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Cited by 64Endometriosis Research and TreatmentPleural and Pulmonary DiseasesGynecological conditions and treatments

Endometriosis of the diaphragm: Four cases treated with a combination of laparoscopy and thoracoscopy

Nezhat, Camran, Nicoll, Linda M., Bhagan, Lisa, Huang, Jian Qun, Bosev, Dorian, Hajhosseini, Babak, Beygui, Ramin E.·2009·Journal of Minimally Invasive Gynecology
DOI 10.1016/j.jmig.2009.06.012
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Abstract

Study 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.Design Case series (Canadian Task Force Classification II2).Setting Tertiary care referral center.Patients Four women with diaphragmatic endometriosis.Interventions Laparoscopy and thoracoscopy.Measurements We retrospectively reviewed the charts of 4 consecutive women with diaphragmatic endometriosis who underwent laparoscopy and thoracoscopy from June 2008 through September 2008.Main 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.

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  • Use of pleurodesis allowed a median recurrence-free interval of 61 months in 28 patients.

    “Use of pleurodesis was only demonstrated to allow a median recurrence-free interval of 61 mo in 28 patients.”

    From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [51]

  • Pleurodesis decreases the recurrence rate of pneumothorax after VATS by 20%-25% compared with no pleurodesis.

    “It was reported to decrease the recurrence rate of pneumothorax after VATS by 20%–25% compared with those who did not have pleurodesis performed at the time of surgery.51,62,63”

    From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [51]

  • A combined VL/VATS procedure may not be necessary in all cases of suspected TES.

    “Although a combined VATS with VL approach is based on principles that would provide a more comprehensive treatment to a disease that may involve both the pelvic and thoracic cavities, a combined VL/VATS procedure may not be necessary in all cases of suspected TES.37,51”

    From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [51]

  • Isolated diaphragmatic endometriosis may present with cyclic neck, shoulder, right upper quadrant or epigastric pain.

    “Isolated diaphragmatic endometriosis may present with cyclic neck, shoulder, right upper quadrant or epigastric pain [ 56 , 57 , 58 ].”

    From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [58]

  • The use of pleurodesis effectively reduces the recurrence rate of catamenial pneumothorax by 20-25%.

    “The use of pleurodesis effectively reduces the recurrence rate of catamenial pneumothorax by 20–25% [ 58 ].”

    From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [58]

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Authors
Nezhat, C., Nicoll, L. M., Bhagan, L., Huang, J. Q., Bosev, D., Hajhosseini, B., & Beygui, R. E.
Affiliations
  • Stanford Medicine (US)
  • Maichin Dom (BG)
Corresponding author
Nezhat, Camran
ORCID
Venue
Journal of Minimally Invasive Gynecology
Publisher
Elsevier BV
Published
2009-09
Volume
16
Issue
5
Pages
573-580
ISSN
1553-4650 (ISSN-L)
DOI
10.1016/j.jmig.2009.06.012
OpenAlex
W2053493610
Cited by
64
References
45
Citations by year
2026: 7 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 3 · 2016: 1 · 2015: 3 · 2014: 4 · 2013: 3 · 2012: 5
FWCI
3.89
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Minimally Invasive Gynecology (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, laparoscopy, thoracoscopy, catamenial pneumothorax, chest pain, pelvic pain, minimally invasive surgery, endometriosis recurrence
MeSH terms
Adult, Chest Pain, Diaphragm, Endometriosis, Female, Hemothorax, Humans, Muscular Diseases, Pelvis, Laparoscopy, Retrospective Studies, Thoracoscopy, Pelvic Pain, Laser Therapy

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