title: Laparoscopic resection of an intradiaphragmatic bronchogenic cyst.
abstract: BACKGROUND
  A 43-year-old woman with recurrent hiccup and discomfort in the right upper abdomen was diagnosed by computed tomographic (CT) scan with a cystic tumor in the right liver. Echinococcus serology was negative.
  
  
  METHODS
  A laparoscopic procedure was chosen as standard therapy for symptomatic cystic liver tumors. The presumed tumor turned out to be a diaphragmatic cyst 8 cm in diameter at the center of the right hemi-diaphragm. By using the ultrasonic device, the cystic tumor was completely and safely removed from the diaphragm. The defect was closed by using nonabsorbable sutures. A chest drain was inserted for 1 day.
  
  
  RESULTS
  The postoperative course was uneventful, and the patient was discharged on day 4. The histopathological examination revealed a bronchogenic cyst. No recurrence was noted by CT-scan after 12 and 24 months.
  
  
  CONCLUSIONS
  Due to this rare diagnosis, the intradiaphragmatic location of a bronchogenic cyst is difficult to identify with radiological methods. Complete surgical excision is the treatment of choice. The conventional surgical approach is a posterolateral thoracotomy. In the literature, video-assisted thoracoscopic surgery (VATS) has been described as a safe and effective procedure. In our case, we could demonstrate that the laparoscopic excision of a cyst including partial diaphragmatic resection can be done safely in a diaphragmatic location with all the advantages of minimally invasive surgery.
authors.affiliation: Department of Surgery, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette/ Luxembourg. nikolaus.zuegel@chem.lu
authors.forename: Nico P
authors.initials: NP
authors.lastname: Zügel
authors.forename: Martin
authors.initials: M
authors.lastname: Kox
authors.forename: Reinhold A
authors.initials: RA
authors.lastname: Lang
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Hüttl