An estimated 12% of extrapelvic endometriosis involves the diaphragm or thoracic cavity – most commonly the diaphragm – and in some hospitals, its occurrence is drawing together gynecologic surgeons skilled in video-assisted laparoscopy (VALS) with thoracic surgeons trained in video-assisted thoracoscopic surgery (VATS) to diagnose and treat the most severe cases.

Most diaphragmatic lesions occur on the abdominal side and right hemidiaphragm, and can be successfully removed in symptomatic patients with hydrodissection and vaporization or excision. But when lesions are believed to be deep or involve the entire thickness of the diaphragm, and/or when patients experience catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules (defined as thoracic endometriosis syndrome), a combined VALS-VATS procedure becomes a good option, said Ceana Nezhat, MD, a gynecologic surgeon and medical director of the Nezhat Medical Center in Atlanta.

READ FULL ARTICLE HERE