1
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Yongue C, Geraci TC, Chang SH. Management of Diaphragm Paralysis and Eventration. Thorac Surg Clin 2024; 34:179-187. [PMID: 38705666 DOI: 10.1016/j.thorsurg.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
An elevated diaphragm may be due to eventration or paralysis. Diaphragm elevation is often asymptomatic and found incidentally on imaging. Fluoroscopic testing can be used to differentiate eventration (no paradoxic motion) from paralysis (paradoxic motion). Regardless of etiology, a diaphragm plication is indicated in all symptomatic patients with an elevated diaphragm. Plication can be approached either from a thoracic or abdominal approach, though most thoracic surgeons perform minimally invasive thoracoscopic plication. The goal of plication is to improve lung volumes and decrease paradoxic elevation of the hemidiaphragm. Diaphragm plication is safe, has excellent outcomes, and is associated with symptom improvement.
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Affiliation(s)
- Camille Yongue
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA.
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2
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Rameni DA, Worrell SG. Reconstructive Techniques for Diaphragm Resection. Thorac Surg Clin 2024; 34:127-131. [PMID: 38705660 DOI: 10.1016/j.thorsurg.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
A variety of diaphragmatic and non-diaphragmatic pathologies may require resection, reconstruction, or repair of the diaphragm. Adequate reconstruction is crucial in cases of diaphragmatic resection to prevent the herniation of abdominal organs into the chest and to maintain optimal respiratory function. This article aims to provide a detailed overview of the techniques used for surgical diaphragm reconstruction, taking into account factors such as the size and location of the defect, available options for reconstructive materials, potential challenges and pitfalls, and considerations related to the recurrence or failure of the repair.
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Affiliation(s)
- Dina Al Rameni
- Divison of Cardiothoracic Surgery, Department of Surgery, University of Arizona- College of Medicine, 1501 North Campbell Avenue, Room #4302, PO Box 245071, Tucson, AZ 85724, USA. https://twitter.com/DinaSRamini
| | - Stephanie G Worrell
- Divison of Cardiothoracic Surgery, Department of Surgery, University of Arizona- College of Medicine, 1501 North Campbell Avenue, Room #4302, PO Box 245071, Tucson, AZ 85724, USA; University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
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3
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Balamurugan G, Bhandarwar A, Wagh A, Bakhshi G, Ansari K, Bhondve S, Dhimole N, Jawale H. Comparison of short-term outcomes of video-assisted thoracoscopic (VATS) plication of diaphragmatic eventration - a six-year prospective cohort study. Updates Surg 2024; 76:279-288. [PMID: 37436542 DOI: 10.1007/s13304-023-01583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
Diaphragmatic eventration is one of the rarest conditions characterized by elevation of the hemidiaphragm while maintaining its normal attachments. In recent years, video-assisted thoracoscopic surgery (VATS) has gained popularity for diaphragmatic surgery. In this study, we share our experience over six years with VATS plication of diaphragmatic eventration. We conducted a prospective study at our institute for six years from April 2016 to March 2021, which included 37 symptomatic patients with diaphragmatic eventration. The sample size reported in this study is one of the largest to date for VATS diaphragmatic plication. Of these, 18 patients underwent combined stapler and suture plication, and 19 patients underwent single modality approach (10-stapled resection, 9-suture alone plication). All patients were followed-up for a minimum of 2 years. Comparative analysis of the combined approach and the single modality approach was performed. The mean operative time was significantly longer with the combined approach (p value < 0.01). However, there was no difference in postoperative pain (p value = 0.50), analgesia requirement (p value = 0.72), or pleural drainage (p value = 0.32) between the two approaches. Although not statistically significant, the combined approach had fewer post-operative complications (p value = 0.32). Besides, the Single modality approach resulted in one recurrence (p value = 0.32) and one mortality (p value = 0.32). VATS diaphragmatic plication using staplers and/or sutures is safe and efficacious in the management of diaphragmatic eventration. Surgeons should consider using both staplers and sutures whenever possible, rather than selecting one over the other.
