TY - JOUR
T1 - Robotic Excision of Full-thickness Diaphragmatic Endometriosis
AU - Delara, Ritchie
AU - Suárez-Salvador, Elena
AU - Magrina, Javier
AU - Magtibay, Paul
N1 - Publisher Copyright:
© 2019 AAGL
PY - 2020/5/1
Y1 - 2020/5/1
N2 - 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.
AB - 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.
KW - Diaphragm
KW - Extrapelvic endometriosis
KW - Robotic-assisted excision
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U2 - 10.1016/j.jmig.2019.08.025
DO - 10.1016/j.jmig.2019.08.025
M3 - Article
C2 - 31487553
AN - SCOPUS:85073001370
SN - 1553-4650
VL - 27
SP - 815
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 4
ER -