Thoracoscopic diaphragmatic plication for diaphragmatic paralysis with consecutive eventration and respiratory compromise is a desirable alternative to standard thoracotomy. Since minimally invasive techniques usually involve suturing of the diaphragm, most surgeons use a video-assisted approach with a minithoracotomy. Herein we describe our completely thoracoscopic technique for diaphragmatic plication including outcome.
We present our technique and experience for completely thoracoscopic diaphragmatic plication for the treatment of symptomatic diaphragmatic paralysis in six consecutive patients. The surgical technique basically consisted of stapling of the abundant diaphragm and reinforcement of the staple line using a self-locking thread. Primary outcome measure was the postoperative result (flattened diaphragm) and resolution of symptoms. Secondary outcome was improvement of lung function values 3 months after surgery.
Between June 2015 and March 2016, six patients have been operated for symptomatic diaphragmatic paralysis, with one of them suffering from additional transdiaphragmatic hernia. Flattening of the diaphragm was achieved in all 6 patients with resolution of their pre-existing symptoms within days after surgery and without any surgical complications. Lung function volumes measured 3 months postoperative improved markedly with an increase in FEV1 as well as FVC of 540 ml (SD ± 193 ml) and 776 ml (SD ± 121 ml), respectively.
In our experience, the presented technique is a safe and simple minimally invasive way to perform a completely thoracoscopic diaphragmatic plication with excellent results so far.
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Qureshi A (2009) Diaphragm paralysis. Semin Respir Crit Care Med 30(3):315–320
Gharagozloo F, McReynolds SD, Snyder L (1995) Thoracoscopic plication of the diaphragm. Surg Endosc 9:1204–1206
Mouroux J, Padovani B, Poirier NC et al (1996) Technique for the repair of diaphragmatic eventration. Ann Thorac Surg 62:905–907
Moon SW, Wang YP, Kim YW et al (2000) Thoracoscopic plication of diaphragmatic eventration using endostaplers. Ann Thorac Surg 70(1):299–300
Kim Do H, Joo Hwang J, Kim KD (2007) Thoracoscopic diaphragmatic plication using three 5 mm ports. Interact CardioVasc Thorac Surg 6(3):280–281
Dunning J (2015) Thoracoscopic diaphragm plication. Interact CardioVasc Thorac Surg 20(5):689–690
Kara HV, Roach MJ, Balderson SS, D’Amico TA (2015) Thoracoscopic diaphragm plication. Ann Cardiothorac Surg 4(6):573–575
Minegishi K, Nakano T, Shibano T et al (2014) Diaphragmatic hernia complicated with diaphragmatic resection by automatic stapling device. Kyobu Geka 67(11):959–962
Conflict of interest
All authors declare that they have no conflict of interest.
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Kocher, G.J., Zehnder, A. & Schmid, R.A. Completely Thoracoscopic Diaphragmatic Plication. World J Surg 41, 1019–1022 (2017). https://doi.org/10.1007/s00268-016-3789-2
- Staple Line
- Thoracoscopic Approach
- Phrenic Nerve Paralysis
- Diaphragmatic Paralysis
- Intraabdominal Organ