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Affiliation(s)
- G Balamurugan
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India.
| | - Ajay Bhandarwar
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Amol Wagh
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Girish Bakhshi
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Kashif Ansari
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Supriya Bhondve
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Nikhil Dhimole
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Hemant Jawale
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
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4
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Beshay M, Abdel Bary M, Kösek V, Vordemvenne T, Mertzlufft F, Schulte am Esch J. Minimally-Invasive Diaphragmatic Plication in Patients with Unilateral Diaphragmatic Paralysis. J Clin Med 2023; 12:5301. [PMID: 37629343 PMCID: PMC10455218 DOI: 10.3390/jcm12165301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Diaphragm eventration (DE) represents a frequent problem with consecutive major impacts on respiratory function and the quality of life of the patients. The role of diaphragmatic plication (DP) is still underestimated. The aim of the present study is to evaluate the efficacy of minimally-invasive surgical diaphragmatic plication for the management of unilateral diaphragmatic eventration, to the best of our knowledge, this is the largest series reported in the literature using a non-resectional technique. Methods: All patients with unilateral diaphragmatic paralysis admitted for diaphragmatic plication (DP) between January 2008 and December 2022 formed the cohort of this retrospective analysis. DP procedure was done to plicate the diaphragm without resection or replacement with synthetic materials. Patients were divided into two groups: Group I included patients who underwent DP through an open thoracotomy, and Group II included patients who underwent DP through video-assisted thoracoscopic surgery (VATS). Data from all patients were collected prospectively and subsequently analyzed retrospectively. Patients' characteristics, lung function tests, radiological findings, type of surgical procedures, complications, and postoperative follow-up were compared. The primary outcome measure was the postoperative result (deeper position of the paralyzed diaphragm) and improvement of dyspnea. The secondary outcome was lung function values over a long-term follow-up. Results: The study included a total of 134 patients who underwent diaphragmatic plication during the study period. 94 (71.7%) were males, mean age of 64 (SD ± 14.0). Group I (thoracotomy group) consisted of 46 patients (35 male). Group II (VATS-group) consisted of 88 patients (69 male). The majority of patients demonstrated impaired lung functions (n = 126). The mean length of diaphragmatic displacement was 8 cm (SD ± 113.8 cm). The mean duration of the entire procedure, including placement of the epidural catheter (EDC), was longer in group I than in group II (p = 0.016). This was also observed for the mean length of the surgical procedure itself (p = 0.031). Most patients in group I had EDC (n = 38) (p = 0.001). Patients in group I required more medication for pain control (p = 0.022). A lower position of the diaphragm was achieved in all patients (p < 0.001). The length of hospital stay was 7 (SD ± 4.5) days in group I vs. 4.5 (SD ± 3.2) days in group II (p = 0.036). Minor complications occurred in 3% (n = 4) in group I vs. 2% (n = 3) in group II. No mortality was observed in any of the groups. Postoperative follow-up of patients at 6, 12, and 24 months showed a significant increase in forced vital capacity (FVC) up to 25% (SD ± 10%-35%) (p = 0.019), in forced expiratory volume in 1 s (FEV1) up to 20% (SD ± 12%-38%) in both groups (p = 0.026), also in the diffusion capacity of carbon monoxide (DLCO) up to 15% (SD ± 10%-20%) was noticed in both groups. Chronic pain symptoms were noted in 13% (n = 6) in group I vs. 2% (n = 2) in group II (p = 0.014). Except for one patient in group II, no recurrence of DE was observed. Conclusions: Diaphragm plication is an effective procedure to reduce debilitating dyspnea and improve lung function in patients suffering from diaphragm eventration. Minimally invasive diaphragmatic plication using VATS procedures is a safe and feasible procedure for the management of unilateral diaphragmatic paralysis. VATS-DP is superior to open procedure in terms of pain management and length of hospital stay, hence, accelerated recovery is more likely. Careful patient selection is crucial to achieving optimal outcomes. Prospective studies are needed to validate these results.
