A single centre multidisciplinary team retrospective review of fifty cases of robot-assisted surgery for diaphragmatic and thoracic endometriosis.

INTRODUCTION

Diaphragmatic and thoracic endometriosis (DTE) is considered rare, often presenting with non-specific cyclical thoracic symptoms. Diagnosis and surgical management remain challenging due to the need for cross-specialty expertise. This study reports the first series of robot-assisted surgeries for DTE performed by a single, consistent multidisciplinary team.

MATERIAL AND

METHODS

This was a retrospective case series of 50 consecutive DTE surgeries performed between July 2020 and March 2023 in a specialist private hospital in the United Kingdom. Procedures involving robot-assisted laparoscopy (RAL) for pelvic/diaphragmatic disease and/or robot-assisted video-assisted thoracoscopic surgery (RAVATS) for thoracic disease were included. All cases involved a multidisciplinary collaboration between gynecological, hepato-pancreato-biliary, and thoracic robotic surgeons. Data on presentation, operative metrics, histology, and 90-day outcomes were collected and analyzed.

RESULTS

Forty-six women underwent 50 procedures; 29 involved RAL only, 13 involved RAL with RAVATS, and 5 were RAVATS only. Median operative time was 236 min for three-compartment cases. No cases required conversion to open surgery. Endometriosis was confirmed histologically in 64.4% of abdominal diaphragm cases and 45% of thoracic cases. The right hemidiaphragm was most commonly affected. No Clavien-Dindo ≥II complications occurred. Combined three-compartment procedures were significantly shorter overall than staged approaches (p = 0.01).

CONCLUSIONS

Robot-assisted surgery for DTE is safe, feasible, and may enhance disease recognition and excision, particularly when conducted by a dedicated multidisciplinary team. Simultaneous multi-compartment surgery improves operative efficiency and reduces the risk of incomplete treatment. DTE warrants evaluation in specialized centers, in a multidisciplinary fashion.