OBJECTIVE To present a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis. DESIGN Surgical video. SETTING Academic tertiary care hospital. PATIENT(S) 35-year-old nulliparous woman observed for chronic pelvic pain and infertility with a diagnosis of diaphragmatic endometriosis at a prior laparoscopy. Symptoms included severe chest pain and right shoulder tip pain, refractory to multiple medical therapies. INTERVENTION(S) Laparoscopic excision of pericardial and diaphragmatic endometriosis. MAIN OUTCOME MEASURE(S) Description of the relevant anatomy, the literature surrounding pericardial and diaphragmatic endometriosis, and the approach to the surgical intervention and postoperative care. RESULT(S) The laparoscopic excision of the full-thickness pericardial and diaphragmatic endometriotic lesions was successfully completed according to five reproducible steps: upper abdominal survey, liver mobilization, excision of diaphragmatic endometriosis, intrathoracic laparoscopic exploration, and closure of the diaphragmatic defect. CONCLUSION(S) Although rare and challenging to diagnose and treat, pericardial and diaphragmatic endometriosis and its potentially debilitating symptoms can be successfully managed through a multidisciplinary and stepwise surgical intervention.

中文翻译：

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腹腔镜切除心包和膈肌子宫内膜异位症

目的 提出一种五步法腹腔镜切除心包和膈肌子宫内膜异位症。设计手术视频。设置 学术三级医院。患者 35 岁的未产妇因慢性盆腔疼痛和不孕症而在先前的腹腔镜检查中被诊断为膈肌子宫内膜异位症。症状包括严重的胸痛和右肩尖疼痛，对多种药物治疗无效。干预(S) 腹腔镜切除心包和膈肌子宫内膜异位症。主要结局指标 相关解剖结构的描述、有关心包和膈肌子宫内膜异位症的文献，以及手术干预和术后护理的方法。结果 腹腔镜下全层心包和膈肌子宫内膜异位病变切除术按照上腹部检查、肝脏动员、膈肌子宫内膜异位症切除、胸腔内腹腔镜探查和膈肌缺损闭合五个可重复步骤成功完成。结论（S）虽然罕见且诊断和治疗具有挑战性，但心包和膈肌子宫内膜异位症及其潜在的衰弱症状可以通过多学科和逐步手术干预成功控制。