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Affiliation(s)
- Morris Beshay
- Department of General Thoracic Surgery, University Hospital OWL, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Mohamed Abdel Bary
- Department of Cardiothoracic Surgery, South Valley University, Qena 83523, Egypt;
| | - Volkan Kösek
- Department of Thoracic Surgery, Klinik am Park, Klinikum, 44536 Luenen, Germany;
| | - Thomas Vordemvenne
- Department of Accident and Trauma Surgery, University Hospital OWL, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany;
| | - Fritz Mertzlufft
- Forschungsverbund BioMedizin Bielefeld, OWL (FBMB e.V.), Maraweg 21, 33699 Bielefeld, Germany;
| | - Jan Schulte am Esch
- Department of General and Visceral Surgery, University Hospital OWL, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany;
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5
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Le UT, Titze L, Passlick B, Schmid S. [Robotic Diaphragm Plication]. Zentralbl Chir 2023; 148:S41-S47. [PMID: 36889335 DOI: 10.1055/a-2003-1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Acquired unilateral hemidiaphragm elevation is characterised by dyspnoea, which is typically aggravated when lying down, bending over or during swimming. The most common causes are idiopathic or due to injury to the phrenic nerve during cervical or cardio-thoracic surgery. To date, surgical diaphragm plication remains the only effective treatment. The aim of the procedure is to plicate the diaphragm to restore its tension and thus improve breathing mechanics, increase the available space for the lung and reduce compression from abdominal organs. In the past, various techniques using open and minimally invasive approaches have been described. Robot-assisted thoracoscopic diaphragm plication combines the advantages of a minimally invasive approach with excellent visualisation and freedom of movement. It was shown to be a safe technique which is easy to establish and can significantly improve pulmonary function.
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Affiliation(s)
- Uyen-Thao Le
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Laurin Titze
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | | | - Severin Schmid
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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Gritsiuta AI, Gordon M, Bakhos CT, Abbas AE, Petrov RV. Minimally Invasive Diaphragm Plication for Acquired Unilateral Diaphragm Paralysis: A Systematic Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:180-190. [PMID: 35549933 DOI: 10.1177/15569845221097761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Diaphragm paralysis is a relatively uncommon entity that can be both congenital and acquired in nature. While commonly asymptomatic, it can also cause a significant decrease in pulmonary function and reserve, particularly in patients with underlying pulmonary diseases. Our aim was to summarize the current literature regarding the minimally invasive techniques used in the surgical correction of acquired diaphragm paralysis via traditional and robotic minimally invasive approaches. Methods: We conducted a systematic review of available literature using the Cochrane methodology and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 6,561 citations were identified through initial database and reference searches, of which 90 articles met the inclusion criteria for review. After further assessment, 33 appropriate full-text studies were selected for the review. Of the selected publications, the majority represented case reports and single-center retrospective studies with level of evidence 4. Only 1 level 2b study (individual cohort study) was identified, comparing minimally invasive and open approaches. Conclusions: Each of the minimally invasive approaches has its unique benefits and disadvantages, which are summarized and delineated in this article. Ultimately, no preferred method of diaphragm plication for diaphragm paralysis can be recommended at this time based on clinical data. The choice of procedure and surgical approach continues to be selected based on the surgeon's experience and preference.
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Affiliation(s)
- Andrei I Gritsiuta
- Department of Surgical Services, 6595University of Pittsburgh Medical Center, PA, USA
| | - Matthew Gordon
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Charles T Bakhos
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Abbas E Abbas
- Department of Thoracic Oncology, 12321Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Roman V Petrov
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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7
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Abdel-Bary M, Rashad A, Elgendy H, Zaki M, Abdelhamid MY, Beshay M, Abdelaal KM. Clinical and sonographic evaluation of the diaphragm after plication in adults with unilateral eventration: a retrospective study. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-021-00108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration.
Results
Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P < 0.001), and 6 months 2.6 ± 0.9 cm (P < 0.001), compared to preoperative values (10.1 ± 2.8 cm). diaphragm ultrasonography showed normal motility of the plicated cupola in all cases, and there was a highly significant decrease in the mean height of eventration at 1 week (3.1 ± 1.1 cm, P < 0.001), and 6 months (2.3 ± 0.5 cm, P < 0.001) compared to preoperative values (10.3 ± 2.2 cm). There was a highly significant increase in the diaphragm thickness at 1 week (2.7 ± 0.3 mm, P < 0.001), and 6 months (2.9 ± 0.2 mm, P < 0.001), compared to the preoperative value. There was a highly significant improvement in the degree of excursion 1 week (25 ± 4.3 mm, P < 0.001), and 6 months (28 ± 5.2 mm, P < 0.001), compared to the preoperative value (15 ± 6.2 mm). No fluid collection or surroundings organ injuries were detected. The mean FVC and FEV1 showed a highly significant improvement at 1 week (66.7 ± 6%, 78.2 ± 9.8%), and 6 months (68.8 ± 5.7%, 80.4 ± 10.3%), compared to the preoperative value (58.8 ± 8% and 70.9 ± 10.3%).
