Robotic Excision of Full-thickness Diaphragmatic Endometriosis

Ritchie Delara, Elena Suárez-Salvador, Javier Magrina, Paul Magtibay

Research output: Contribution to journalArticle

Abstract

Study Objective: To describe a robotic approach to excision of full-thickness diaphragmatic endometriosis. Design: Surgical technique demonstration. Setting: Symptomatic diaphragmatic endometriosis is commonly associated with lesions that are deeply invasive. In the presence of symptomatic diaphragmatic endometriosis, the posterior diaphragm should be explored. Interventions: This video presents a systematic robotic approach to the excision of diaphragmatic endometriosis, highlighting key anatomic landmarks and technical considerations to complete the procedure safely and effectively. Resection of hepatic ligaments, use of a 30° endoscope, and right lateral access can be used to visualize this anatomic area [1]. The phrenic nerve is rarely identified during laparoscopy, if at all, and an inability to identify this structure during hemidiaphragm resection does not seem to result in significant patient morbidity. After diaphragm resection, the pleural cavity and lung should be systematically inspected to rule out the presence of additional endometriotic lesions. If the long axis of the diaphragmatic defect is parallel to the posterior chest wall and can be closed tension-free, then mesh is not necessary [1]. Insertion of a red rubber catheter into the thorax along with the use of negative pressure suction at the end of closure of the diaphragmatic defect may avoid use of a postoperative chest tube. Conclusion: The use of robotic assistance for resection of diaphragmatic endometriosis makes this procedure easy and safe to perform. Compared with ablative procedures, complete surgical excision offers higher rates of symptom improvement and resolution in patients with diaphragmatic endometriosis.

Original languageEnglish (US)
JournalJournal of Minimally Invasive Gynecology
DOIs
StateAccepted/In press - Jan 1 2019

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Robotics
Endometriosis
Diaphragm
Anatomic Landmarks
Pleural Cavity
Chest Tubes
Phrenic Nerve
Endoscopes
Rubber
Suction
Thoracic Wall
Ligaments
Laparoscopy
Thorax
Catheters
Morbidity
Pressure
Lung
Liver

Keywords

  • Diaphragm
  • Extrapelvic endometriosis
  • Robotic-assisted excision

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Robotic Excision of Full-thickness Diaphragmatic Endometriosis. / Delara, Ritchie; Suárez-Salvador, Elena; Magrina, Javier; Magtibay, Paul.

In: Journal of Minimally Invasive Gynecology, 01.01.2019.

Research output: Contribution to journalArticle

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