Video-assisted thoracoscopic diaphragm plication using a running suture technique is durable and effective

Area of Science:

• Thoracic surgery
• Minimally invasive procedures
• Pulmonary function testing

Background:

• Minimally invasive diaphragm plication techniques face challenges with technical limitations, leading to potential failure or reduced efficacy.
• Surgeons have expressed hesitation due to the complexity of existing methods.

Purpose of the Study:

• To demonstrate the efficacy and durability of a thoracoscopic diaphragm plication technique utilizing a single running suture.
• To address the technical hurdles associated with traditional plication methods.

Main Methods:

• Retrospective review of patients undergoing thoracoscopic diaphragm plication since 2008.
• Utilized a single, buttressed, double-layered, to-and-fro running suture, with optional horizontal mattress sutures.
• Assessed outcomes including operative mortality, hospital stay, complications, pulmonary function tests, and dyspnea indices.

Main Results:

• Eighteen patients underwent the procedure with no operative mortality and 2 late deaths.
• Significant improvements observed in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) post-operation (P=.002).
• Patients experienced moderate to major improvements in dyspnea, sustained over a median follow-up of 29.4 months.

Conclusions:

• Thoracoscopic diaphragm plication with a running suture is a safe and effective procedure.
• This technique offers excellent early and long-term improvements in pulmonary function and symptom relief.
• It overcomes the technical difficulties of multiple interrupted sutures in video-assisted thoracoscopic surgery without compromising efficacy or durability.