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Related Experiment Video

Updated: Feb 16, 2026

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
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Laparoscopic transdiaphragmatic chest surgery: Early experience.

Rafael Santiago Andrade1, Ilitch Diaz-Gutierrez1, Jacob Hutchins2

  • 1Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.

The Journal of Thoracic and Cardiovascular Surgery
|December 19, 2017
PubMed
Summary

Laparoscopic transdiaphragmatic (LTD) chest surgery offers a minimally invasive approach, reducing postoperative pain and narcotic use compared to conventional VATS. This technique is feasible and safe for various thoracic procedures.

Keywords:
VATSdiaphragmlaparoscopylunglung neoplasmsnarcoticspain

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Area of Science:

  • Thoracic Surgery
  • Minimally Invasive Procedures
  • Surgical Innovation

Background:

  • Conventional video-assisted thoracoscopic surgery (VATS) involves intercostal incisions, potentially leading to significant postoperative pain.
  • Minimizing postoperative pain is a key goal in thoracic surgery to improve patient recovery and outcomes.

Purpose of the Study:

  • To describe the technique and evaluate the safety of laparoscopic transdiaphragmatic (LTD) chest surgery.
  • To assess the potential of LTD chest surgery to reduce postoperative pain and narcotic requirements.

Main Methods:

  • A retrospective review of 28 patients undergoing LTD chest surgery between September 2010 and April 2017.
  • LTD involves abdominal port placement, diaphragmatic openings, and standard VATS for intrathoracic procedures, with diaphragmatic closure at the end.
  • Narcotic use was compared between LTD lung resection patients and historical controls undergoing conventional VATS.

Main Results:

  • 28 LTD procedures were performed for various indications including lung nodules and cancer.
  • Operative times varied, with median times of 138 minutes for wedge resections and 296 minutes for anatomic resections.
  • LTD chest surgery patients demonstrated significantly lower postoperative narcotic use compared to conventional VATS controls (P = .039), with an overall complication rate of 28.6% and no diaphragmatic hernias on follow-up CT scans.

Conclusions:

  • Laparoscopic transdiaphragmatic chest surgery appears feasible and safe in the short- to midterm follow-up period.
  • Further research is needed to define patient selection criteria, optimize operative times, and conduct long-term follow-up and prospective comparisons with conventional VATS.