete Quality," IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com.
Horace
H
Roman
Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
Basma
B
Darwish
Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
Delphine
D
Provost
Department of Thoracic Surgery, Rouen University Hospital, Rouen, France.
Jean-Marc
JM
Baste
D055011:Ablation Techniques / Q000009:adverse effects; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D010298:Parity; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013906:Thoracoscopy / Q000009:adverse effects; D016896:Treatment Outcome
Diaphragmatic endometriosis; ablation; plasma energy; resection; robotic surgery