Multidisciplinary Treatment for Thoracic and

Background and Objectives: Thoracic endometriosis is a rare form of extragenital endometriosis with important clinical ramifications. Up to 80 % of women with thoracic endometriosis have concomitant abdominopelvic endo-metriosis, yet the surgical treatment is usually performed with separate procedures. This is the largest published series of the combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic and thoracic endometriosis. The objec-tives of this series are to further evaluate the manifesta-tions of thoracic endometriosis, assess the multidisci-plinary surgical approach, and discuss our institution’s protocols. Methods: This is a retrospective, institutional review board–approved case series of 25 consecutive women who underwent combined video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic, diaphragmatic, and thoracic endometri-osis from January 1, 2008, to September 30, 2013. All surgeries were performed at a tertiary referral center by the same primary surgeons. Data were collected by chart review. Results: Twenty-five patients were included, with a mean age of 37.7 years. Eighty percent of patients had catame-nial chest pain, and in 40 % this was their only chest complaint. Shoulder pain was noted in 40 % of patients, catamenial pneumothorax in 24%, and hemoptysis in 12%. One hundred percent of patients were found to have endometriosis in the pelvis, 100 % in the diaphragm, 64% in the chest wall, and 40 % in the parenchyma. There were 2 major postoperative complications: 1 diaphragmatic her-nia and 1 vaginal cuff hematoma. Conclusion: Clinical suspicion and preoperative assess-ment are crucial in the diagnosis of thoracic endometriosis and allow for a multidisciplinary approach. The combina-tion of video-assisted thoracoscopic surgery and tradi-tional laparoscopy for the treatment of endometriosis op-timally addresses the pelvis, diaphragm, and thoracic cavity in a single operation.