Repair of a diaphragmatic injury during hand assisted laparoscopic nephrectomy using an onlay patch of polypropylene and polyglactin mesh.
OBJECTIVE
We describe a simple and time efficient technique for repairing a diaphragmatic injury occurring during right hand assisted laparoscopic radical nephrectomy.


METHODS
A dual layer polypropylene and polyglactin mesh was created extracorporeally by sewing a 2 x 2 piece of polypropylene mesh to a 2 x 2 piece of polyglactin mesh with 4, 4-zero interrupted polyglactin sutures. This dual layer was then positioned manually over the diaphragmatic rent and secured with a laparoscopic stapling device. A 16Fr chest tube was placed at the conclusion of the procedure.


RESULTS
Overall operative time was 3.5 hours with an estimated blood loss of 100 cc. Repair of the diaphragmatic injury extended operative time by 25 minutes. Extubation was done at the conclusion of the case and the chest tube was removed within 36 hours of the procedure. The patient was discharged home on postoperative day 3. At 14 months of followup the patient remained disease-free on radiography and without pulmonary or gastrointestinal sequelae.


CONCLUSIONS
We describe a simple and time efficient technique for repairing diaphragmatic injury occurring during right hand assisted laparoscopy. This technique takes advantage of the manual and tactile sensation provided by the hand assistance device, provides a tension-free repair and avoids laparoscopic suturing.
Gonzalez
Chris M
CM
Veterans Administration Lakeside Division and Northwestern University Department of Urology, Chicago, Illinois, USA.
Batler
Robert A
RA
Feldman
Michael
M
Rubenstein
Jonathon N
JN
Nadler
Robert B
RB
Schoor
Richard A
RA
D015505:Chest Tubes; D003964:Diaphragm / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011098:Polyglactin 910; D011126:Polypropylenes; D013526:Surgical Mesh; D017792:Surgical Stapling; D013536:Suture Techniques
D011126:Polypropylenes; D011098:Polyglactin 910