Diaphragmatic endometriosis: robotic approaches and techniques

Authors

Gaby Moawad, Department of Obstetrics and Gynecology, George Washington University, Washington D.C; The Center for Endometriosis and Advanced Pelvic Surgery, Washington D.C. Electronic address: gnmoawad@gmail.com.
Youssef Youssef, Department of Obstetrics and Gynecology, Hurley Medical Center-Michigan State University, Michigan.
Jean Marc Ayoubi, Department of Obstetrics and Gynecology and Reproductive Medicine, Hôpital Foch, Suresnes, France, (e)Department of General Surgery, University Hospital of Fribourg, Fribourg, Switzerland.
Anis Feki, Clinique Tivoili-Ducos, Bordeaux, France.
Dominique De Ziegler, Department of Obstetrics and Gynecology and Reproductive Medicine, Hôpital Foch, Suresnes, France, (e)Department of General Surgery, University Hospital of Fribourg, Fribourg, Switzerland.
Horace Roman, Clinique Tivoili-Ducos, Bordeaux, France.

Document Type

Journal Article

Publication Date

11-8-2022

Journal

Fertility and sterility

DOI

10.1016/j.fertnstert.2022.09.019

Keywords

Diaphragmatic endometriosis; diaphragm; excision; robotic-surgical management

Abstract

OBJECTIVE: To present different approaches used in the surgical management of diaphragmatic endometriosis using the Davinci Robotic system. DESIGN: A video article presenting patient positioning, port placement, and surgical techniques used in robotic excision of diaphragmatic endometriosis with concomitant pelvic disease. SETTING: Endometriosis center. PATIENT(S): Patients undergoing excision of diaphragmatic endometriosis. INTERVENTION(S): Systematic robotic approach to excise diaphragmatic lesions depending on the depth of invasion. MAIN OUTCOME MEASURES(S): The advantages and disadvantages of the lithotomy and the lateral decubitus approach were reviewed. Ports placements are illustrated according to the chosen approach. Diaphragmatic peritoneal stripping, diaphragmatic shaving, and diaphragmatic excision are different techniques used according to the depth of invasion. RESULTS(S): N/A. CONCLUSION(S): The choice of approach between the lithotomy position and the left lateral decubitus position depend on the extent of the diaphragmatic disease and the presence of concomitant pelvic lesions. Despite the lack of high-quality evidence, the advantages of the robotic system may improve the outcomes in such difficult cases in comparison with conventional laparoscopy.

APA Citation

Moawad, Gaby; Youssef, Youssef; Ayoubi, Jean Marc; Feki, Anis; De Ziegler, Dominique; and Roman, Horace, "Diaphragmatic endometriosis: robotic approaches and techniques" (2022). GW Authored Works. Paper 1958.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1958

Department

Obstetrics and Gynecology