In this panel discussion, surgeons Leanne Ashrafian and Andrea Bille, both consultant thoracic surgeons in the Department of Thoracic Surgery at Guy’s St Thomas’ NHS Foundation Trust, join Ammara Watkins, Associate Professor of Surgery in the Department of Cardiothoracic Surgery at Beth Israel Lahey Health, to explore complex thoracic endometriosis.
The discussion begins by addressing how patients with thoracic endometriosis present in a surgical setting, emphasizing the critical importance of a thorough clinical history during the assessment process. The panel then examines the indications for surgical intervention, specifically noting that surgery should be considered once symptoms significantly impact patients’ quality of life, and advocating for a lower threshold for performing thoracoscopy.
Regarding technical surgical considerations, the surgeons discuss optimal port placement, the application of robotics, and specific strategies for diaphragm management. They also evaluate the use of mesh, including considerations regarding future pregnancy, and define the appropriate scenarios for utilizing pleurodesis. Furthermore, the panel highlights the value of a multidisciplinary approach through combined thoracic and gynecology surgery, addresses management of parenchymal disease, and concludes by discussing the necessity of future clinical trials and the development of a formal consensus statement for the treatment of complex thoracic endometriosis.
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