Diaphragmatic endometriosis: robotic approaches and techniques.

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.