Robot-assisted resection of diaphragmatic and hepatorenal recess peritoneal endometriosis: Two cases and a narrative review.

In this report, we describe two cases of diaphragmatic endometriosis with concurrent hepatorenal recess peritoneal involvement managed using robotic-assisted laparoscopic surgery with the da Vinci Xi platform. In both patients, diaphragmatic implants and hepatorenal recess peritoneal lesions were excised en bloc, followed by resection of additional pelvic and abdominal lesions. Case 1 involved a 45-year-old woman whose pathology confirmed endometriosis in 28 of 46 sites, including the diaphragm, umbilicus, bowel, hepatorenal recess peritoneum, and pelvic peritoneum. Case 2 involved a 32-year-old woman with histopathologic evidence of endometriosis in 26 of 34 resected sites, including the appendix, diaphragm, hepatorenal recess peritoneum, pelvic peritoneum, and large colon. The total operative times were 344 min for Case 1 and 193 min for Case 2, with estimated blood losses of 50 and 15 mL, respectively. Both procedures were completed using minimally invasive techniques, with uneventful postoperative recovery. To our knowledge, these cases represent the first report of robot-assisted minimally invasive resection of concurrent diaphragmatic and hepatorenal recess peritoneal endometriosis. Robotic surgery offers superior visualization and instrument dexterity, enabling safe excision of complex extrapelvic disease.