Laparoscopic Excision of Pericardial and Diaphragmatic Endometriosis

372 Views | Sep 24, 2020

Authors: Dong Bach Nguyen, Sebastien Gilbert, Kristina Arendas, Caitlin Jago, Sukhbir Sony Singh

Affliations: University of Ottawa, The Ottawa Hospital

This video presents a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis. Clinically, endometriosis affects the thoracic cavity in less than 1% of cases, most commonly involving the diaphragm and treated using a VATS approach. Pericardial endometriosis is an even rarer entity, with only 4 case reports published to date. We present the case of a 35-year-old in order to illustrate the approach to a laparoscopic excision of diaphragmatic and pericardial endometriosis. In consultation with the Thoracic team, she is consented for a completion surgery of thoracic endometriosis identified at a prior laparoscopy, symptomatic for right shoulder and mid-chest pain, and unresponsive to medical therapy. The surgical approach consists of 5 reproducible steps: 1. Upper abdominal survey 2. Liver mobilization 3. Excision of diaphragmatic and pericardial lesions 4. Intra-thoracic laparoscopic exploration 5. Closure of the diaphragmatic defect