Uniportal-VATS approach to thoracic endometriosis syndrome: a case report

Gian Maria Ferretti, Elisa Meacci, Dania Nachira, Maria Teresa Congedo, Luca Pogliani, Edoardo Zanfrini, Amedeo Giuseppe Iaffalfano, Leonardo Petracca Ciavarella, Maria Letizia Vita, Marco Chiappetta, Venanzio Porziella, Stefano Margaritora

Abstract

Nowadays, endometriosis is considered a common benign disease. It affects between 6% and 10% of women of childbearing and it’s characterized by the presence of islands of endometrial-like cells outside the uterine cavity, more often located on the intraperitoneal surface of reproductive organs. The thoracic cavity is the second major district where it’s possible to find islands of endometriosis affecting the parietal and/or visceral pleural surface, the diaphragm or the lung parenchyma, therefore causing a variety of symptoms and manifestations, all together named as thoracic endometriosis syndrome (TES). The first line therapy for TES is medical aimed at suppressing ovarian steroid hormone production. Indications for pulmonary surgery as a second line therapeutic management of patients with TES are hormonal therapy failure, intolerable adverse effects or symptom recurrence after cessation of medical treatment. Surgery should be the preferred therapeutic option when the patient is planning future pregnancies. To date, video-assisted-thoracoscopy (VATS) represents an important surgical tool in TES patients, as it allows to carry out many procedures for diagnostic and therapeutic purposes. In patients with centrally located bronchial endometriosis, sub-segmentectomies, segmentectomies or lobectomies may be required. We present the case of a patient with TES, treated with a feasible, safe and least invasive thoracic surgical technique available nowadays in many settings: uniportal-VATS.