title: Laparoscopic repair of diaphragmatic defect by total intracorporeal suturing: clinical and technical considerations.
abstract: OBJECTIVE
  The use of laparoscopy in urology is increasing. Tumor of the kidney or adrenal gland and, in some cases, metastatic disease can involve the diaphragm. We describe the application of laparoscopic suturing techniques in the case of diaphragmatic involvement with a renal tumor.
  
  
  METHODS
  After resection of the tumor and a small area of the diaphragm, a chest tube was placed under laparoscopic guidance. The tube was kept clamped until the end of the procedure. Decreasing intraabdominal pneumoperitoneum pressure made suturing easier with less tension on the edges of the diaphragmatic incision. Nonabsorbable interrupted horizontal mattress sutures were placed to close the diaphragmatic defect.
  
  
  RESULTS
  The repair was uneventful; no intraoperative complications occurred. Extubation was done at the end of the procedure in the operating room. The chest tube was removed on postoperative day 2, and the patient was discharged on postoperative day 3.
  
  
  CONCLUSIONS
  Laparoscopic repair of the diaphragm should be commensurate with traditional open surgical principles. In this regard, it is essential that surgeons interested in performing "advanced" laparoscopic oncologic surgery become facile in laparoscopic suturing.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rehman
authors.forename: J
authors.initials: J
authors.lastname: Landman
authors.forename: K
authors.initials: K
authors.lastname: Kerbl
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D003964:Diaphragm / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D010535:Laparoscopy; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D013526:Surgical Mesh; D013536:Suture Techniques