Intraoperative Management of Right Diaphragmatic Endometriosis during Laparoscopic Partial Resection of Liver Segment 8

Abstract

Laparoscopic partial resection of liver S8 was performed for hepatocellular carcinoma (HCC) with thoracic endometriosis on the right diaphragm in a 71-year-old woman who had undergone laparoscopic partial resection of liver S6 for HCC in the past. During subsequent follow-up, a new lesion was noted in liver S8, and a laparoscopic repeat partial resection was performed. During detachment of the adhesions caused by the liver resection, a paradoxical movement of the right diaphragm was observed. Numerous small holes were found in the right diaphragm unrelated to adhesiolysis, and the right lung was visible through the holes. Thoracic endometriosis on the right diaphragm was diagnosed. Wet gauze was used to cover the holes of the right diaphragm, and they were pushed cranially with the assistant's forceps for a stable operative field because of the paradoxical movement of the diaphragm. Finally, when the holes were covered with a polyglycolic acid sheet at the end of the intra-abdominal procedures, the paradoxical movement disappeared completely.