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Cited by 24Endometriosis Research and TreatmentPleural and Pulmonary DiseasesGynecological conditions and treatments

Minimally invasive treatment of diaphragmatic endometriosis: A 15-year single referral center’s experience on 215 patients

Ceccaroni, Marcello, Roviglione, Giovanni, Farulla, Antonino, Bertoglio, Pietro, Clarizia, Roberto, Viti, Andrea, Mautone, Daniele, Ceccarello, Matteo +2 more·2021·Surgical Endoscopy
DOI 10.1007/s00464-020-08186-z
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Abstract

Background Diaphragmatic endometriosis (DE) is a rare and often misdiagnosed condition. Most of the times it is asymptomatic and due to the low accuracy of diagnostic tests, it is almost always detected during surgery for pelvic endometriosis. Its management is challenging and, until now, there are not guidelines about its treatment.Methods We describe a consecutive series of patients with DE managed by laparoscopy and videothoracoscopy (VATS) in our referral center in a period of 15 years. We developed a flow-chart classifying DE implants in foci, plaques and nodules and proposing an algorithm with the aim of standardizing the surgical approach.Results 215 patients were treated for DE. Lesions were almost always localized on the right hemidiaphragm (91%), and the endometriotic implants were distributed as: foci in 133 (62%), plaques in 24 (11%) and nodules in 58 patients (27%), respectively. In all cases of isolated pleural involvement, concomitant diaphragmatic hernia or lesions of the thoracic side of the diaphragm VATS was performed, alone or combined with laparoscopy, resulting in a total of 26 procedures. Following the proposed algorithm, specific surgical techniques were identified as the better approaches for the different types of the lesion, such as Argon Beam Coagulation and diathermocoagulation for diaphragmatic foci, peritoneal stripping for plaques, and nodulectomy or full-thickness resection of diaphragm for nodules.Conclusions It is crucial to standardize the surgical approach of DE, according to the type of lesion, thus reducing the rate of under- or over-treatments and intra or postoperative complications. This kind of surgery should be performed in a Referral Center by a gynecologic surgeon with oncogynecologic expertise and skills, with the eventual support of a laparoscopic general surgeon, a specialized thoracic surgeon and a trained anesthesiologist.

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Authors
Ceccaroni, M., Roviglione, G., Farulla, A., Bertoglio, P., Clarizia, R., Viti, A., Mautone, D., Ceccarello, M., Stepniewska, A., & Terzi, A. C.
Affiliations
  • Ospedale Sacro Cuore Don Calabria (IT)
  • University of Modena and Reggio Emilia (IT)
Corresponding author
Roviglione, Giovanni
ORCID
Venue
Surgical Endoscopy
Publisher
Springer Science and Business Media LLC
Published
2021-01-04
Volume
35
Issue
12
Pages
6807-6817
ISSN
  • 0930-2794 (ISSN-L)
  • 1432-2218
DOI
10.1007/s00464-020-08186-z
OpenAlex
W3120330796
Cited by
24
References
32
Citations by year
2026: 4 · 2025: 8 · 2024: 7 · 2023: 1 · 2022: 4
FWCI
2.59
Type
journal article
Language
en
Update notices
correction (2021-01-13)
Open access
closed
Licence
Locations
  • Surgical Endoscopy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pleural and Pulmonary Diseases
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
Keywords
diaphragmatic endometriosis, minimally invasive surgery, video-assisted thoracoscopic surgery, laparoscopy, diaphragmatic hernia, nodulectomy, argon beam coagulation, diathermocoagulation, thoracic endometriosis
MeSH terms
Overtreatment, Diaphragm, Endometriosis, Female, Humans, Laparoscopy, Referral and Consultation

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