Laparoscopic excision of pericardial and diaphragmatic endometriosis.

Objective: To present a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis.

Design: Surgical video.

Setting: Academic tertiary care hospital.

Patient(s): 35-year-old nulliparous woman observed for chronic pelvic pain and infertility with a diagnosis of diaphragmatic endometriosis at a prior laparoscopy. Symptoms included severe chest pain and right shoulder tip pain, refractory to multiple medical therapies.

Intervention(s): Laparoscopic excision of pericardial and diaphragmatic endometriosis.

Main Outcome Measure(s): Description of the relevant anatomy, the literature surrounding pericardial and diaphragmatic endometriosis, and the approach to the surgical intervention and postoperative care.

Result(s): The laparoscopic excision of the full-thickness pericardial and diaphragmatic endometriotic lesions was successfully completed according to five reproducible steps: upper abdominal survey, liver mobilization, excision of diaphragmatic endometriosis, intrathoracic laparoscopic exploration, and closure of the diaphragmatic defect.

Conclusion(s): Although rare and challenging to diagnose and treat, pericardial and diaphragmatic endometriosis and its potentially debilitating symptoms can be successfully managed through a multidisciplinary and stepwise surgical intervention.