Surgical and functional outcomes of uniportal video-assisted thoracoscopic diaphragm plication: a retrospective study

To evaluate the perioperative and functional outcomes, safety, and feasibility of uniportal video-assisted thoracoscopic diaphragm plication in patients with symptomatic unilateral diaphragmatic paralysis or eventration.

Sixty-one symptomatic patients who underwent uniportal video-assisted thoracoscopic diaphragm plication between January 2013 and May 2025 were retrospectively analyzed. Demographics, etiology, operative time, complications, chest tube duration, hospital stay, pre- and postoperative spirometry (forced expiratory volume in 1 s, forced vital capacity), modified Medical Research Council dyspnea scores, visual analog scale pain scores, and rescue opioid use duration were evaluated.

Mean age was 53.5 ± 12.6 years, and 39 patients (63.9%) were male. Etiologies included idiopathic (44.3%), iatrogenic/postoperative (26.2%), traumatic (23.0%), infectious/inflammatory (3.3%), and other identifiable causes (3.3%). All procedures were completed via a uniportal approach without conversion to thoracotomy. Mean operative time was 45.2 ± 9.1 min, and mean hospital stay was 3.2 ± 1.2 days. Forced expiratory volume in 1 s increased from 1.63 ± 0.25 L preoperatively to 2.02 ± 0.30 L at 6 months and 2.00 ± 0.28 L at 12 months (p < 0.001). Forced vital capacity increased from 1.95 ± 0.32 L to 2.44 ± 0.38 L and 2.42 ± 0.35 L at 6 and 12 months, respectively (p < 0.001). Median dyspnea scores improved from 3 to 1 (p < 0.001), with symptomatic improvement in 95.1% of patients at 12 months. Four patients (6.6%) had Clavien-Dindo grade II-IIIa complications; no plication failure or recurrence occurred.

Uniportal video-assisted thoracoscopic diaphragm plication was feasible and associated with low morbidity, short hospital stay, and sustained improvements in pulmonary function and dyspnea through 12 months of follow-up.