Conclusions
Surgical diaphragmatic plication is an effective and safe procedure that can be performed to treat symptomatic adults with unilateral diaphragmatic eventration. Diaphragm ultrasonography can be used as a simple bedside test to evaluate unilateral diaphragmatic eventration cases and their postoperative follow-up.
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8
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Kimura Y, Ishioka D, Kamiyama H, Tsujinaka S, Rikiyama T. Laparoscopic surgery for strangulated diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: a case report. Surg Case Rep 2021; 7:206. [PMID: 34529186 PMCID: PMC8446140 DOI: 10.1186/s40792-021-01291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC), but delayed thermal damage can cause diaphragmatic hernia (DH). Surgery is recommended for DH, and open surgery is widely accepted. This report presents a case of laparoscopic surgery for strangulated DH that occurred after RFA. CASE PRESENTATION An 80-year-old woman with a history of hepatitis C-induced liver cirrhosis and HCC was admitted to our institution owing to sudden-onset intense epigastric pain. Twenty-two months earlier, she received RFA treatment for HCC located in segment 6/7. Contrast-enhanced computed tomography revealed herniation of the small intestine into the thoracic cavity, with mesenteric fat haziness. Emergency laparoscopic surgery was performed, and the patient was diagnosed with strangulated DH associated with the prior RFA. The defect was closed using absorbable sutures, and the ischaemic small intestine was resected via mini-laparotomy. The patient was discharged on the 10th postoperative day without complications, and no evidence of DH recurrence 15 months after surgery was noted. CONCLUSIONS Laparoscopic surgery seems useful and feasible for strangulated DH.
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Affiliation(s)
- Yasuaki Kimura
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan. .,Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan.
| | - Daisuke Ishioka
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan.,Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Hidenori Kamiyama
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
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9
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Draeger H, Salman J, Aburahma K, Becker LS, Siemeni T, Boethig D, Sommer W, Avsar M, Bobylev D, Schwerk N, Müller C, Greer M, Gottlieb J, Welte T, Hoeper MM, Hinrichs JB, Tudorache I, Kühn C, Haverich A, Warnecke G, Ius F. Impact of unilateral diaphragm elevation on postoperative outcomes in bilateral lung transplantation - a retrospective single-center study. Transpl Int 2021; 34:474-487. [PMID: 33393142 DOI: 10.1111/tri.13812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022]
Abstract
This study evaluated the impact of unilateral diaphragm elevation following bilateral lung transplantation on postoperative course. Patient data for all lung transplantations performed at our institution between 01/2010 and 12/2019 were reviewed. Presence of right or left diaphragm elevation was retrospectively evaluated using serial chest X-rays performed while patients were standing and breathing spontaneously. Right elevation was defined by a > 40 mm difference between right and left diaphragmatic height. Left elevation was present if the left diaphragm was at the same height or higher than the right diaphragm. In total, 1093/1213 (90%) lung transplant recipients were included. Of these, 255 (23%) patients exhibited radiologic evidence of diaphragm elevation (right, 55%; left 45%; permanent, 62%). Postoperative course did not differ between groups. Forced expiratory volume in 1 second, forced vital capacity and total lung capacity were lower at 1-year follow-up in patients with permanent than in patients with transient or absent diaphragmatic elevation (P = 0.038, P < 0.001, P = 0.002, respectively). Graft survival did not differ between these groups (P = 0.597). Radiologic evidence of diaphragm elevation was found in 23% of our lung transplant recipients. While lung function tests were worse in patients with permanent elevation, diaphragm elevation did not have any relevant impact on outcomes.
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Affiliation(s)
- Helge Draeger
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
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10
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Bin Asaf B, Kodaganur Gopinath S, Kumar A, Puri HV, Pulle MV, Bishnoi S. Robotic diaphragmatic plication for eventration: A retrospective analysis of efficacy, safety, and feasibility. Asian J Endosc Surg 2021; 14:70-76. [PMID: 32677317 DOI: 10.1111/ases.12833] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Eventration of the diaphragm results in impaired respiratory mechanics, which leads to symptoms of dyspnea. Robotic diaphragmatic plication is a recently reported technique that has had good immediate outcomes. The aim of this study was to describe our transthoracic and transabdominal plication techniques and to analyze the safety, efficacy, and feasibility of robotic diaphragmatic plication in an Indian setting. METHODS This retrospective study was conducted at a large tertiary care center in a dedicated thoracic surgery unit. To measure the efficacy of plication, we administered a pulmonary function test to each patient at baseline and 6 months postoperatively and then compared the results. RESULTS Eighteen patients underwent robotic diaphragmatic plication during the study period. Of these 18 patients, 12 underwent surgery via a transabdominal approach, and 6 underwent surgery via a transthoracic approach. Surgery was completed robotically in 17 patients. The comparison of the preoperative and postoperative pulmonary function test results showed that the mean ± SD increase in forced expiratory volume in 1 second (FEV1 ) was 19.9 ± 22.0% (P = .002) and the mean increase in FEV1 /forced vital capacity was 5.7 ± 2.5 % (P = .225), indicating a significant improvement in FEV1 after surgery. CONCLUSION Robotic diaphragmatic plication can be performed transthoracically or transabdominally with good surgical outcomes. It is safe, effective, and feasible.
