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Multidisciplinary Treatment for Thoracic and Abdominopelvic Endometriosis
Open accessAbstract
BACKGROUND AND OBJECTIVES: 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. CONCLUSION: 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.
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“The most common site of endometriosis outside of the abdominopelvic cavity is within the thoracic cavity8–10”
From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [10]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“However, there is significant variety in the morphological appearance of endometriotic lesions with clear vesicular lesions, fibrotic white lesions, and liver adhesions reported.10,37”
From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [10]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Outside of the well-established clinical manifestations of TES, cases of isolated diaphragmatic endometriosis are typically asymptomatic but can result in irritation of the phrenic nerve. This can produce a syndrome of only catamenial pain, presenting as cyclic neck, shoulder, right upper quadrant, or epigastric pain.2,9,10,31,35–37”
From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [10]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The diagnosis of thoracic endometriosis by endoscopic visualization can be delayed due to a traditional focus on pelvic disease, the variable appearance of endometriotic lesions, and unseen posterior diaphragmatic disease hidden behind the liver.10,37”
From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [10]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations, including catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, and pulmonary nodules. Collectively, this is known as thoracic endometriosis syndrome (TES).8–10”
From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [10]
The cited source says what the claim attributes to it.
In the citing paper
“For thoracic endometriosis, hormone treatment can be offered.”
From ESHRE guideline: endometriosis (2022) · cites this paper as Nezhat et al., 2014
In the citing paper
“The most common symptoms associated with CP are chest or shoulder pain, cough, dyspnea, and shortness of breath.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [72]
In the citing paper
“Nezhat et al reported that TE was found in diaphragm (100%), chest wall (64%), and parenchyma (64%) using the VATS procedure.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [72]
In the citing paper
“A sizable number of extra abdominopelvic manifestations have been described, more commonly in the thorax [ 6 , 7 , 8 , 9 , 10 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [8]
In the citing paper
“Without a high index of suspicion, the diagnosis can be delayed [ 8 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [8]
In the citing paper
“The suspicion of TES is primarily based on the patient’s history, which is sufficiently sensitive to recommend surgical intervention when appropriate [ 8 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [8]
In the citing paper
“In 2014, we reported a retrospective observational study wherein 25 patients underwent VATS with video laparoscopy for thoracic, diaphragmatic, and abdominopelvic endometriosis without the use of pleurodesis, and no reports of recurrent pneumothorax were found in the 3-month to 18-month follow-up period [ 8 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [8]
In the citing paper
“In our 2014 retrospective observational study of 25 patients, we reported that 76% of patients with TES had both pleural and abdominal diaphragm involvement [ 8 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [8]
In the citing paper
“The use of monopolar energy is discouraged due to the proximity to the heart and the risk of cardiac arrhythmias, as well as potential muscular contractions [ 8 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [8]
In the citing paper
“Concomitant pelvic endometriosis is frequent, and video laparoscopy at time of VATS is recommended [ 8 , 22 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [8]
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Citations
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Կատամենիալ պնևմոթորաքս. կլինկական դեպքեր և գրականության տվյալների վերլուծություն
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Self-citation
Metadata
- Authors
- Nezhat, C., Main, J., Paka, C., Nezhat, A., & Beygui, R. E.
- Affiliations
- Stanford Medicine (US)
- Corresponding author
- Nezhat, Camran
- Venue
- JSLS : Journal of the Society of Laparoendoscopic Surgeons
- Published
- 2014
- Volume
- 18
- Issue
- 3
- Pages
- e2014.00312
- ISSN
- 1086-8089 (ISSN-L)
- 1938-3797
- PMC
- PMC4154426
- OpenAlex
- W2319230577
- Cited by
- 108
- References
- 30
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 14 · 2023: 10 · 2022: 20 · 2021: 9 · 2020: 7 · 2019: 8 · 2018: 9 · 2017: 6 · 2016: 3 · 2015: 3
- FWCI
- 4.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- JSLS Journal of the Society of Laparoscopic & Robotic Surgeons (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- 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
- thoracic endometriosis, diaphragmatic endometriosis, video-assisted thoracoscopic surgery, laparoscopic surgery, combined surgical approach, catamenial pneumothorax, shoulder pain, hemoptysis, diaphragmatic hernia, postoperative complications, multidisciplinary surgical management
- MeSH terms
- Adult, Endometriosis, Female, Humans, Middle Aged, Pelvis, Laparoscopy, Retrospective Studies, Thoracic Diseases, Thoracic Surgery, Video-Assisted
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