Abstract Introduction Diaphragmatic and thoracic endometriosis (DTE) is considered rare, often presenting with non‐specific cyclical thoracic symptoms. Diagnosis and surgical management remain challenging due to the need for cross‐specialty expertise. This study reports the first series of robot‐assisted surgeries for DTE performed by a single, consistent multidisciplinary team. Material and Methods This was a retrospective case series of 50 consecutive DTE surgeries performed between July 2020 and March 2023 in a specialist private hospital in the United Kingdom. Procedures involving robot‐assisted laparoscopy (RAL) for pelvic/diaphragmatic disease and/or robot‐assisted video‐assisted thoracoscopic surgery (RAVATS) for thoracic disease were included. All cases involved a multidisciplinary collaboration between gynecological, hepato‐pancreato‐biliary, and thoracic robotic surgeons. Data on presentation, operative metrics, histology, and 90‐day outcomes were collected and analyzed. Results Forty‐six women underwent 50 procedures; 29 involved RAL only, 13 involved RAL with RAVATS, and 5 were RAVATS only. Median operative time was 236 min for three‐compartment cases. No cases required conversion to open surgery. Endometriosis was confirmed histologically in 64.4% of abdominal diaphragm cases and 45% of thoracic cases. The right hemidiaphragm was most commonly affected. No Clavien–Dindo ≥II complications occurred. Combined three‐compartment procedures were significantly shorter overall than staged approaches ( p = 0.01). Conclusions Robot‐assisted surgery for DTE is safe, feasible, and may enhance disease recognition and excision, particularly when conducted by a dedicated multidisciplinary team. Simultaneous multi‐compartment surgery improves operative efficiency and reduces the risk of incomplete treatment. DTE warrants evaluation in specialized centers, in a multidisciplinary fashion.
Barton‐Smith et al. (Thu,) studied this question.