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Affiliation(s)
- Belal Bin Asaf
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Arvind Kumar
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Harsh Vardhan Puri
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mohan V Pulle
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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11
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Patel DC, Berry MF, Bhandari P, Backhus LM, Raees S, Trope W, Nash A, Lui NS, Liou DZ, Shrager JB. Paradoxical Motion on Sniff Test Predicts Greater Improvement Following Diaphragm Plication. Ann Thorac Surg 2020; 111:1820-1826. [PMID: 33031777 DOI: 10.1016/j.athoracsur.2020.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/25/2020] [Accepted: 07/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diaphragm plication (DP) improves pulmonary function and quality of life for those with diaphragm paralysis or dysfunction. It is unknown whether differing degrees of diaphragm dysfunction as measured by sniff testing affect results after plication. METHODS Patients who underwent minimally invasive DP from 2008 to 2019 were dichotomized based on sniff test results: paradoxical motion (PM) versus no paradoxical motion (NPM); the latter included normal, decreased, and no motion. Preoperative and postoperative pulmonary function testing (PFT) after DP was compared between groups. The impact of the diaphragm height index, a measure of diaphragm elevation, was also assessed. RESULTS A total of 26 patients underwent preoperative sniff testing, DP, and postoperative PFT. Including all patients, DP resulted in a 17.8% ± 5.5% improvement in forced expiratory volume in 1 second (P < .001), a 14.4% ± 5.3% improvement in forced vital capacity (P < .001), and a 4.7% ± 4.6% improvement in the diffusing capacity of carbon monoxide (P = .539). There were greater improvements in the PM group (n = 16) compared with the NPM group (n = 10) for forced expiratory volume in 1 second (27.2% ± 6.0% versus 3.9% ± 6.2%; P = .017) and forced vital capacity (28.1% ± 5.3% versus -0.5% ± 3.3%; P = .001). There was no difference in the change in the diffusing capacity of carbon monoxide between groups. There were no differences between patients with PM and NPM in the postoperative course or complications. No value for diaphragm height index predicted improvement in PFT after DP. CONCLUSIONS Patients with PM on sniff test have dramatically greater objective improvements in pulmonary function after plication compared with those without PM. Most patients without PM do not demonstrate improvement in standard PFT. Improvements in dyspnea require additional study.
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Affiliation(s)
- Deven C Patel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Health System, Palo Alto, California
| | - Shehzaib Raees
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Winston Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Abraham Nash
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Health System, Palo Alto, California.
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12
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Bawazir OA, Banaja AM. Thoracoscopic repair of diaphragmatic eventration in children: a comparison of two repair techniques. J Pediatr Surg 2020; 55:1152-1156. [PMID: 31937447 DOI: 10.1016/j.jpedsurg.2019.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/27/2019] [Accepted: 11/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thoracoscopic plication has gained popularity in the management of diaphragmatic eventration, and several suturing techniques have been described. However, the superiority of one technique over the other has not been demonstrated. The purpose of this study is to report our experience with diaphragmatic plication and to compare the thoracoscopic interrupted and pleated suture techniques in pediatric patients with diaphragmatic eventration. METHODS This is a retrospective cohort study (level of evidence: 3) performed on 14 patients with diaphragmatic eventration. All patients were symptomatic and had diaphragmatic plication via thoracoscopy. The patients were further divided into two groups according to the repair technique; interrupted repair (n = 9) and pleated repair (n = 5). Preoperative, operative and postoperative data were compared between the two groups. RESULTS The median age was 9.5 months (25th- 75th percentiles: 6 to 15 months), and 8 (57%) were males. Twelve patients (85.71%) had right side eventration, and nine patients (64.29%) had congenital diaphragmatic eventration. One case was converted to open thoracotomy because of adhesions. There was no difference in the preoperative characteristics between both groups. Median operative time was 117 min (25th- 75th percentiles: 101-129 min) and 77 min (25th- 75th percentiles: 73-83 min) in the interrupted and pleated groups, respectively (p = 0.004). One patient had a postoperative elevation of the diaphragm (incomplete repair) in the pleated group (p = 0.357). No recurrence was reported during the follow-up. CONCLUSION Thoracoscopic plication is an effective technique for management of diaphragmatic eventration in children. Pleating technique is easy, fast, and associated with a marked reduction in operative time. TYPE OF THE STUDY Retrospective cohort study. LEVELS OF EVIDENCE Level of evidence: 3.
