Usta T, Gonenc M, Yilmaz S, Akyol G S C, Kale A, Oral E
Facts Views Vis Obgyn. 2022 Dec;14(4):339-341. doi: 10.52054/FVVO.14.4.048.
10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment.
This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis.
The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube.
The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery.
Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.
10%的育龄女性受子宫内膜异位症影响，其中膈子宫内膜异位症占这些病例的1 - 1.5%。膈部子宫内膜异位病变常需手术治疗。
本视频旨在展示膈子宫内膜异位症的表现，并描述我们在机器人辅助腹腔镜下全层切除膈部子宫内膜异位症的经验。
患者为37岁女性，主诉周期性右肩疼痛（持续1年）。她既往有剖宫产瘢痕及脐部子宫内膜异位症切除手术史。腹部磁共振成像（MRI）显示三个子宫内膜异位结节，其中一个位于右半膈，为全层病变。患者接受了机器人辅助腹腔镜子宫内膜异位症手术，由妇科和普通外科团队联合进行。完全切断镰状韧带以充分暴露膈上的子宫内膜异位病变。先切除膈表面的病变。然后切除MRI上描述的较大深部结节，连同膈全层一并切除。有意进入胸腔以实现结节的完全切除。通过此开口对右下胸腔进行腹腔镜评估未发现任何子宫内膜异位病变。切除后，用倒刺缝线修复膈。修复结束时对胸腔进行负压吸引，而非放置胸管。
患者术后第3天出院，未出现并发症。组织病理学检查证实为子宫内膜异位症。术后3个月患者无症状。
机器人辅助手术是一种简便且安全的选择，尤其在这种具有挑战性的双腔手术中，它能提供三维视野，消除感觉丧失并增强深度感知，操作更灵活且无震颤。
