Diaphragmatic Endometriosis: Multidisciplinary Treatment

Abstract

Study objective: To demonstrate a safe laparoscopic procedure for diaphragmatic infiltrative endometriosis.

Design: Video case SETTING: Teaching hospital (Canadian Task Force classification III).

Patients: One patient presenting deep and severe diaphragmatic endometriosis.

Intervention: Laparoscopic cure of diaphragmatic endometriosis.

Measurements and main results: Throughout this video, which was approved by the institutional board review, we demonstrate safe and complete surgical treatment of a patient suffering severe pelvic and diaphragmatic endometriosis. The patient complained of menstrual dyspnea and shoulder pain persisting despite hormonal treatment, associated with persistent dyspareunia and pelvic pain despite a previous laparoscopic surgery. Patient positioning and anesthesia were adapted to the special requirements of the surgical technique and the expected risks. The operation consisted of the exposure of the right diaphragm by mobilization of the liver, CO₂ laser vaporization of left and right diaphragmatic lesions, nerve-sparing excision of infiltrating nodules, and pleural exploration. Finally, we performed an excision of pelvic endometriosis. Participation of 3 surgical teams to this procedure allowed a safe and complete laparoscopic treatment with resolution of pain symptoms at a 1- and 3-month follow-up.

Conclusion: Laparoscopic treatment allows a safe and complete treatment of diaphragmatic endometriosis.

Keywords: CO(2) laser surgery; Diaphragmatic endometriosis; Multidisciplinary treatment.