This video demonstrates a VATS diaphragm plication. The patient had phrenic nerve paralysis of the left hemidiaphragm from an unknown cause. The patient had to give up his job due to shortness of breath and had a restrictive defect that was 30% worse in supine lung function testing. Ventilation scanning also demonstrated only 20% left lung ventilation. He was accepted for VATS plication. The operation was performed using two 5mm ports and a 10mm port using CO2 unsufflation. An endostitch device was used to progressively plicate the diaphragm and pledgets were added to each suture. The operating time was 120 minutes and the patient was discharged on the fourth postoperative day.
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4 Comments
The best video about diaphragm plication. I learned a lot from it, well done Joel.
Thank you . It appeared very straightforward.What is the advantage of not gathering the intermediate portions of diaphragm within the U -stitches. Has it been done on infants ,who develop phrenic nerve palsy after heart surgery !
M. Sharifuzzaman
Thank you for the video. I enjoyed watching it and it appeared very straightforward. I think your point about placing the camera port high to avoid injury is an important one. Also, the monitor should be placed at the foot of the bed for appropriate orientation. As I was watching the video, I thought that the Ty knot device could be useful in this surgery to tie all that suturing. I was wondering if you had any experience with this device? Thanks again for sharing the video!
Thanks for all the positive comments. I didn’t gather the intermediate portion just for ease or suturing and it felt safer to have some diaphragm under the sutures rather than spleen or stomach !! I haven’t tried the Ty know device. I will go and have a look online to learn more about that.
Of note his plication was very tight and the diaphragm below the right. The patient is having a bit of trouble with food in that he feel s full very quickly. I am getting an OGD. Don’t think I placed any sutures in the stomach and that would probably cause bleeding. But I wonder if I did it too tight or too tight medially ? the OGD will tell all but any thoughts on that ?