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Thoracoscopic diaphragmatic plication

T S Guy1, P F Montany

  • 1Department of Surgery, Landstuhl Regional Medical Center, U.S. Army, Germany.

Surgical Laparoscopy & Endoscopy
|August 15, 1998
PubMed
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Video-assisted thoracoscopic surgery (VATS) effectively plicated a paralyzed hemidiaphragm in a patient with diaphragm paralysis. This minimally invasive approach improved symptoms of shortness of breath and breathing difficulties.

Area of Science:

  • Thoracic surgery
  • Minimally invasive procedures
  • Diaphragm plication

Background:

  • Diaphragm paralysis can result from iatrogenic phrenic nerve injury.
  • Phrenic nerve transection during thoracic outlet syndrome surgery can lead to diaphragm paralysis.
  • Symptoms include exertional dyspnea and orthopnea, significantly impacting quality of life.

Observation:

  • A 33-year-old woman with reactive airway disease presented with right hemidiaphragm paralysis.
  • The paralysis stemmed from a phrenic nerve transection during a prior right first rib resection for thoracic outlet syndrome.
  • Video-assisted thoracoscopic surgery (VATS) was employed for diaphragm plication.

Findings:

  • Thoracoscopic plication of the paralyzed hemidiaphragm was successfully performed using VATS.

Related Experiment Videos

  • The procedure mimicked open thoracotomy techniques but with a minimally invasive approach.
  • Postoperative recovery was uneventful, characterized by minimal pain and early patient discharge.

    • Implications:

    • VATS offers a viable and effective alternative for treating diaphragm paralysis.
    • Minimally invasive diaphragm plication can lead to significant improvement in respiratory symptoms.
    • This approach may enhance patient recovery and reduce hospital stay compared to open procedures.