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Affiliation(s)
- Osama A Bawazir
- Department of Surgery, Umm Al-Qura University; King Faisal Specialist Hospital & Research Centre.
| | - Abdulaziz M Banaja
- Department of Surgery, Umm Al-Qura University; King Faisal Specialist Hospital & Research Centre.
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13
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Parlak A, Gurpınar AN, Dogruyol H. Double purse-string suturing: An easy plication technique in thoracoscopic repair of diaphragmatic eventration. J Pediatr Surg 2020; 55:967-971. [PMID: 31761455 DOI: 10.1016/j.jpedsurg.2019.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/15/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to describe a new double purse-string suturing plication method that was developed to minimize difficulties experienced in thoracoscopic plication in pediatric patients. METHODS We retrospectively analyzed the data of patients that underwent diaphragmatic eventration repair with new technique developed in our clinic. In this technique, we perform diaphragm plication with continuous double layer purse-string suturing. A third suturing may be necessary in case of wide eventrations. Thoracic drainage catheter is inserted into the thorax on a routine basis. RESULTS Thoracoscopic plication was performed using the double purse-string suturing technique on 16 cases that presented with diaphragmatic eventration between April 2012 and December 2018. The patients' mean age was 2.2 years (6 months-17 years). The main causes of admission were recurrent respiratory system infections (n: 14), respiratory distress with effort (n: 4), ventilator dependence (n: 1), and gastrointestinal complaints such as nutritional problems (n: 1). Diaphragmatic eventration was incidentally detected in 1 patient. No complications were observed during the postoperative period, except for 1 patient that developed pneumothorax. The mean duration of hospital stay was 4.9 days (2-7 days), except for 1 patient who had ventilator dependence and congenital myopathy. The mean descending distance of the diaphragm was 2.3 intercostal spaces at postoperative first month. The clinical outcomes were satisfactory and all patients experienced symptom improvements. CONCLUSIONS Diaphragm plication with double purse-string suturing method enables symmetrical stretching of the diaphragmatic muscles. Therefore, the diaphragmatic surface and costophrenic sinium are protected and remain functional. The advantages of this new double purse-string suturing method are easy application and durability. We believe that this method can become a preferred thoracoscopic plication technique for treatment of diaphragmatic eventration.
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Affiliation(s)
- Ayse Parlak
- Department of Pediatric Surgery, Uludag University Medical Faculty, Bursa, Turkey.
