Robot-assisted thoracoscopic plication for diaphragmatic eventration

• Published in: Journal of pediatric surgery Vol. 55; no. 12; pp. 2787 - 2790
• Main Authors: Xu, Pei-pei, Chang, Xiao-pan, Tang, Shao-tao, Li, Shuai, Cao, Guo-qing, Zhang, Xi, Chi, Shui-qing, Fang, Mi-jing, Yang, De-hua, Li, Xiang-yang
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020
• Subjects: Diaphragmatic eventration; Knot-tying; Robot-assisted thoracoscopic plication; Suturing; Thoracoscopic plication; Suturing; Thoracoscopic plication; Robot-assisted thoracoscopic plication; Diaphragmatic eventration; Knot-tying
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2020.06.034

Though conventional thoracoscopic plication is a favorable option of diaphragmatic eventration (DE), ribs limited the movement of trocars, making it difficult to suturing, knot-tying and time-consuming. The purpose of this study was to evaluate delicate surgical maneuvers and suturing time for the management of DE in robot-assisted thoracoscopic plication (RATP). From January 2015 to November 2019, 20 patients (14 males; mean age: 10.5 ± 5.2 months; mean weight: 8.6 ± 4.5 kg) who underwent diaphragmatic plication for DE were reviewed at our institution. There were 13 patients with congenital diaphragmatic eventration and 7 patients with acquired diaphragm eventration after congenital heart surgery. RATP was performed on 9 patients (3 on the left and 6 on the right), and conventional thoracoscopic plication (CTP) was applied to 11 patients (5 on the left and 6 on the right). Demographics, the suturing time and complications were respectively evaluated. There was no difference between 2 groups with respect to gender, age at surgery and weight (p > 0.05). No conversion to thoracotomy was needed. The suturing time in RATP group was shorter than CTP group (27.7 ± 3.4 min vs 48.1 ± 4.2 min, p < 0.001). One patient (9.09%) experienced recurrence in CTP group and none was found in RATP group. Diaphragmatic plication with robot-assisted thoracoscopy or conventional thoracoscopy in DE has minimally invasive and good effect on children. RATP overcome the intercostal limitations to complete delicate suturing and free knot-tying, and has better ergonomics. Level III. •Ribs limited the movement of trocars in conventional thoracoscopic plication of diaphragmatic eventration.•Diaphragmatic plication with robot-assisted thoracoscopy or conventional thoracoscopy in diaphragmatic eventration has minimally invasive and good effect on children.•Robot-assisted thoracoscopic plication overcome the intercostal limitations to complete delicate suturing and free knot-tying, and has better ergonomics.