2968 A Combination of Robotic-Assisted Excision and CO2 Laser Ablation for the Treatment of Superficial Diaphragmatic Endometriosis

Video Objective To demonstrate treatment of superficial diaphragmatic endometriosis with the combined modalities of robotic excision and CO2 laser ablation. To provide a rationale for using one particular modality over the other for a given lesion. Setting The patient is a 26-year-old G0 who presented with cyclic pelvic and shoulder pain. A diagnostic laparoscopy demonstrated endometriosis involving the diaphragm, and she was referred to a center of excellence in minimally invasive gynecologic surgery. A chest MRI showed no thoracic endometriosis. Interventions The patient underwent robotic-assisted laparoscopic surgery that revealed superficial diaphragmatic endometriosis. Excision was undertaken for accessible lesions that were lateral to the fibrous pericardium and phrenic nerve. CO2 laser ablation allowed for treatment of medial lesions near the pericardium while minimizing thermal spread. The use of laser ablation also allowed for treatment of lesions that were inaccessible for excision. Conclusion Combining the modalities of robotic excision and CO2 laser ablation achieves efficient treatment of superficial diaphragmatic endometriosis while minimizing the risk of injury to the phrenic nerve and mediastinal structures.