Thoracoscopic Diaphragmatic Plication
Timestops (4)
Tools Used
Topic Overview
Key Takeaways
- Thoracoscopic diaphragmatic plication uses 3 ports with camera below scapula; CO2 insufflation compresses lung without single-lung ventilation.
- Place 5-6 reefing sutures in rows using knot pusher due to tension; each stitch takes ≥3 bites to roll and flatten diaphragm effectively.
- Avoid excessive tension on individual sutures to prevent diaphragmatic muscle tear; expect 10-15% repair laxity loss in first weeks post-op.
- No chest tube typically required; patients often wean rapidly from ventilator and extubate early after procedure.
- Second imbrication row further reduces diaphragmatic laxity; surgeon positioned at patient's head with lateral decubitus positioning.
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Transcript
This video demonstrates a thoracoscopic diaphragmatic placation in an infant who had ventation. Here you can see the patient positioning with the surgeon located near the patient's head and the patient in a lateral decubitus position. Anesthesia is near the patient's face. Here you see the port placement. The camera port is placed just below the tip of the scapula, and the right and left hand operating ports are placed in the anterior and posterior axillary line. Here you can see the first ditch being cinched down. Single lung ventilation is generally not required, and CO2 is used to compress the lung as well as help compress the diaphragm. A series of reefing sutures are placed and because of the tension and the small spaces and difficult angles, in general, generally we use a knot pusher to tie these sutures down. A 5 millimeter step port is placed for access with the right hand, and an RB1 needle on a 2 at the bond suture can be dragged down through this using a 3 millimeter needle driver. A series of reefing sutures are then placed, um, getting at least 3 bites of the diaphragm which each stitch, which helps roll the diaphragm in and flatten it out. In general, 5 or 6 sutures are placed in line for the initial. Set of lication sutures. With each suture, more room develops within the chest cavity and makes the placement of further sutures easier. You can see that we grab slightly further back with each stitch to placate more of the diaphragm. As we progress Care should be taken not to apply too much tension on any one suture as these stitches can tear through the diaphragmatic muscle. These sutures can also be tied internally, but again, because the tissues are relatively strong. Uh, and there is a fair amount of tension while trying to flatten the diaphragm and not for sure works well. Now with the initial row of sutures put in, a 2nd row is placed, again, bringing in. More tissue. And decreasing the laxity in the diaphragm. In general, you will lose about 10 to 15% of your repair uh after the first few weeks as measured on chest X-ray, but this is not usually significant. Here you see the 2nd row of sutures going in. Uh, imbricating the first row. We generally do not leave a chest tube after this procedure. And often the patients. Can be weaned quickly from the ventilator. And extubated.