| | - Arif Nuri Gurpınar
- Department of Pediatric Surgery, Uludag University Medical Faculty, Bursa, Turkey
| | - Hasan Dogruyol
- Department of Pediatric Surgery, Uludag University Medical Faculty, Bursa, Turkey
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14
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Le Pimpec-Barthes F, Hernigou A, Mazzella A, Legras A, Rivera C, Bouacida I, Arame A, Badia A, Das Neves Pereira JC, Morelot-Panzini C, Similowski T, Riquet M, Vilfaillot A, Mangiameli G. Dynamic magnetic resonance imaging in unilateral diaphragm eventration: knowledge improvement before and after plication. J Thorac Dis 2019; 11:3467-3475. [PMID: 31559052 DOI: 10.21037/jtd.2019.07.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The assessment before surgical plication for unilateral hemidiaphragm (HD) eventration is not clearly defined and no precise criteria exist to really understand which patient is operated with which results depending on the technique used. The goal of this study was to evaluate the place of dynamic magnetic resonance imaging (dMRI) before and after plication by developing measurement criteria. Methods Between 2006 and 2017, 18 patients (group1: Gp1) were operated for eventrations, 15 left-sided (Gp1L) and 3 right-sided (Gp1R). All had preoperative and postoperative evaluations including dMRI and pulmonary function tests. Five healthy volunteer subjects (group2: Gp2) had the same imaging protocol. For each HD, we measured the respiratory excursion at three fixed points (S1, S2, S3) and the height of curvature on sagittal plane. We also searched for upward paradoxical diaphragm movements. Results Before surgery, no excursion (n=13) or extremely reduced excursion (n=5) was detected on the injured HD (IHD) in Gp1. Upward paradoxical movements were identified only in Gp1L (n=6). Compared with Gp2 subjects, the healthy HD for Gp1L patients had significantly reduced excursion values at three sites S1 (P=0.038), S2 (P=0.006), and S3 (P=0.004). After plication, the decreasing height of curvature confirmed a tightening of the IHD in all patients (median value from 100 to 39.5 mm in Gp1L and 92 to 74 mm in Gp1R, P=0.0001). All upward paradoxical movements disappeared. Healthy HD excursions in Gp1L normalised their values. All those imaging improvements were correlated with postoperative improvements of dyspnoea score (P<0.0001) and vital capacity (P=0.002). Conclusions dMRI and the standardised grid we developed not only improve the knowledge of unilateral diaphragm eventration but also permit to evaluate the quality of its surgical repair. It also demonstrates that a dysfunction of the healthy HD contralateral to eventration is possible and reversible after plication of the IHD.
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Affiliation(s)
- Francoise Le Pimpec-Barthes
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Anne Hernigou
- Department of radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antonio Mazzella
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Legras
- Department of Thoracic and Cardiovascular Surgery, Hôpital Trousseau, Chru de Tours, Paris, France
| | - Caroline Rivera
- Division of Surgery, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Imen Bouacida
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alex Arame
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Badia
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Juan Carlos Das Neves Pereira
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Capucine Morelot-Panzini
- Division of Respiratory and Intensive Medicine Unit, Groupe Hospitalier Pitié-Salpêtrière, Paris, France Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Thomas Similowski
- Division of Respiratory and Intensive Medicine Unit, Groupe Hospitalier Pitié-Salpêtrière, Paris, France Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Marc Riquet
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Vilfaillot
- Clinical Investigation Unit, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, INSERM, Clinical Investigation Unit 1418, Paris, France
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery and Lung Transplantation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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15
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Takahashi Y, Miyajima M, Mishina T, Maki R, Tada M, Tsuruta K, Watanabe A. Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer. J Cardiothorac Surg 2018; 13:86. [PMID: 29986737 PMCID: PMC6038337 DOI: 10.1186/s13019-018-0766-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background Combined resection of a phrenic nerve is occasionally required in T3 primary lung carcinomas invading the phrenic nerve to completely remove a malignant tumour, resulting in diaphragmatic paralysis. We describe the first case of thoracoscopic lobectomy and diaphragmatic plication as a one-stage surgery for lung cancer invading the phrenic nerve. Case presentation A 56-year-old woman with a T3N0M0 primary adenosquamous carcinoma in the left upper lobe presented with suspicious invasion to the anterior mediastinal fat tissue and left phrenic nerve and underwent left upper lobectomy, node dissection, and partial resection of the anterior mediastinal fat tissue with the left phrenic nerve. Furthermore, thoracoscopic diaphragmatic plication was performed as a concomitant procedure. The patient’s postoperative course was favourable, without any complications, and respiratory function was preserved for 1 year postoperatively. Conclusions Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer invading the phrenic nerve is effective for preservation of postoperative pulmonary function.
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Affiliation(s)
- Yuki Takahashi
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Masahiro Miyajima
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Taijiro Mishina
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Ryunosuke Maki
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Makoto Tada
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Kodai Tsuruta
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Atsushi Watanabe
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan.
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16
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Kim MP, Chan EY. Knotless suture allows for successful thoracoscopic diaphragm plication. J Surg Case Rep 2018; 2017:rjx225. [PMID: 29423156 PMCID: PMC5798015 DOI: 10.1093/jscr/rjx225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/28/2017] [Indexed: 11/13/2022] Open
Abstract
Diaphragm paralysis can cause significant shortness of breath. This condition can be treated with diaphragm plication. We illustrate two cases where we used a knotless suture and total portal thoracoscopic technique to successfully plicate the diaphragm. A 70-year-old female with right-sided and a 44-year-old male with left-sided diaphragm paralysis. Both patients had a sniff test that showed paradoxical movement of the diaphragm. The port placements during the procedure were different due to the laterality but both patients had three 5-mm ports and one 12-mm port for the procedure. Plication was performed using the Endo Stitch knotless suture. Both patients went home on post-operative Day 1 without any complications. After 1 month, both patients had significant improvement in shortness of breath with resolution of the diaphragm elevation.
