565 Robot-Assisted Surgery for Thoracic Endometriosis Syndrome – a Single-Centre, Retrospective Review of the First Fifty Cases

Abstract Aim Thoracic endometriosis syndrome (TES) is underdiagnosed, due to cyclical thoracic symptoms being underreported. Management of TES also remains controversial, with abdominal and thoracic approaches proposed, both laparoscopically and robotically, and no guidelines available. We aimed to characterise our experience with a multidisciplinary, robot-assisted approach, with a focus on symptom prevalence and surgical outcomes. Method A retrospective review of all consecutive procedures for TES between July 2020 and March 2023 surgery was performed. Robot-assisted removal of endometriosis from the underside of the diaphragm, from the pleura or superior diaphragm, or wedge resection of the lung through videoscope-assisted thoracic surgery, in any combination with or without pelvic endometriosis removal, were included. Presenting symptoms, intra-operative, and histological outcomes were analysed. Results Fifty robotic TES procedures, on forty-six patients were undertaken; median age was 32 (IQR 26–36). Cyclical shoulder tip pain (n = 29, 63%), costal margin pain (n=18, 39.1%), and scapular pain (n=11, 23.9%). There were no major Clavien-Dindo complications. Median blood loss was 10ml (IQR 6.25–27.25), and median length of stay was 1 day (IQR 1–2 ). The majority of the underside of the diaphragm specimen (n=35, 77.8%), and the pleural, and lung specimens (n=17, 85%) were either histologically positive for endometriosis or showed inflammation consistent with endometriosis. Conclusions Robotic-assisted surgery can be safely used for TES. Management of TES should involve an MDT including gynaecologic, hepato-pancreatico-billary, and thoracic surgeons, with minimally invasive experience. Going forward, long-term, patient-reported outcomes need to be analysed to ensure the effectiveness of robot-assisted surgery in TES.