Right robotic-assisted hybrid diaphragm plication - central tendon fixation

Diaphragm paralysis can lead to significant dyspnoea and, in severe cases, the need for invasive ventilation. Surgical repair via diaphragm plication remains the only surgical option for these patients. Nerve transplantation and pacing have not proven to be effective alternatives. Nevertheless, diaphragm plication, whether through a thoracotomy or via minimally invasive techniques, has proven to yield high recurrence rates during the years following plication surgery. Re-exploration of recurrent cases has identified that plication relapse may be caused secondary to the elasticity of the non-plicated stretched muscle fibres. In contrast, a tendon does not possess elastic properties like those of muscle fibres and thus is not liable to expand gradually over time. We present a novel, minimally invasive technique for diaphragm plication that involves plication of a non-elastic central tendon to a fixed chest wall (central tendon fixation). Utilizing a robotic-assisted approach, our goal was to describe the techniques involved in achieving successful diaphragm plication with mid-term results (2-year follow-up).