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Affiliation(s)
- Min P Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Edward Y Chan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
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17
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Vats Plication of the Diaphragm a Descriptive Observational 10-Year Southampton Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:398-405. [DOI: 10.1097/imi.0000000000000441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective The aim of the study was to report the safety and efficacy of video-assisted thoracoscopic (VATS) plication of the diaphragm at our institution between 2006 and 2016. Methods Adult patients selected on etiology and combination of investigations including plain chest x-ray, computed tomography of chest and abdomen, lung functions in supine and sitting positions, radiological/ultrasonic screening for diaphragmatic movement, and phrenic nerve conduction studies. We incorporated a triportal VATS and Endostitch device for plication, using CO2 insufflation to maximum 12 mm Hg. Bilateral simultaneous plication and high-risk patients were electively admitted to intensive therapy unit postoperatively. Results Thirty-five patients (24 males) had their diaphragm plicated. The mean age was 56.6 years (range = 23–76 years). The mean body mass index was 32.1 (range = 22.2–45.4). Twenty one were right, 13 left, 2 patients had VATS simultaneous bilateral plication, and 1 had sequential VATS bilateral plication. Paralysis was idiopathic in 17, posttraumatic in 5, postremoval of mediastinal tumor in 4, and postcardiac surgery in 3. All patients presented with lifestyle-limiting dyspnea and orthopnea, three were on nocturnal noninvasive ventilation. Five were diabetic and 16 were smokers. The mean supine forced expiratory volume in the first second was 62.5% of predicted. Twenty two were performed by VATS (63%), three converted to thoracotomy, and 13 were open limited thoracotomy (historic). The mean hospital stay was 4.5 days (range = 1–18, mode 2 days). Intensive therapy unit admission was required in six patients for mechanical ventilation 0 to 3 days. Five patients (14%) had no improvement in symptoms. There were no deaths, no 30-day readmissions, and no long-term neuralgia in this series. Conclusions We found minimal access VATS plication of the diaphragm to be feasible and safe, but no firm conclusions should be drawn from our limited resources. We report the feasibility of concomitant bilateral VATS plication of the diaphragm in two adults, and this was not previously reported in the adult population. There is a need for further good quality, prospective studies, and randomized controlled studies evaluating efficacy of VATS diaphragmatic plication.
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Taberham RJ, Raza A, Alzetani A, Woo EB, Chamberlain MH, Koulaxouzidis G, Amer KM. Vats Plication of the Diaphragm a Descriptive Observational 10-Year Southampton Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rhona J. Taberham
- Cardiovascular & Thoracic Centre, Southampton General Hospital, Southampton, UK
| | - Adnan Raza
- Cardiovascular & Thoracic Centre, Southampton General Hospital, Southampton, UK
| | - Aiman Alzetani
- Cardiovascular & Thoracic Centre, Southampton General Hospital, Southampton, UK
| | - Edwin B. Woo
- Cardiovascular & Thoracic Centre, Southampton General Hospital, Southampton, UK
| | | | | | - Khalid M. Amer
- Cardiovascular & Thoracic Centre, Southampton General Hospital, Southampton, UK
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19
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Biswas Roy S, Haworth C, Ipsen T, Kang P, Hill D, Do A, Kuo E. Transabdominal robot-assisted diaphragmatic plication: a 3.5-year experience. Eur J Cardiothorac Surg 2017; 53:247-253. [DOI: 10.1093/ejcts/ezx255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/09/2017] [Indexed: 11/14/2022] Open
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20
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Freeman RK. Sometimes it is not as much about how as it is about why. J Thorac Cardiovasc Surg 2017; 153:1180-1181. [PMID: 28238409 DOI: 10.1016/j.jtcvs.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Richard K Freeman
- Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Ind.
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21
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Greene CL, McFadden PM. You can run, but you can't hide: Good technique but imperfect science. J Thorac Cardiovasc Surg 2017; 153:1189-1190. [PMID: 28185648 DOI: 10.1016/j.jtcvs.2016.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Christina L Greene
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - P Michael McFadden
- Department of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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