Endometriosis of the Diaphragm: Four Cases Treated with a Combination of Laparoscopy and Thoracoscopy

Nezhat, Camran; Nicoll, Linda M.; Bhagan, Lisa; Huang, Jian; Bosev, Dorian; Hajhosseini, Babak; Beygui, Ramin E.

doi:10.1016/j.jmig.2009.06.012

Cited by 51 publications

(47 citation statements)

References 42 publications

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“…45,53,56,57 This combined approach may be particularly helpful in cases of inconclusive VATS, which may be the result of endometriosis involving only the abdominal diaphragm, causing catamenial phrenic nerve irritation and pain. 57…”

Section: Diagnosis: Thoracic Endometriosismentioning

confidence: 99%

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Extragenital Endometriosis

Veeraswamy

Lewis

Mann

et al. 2010

Clinical Obstetrics &Amp; Gynecology

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In recent years, there have been significant changes in many aspects of extragenital endometriosis ranging from the epidemiology to the management of the disease. Advances in minimally invasive surgery and expansion of the field have lead to further research in management of extragenital endometriosis. As a result, treatment has shifted from medical management toward a surgical, multidisciplinary approach. Surgery for extragenital endometriosis clearly improves outcome through relief of symptoms, improved quality-of-life, increased fertility rates, and reduced recurrences. Endoscopy has a pivotal role as both a diagnostic and therapeutic tool.

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Section: Diagnosis: Thoracic Endometriosismentioning

confidence: 99%

“…Larger diaphragmatic perforations can be sutured, although significant recurrences have been reported with this method. 60 Nezhat et al 56 reported the first laparoscopic and thoracoscopic management of diaphragmatic and lung endometriosis.…”

Section: Extragenital Endometriosis 459mentioning

confidence: 99%

Extragenital Endometriosis

Veeraswamy

Lewis

Mann

et al. 2010

Clinical Obstetrics &Amp; Gynecology

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“…In 2009 we published the first reported small case series undergoing a combination of video-assisted thoracoscopic surgery (VATS) and traditional laparoscopy; this series showed that it is a safe and reasonable surgical option. 7 The current series is a larger follow-up study and allows further definition of the clinical manifestations of thoracic endometriosis and evaluation of the multidisciplinary treatment of combined VATS and traditional laparoscopy to address abdominopelvic and thoracic endometriosis in a single operation.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Treatment for Thoracic and Abdominopelvic Endometriosis

Nezhat

Main

Paka

et al. 2014

JSLS

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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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“…We have previously described our standard approach to thoracic endometriosis. 5 Thoracoscopy revealed multiple hemorrhagic areas on the right lung with adhesions to the chest wall, which were resected. Other superficial areas of endometriosis affecting the right chest wall and right hemi-diaphragm were treated using plasma energy.…”

Section: Case Reportmentioning

confidence: 99%