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Uniportal VATS Diaphragm Plication

Tuesday, July 26, 2016

A 60-year-old patient was referred to the author’s clinic for operative treatment of diaphragm eventration with an unknown cause. Two months prior, the patient had been treated at another hospital for arterial embolism of the right leg, which was subsequently amputated. She was unable to be extubated, without obvious reason. Correction of the right hemidiaphragm was noted as a possible solution, with the goal of improving oxygenation and sink retention. The author performed a double-lined diaphragm plication by means of uniportal VATS with CO2 insufflation and use of the GelPOINT (Applied Medical, Rancho Santa Margarita, USA).

Despite some time-consuming adhesiolysis and the need for lung suturing at the end of the operation, incision to closure time was 120 minutes. Oxygenation remarkably improved after the operation, yet the comatose condition remained. The patient was referred back to the hospital where she initially had begun her therapy for further recovery.


Nice job davor. Well done. The gelport looks great. Have you used it for lobectomies too ? I would love to see it used for a lobectomy too If you have a video of this.
Thanks Joel. I have to admit that this idea crossed my mind indeed. However, I haven't used it so far. I had one case (it is going to be presented on next EACTS in Barcelona) - posterior segmentectomy of the right upper lobe by the patient who already underwent lobectomy on the opposite site. It was quite difficult to maintain a proper ventilation with a single lung (lobe) ventilation. Perhaps it would have been a proper indication, giving a try with CO2 insufflation to certain degree going along with a bilateral lung ventilation.

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