title: A simple thoracoscopic plication technique for diaphragmatic eventration in neonates and infants: technical details and initial results.
abstract: OBJECTIVE
  Existing minimal-access surgical approaches for correction of symptomatic diaphragmatic eventration may be technically difficult in neonates and infants. We report technical details and initial outcomes of a novel, simple thoracoscopic repair technique.
  
  
  METHODS
  The technique uses one 3-mm camera port, a 3-mm instrument incision without a port, and an 18-gauge spinal needle, which is passed through the chest wall into the pleural space. The excess diaphragm is first plicated over the needle, after which a non-absorbable suture is passed through the needle and tied extracorporeally. The needle is passed repeatedly until the desired degree of tension is achieved. A retrospective review was performed for all patients undergoing repair by this technique.
  
  
  RESULTS
  Nine patients have undergone thoracoscopic plication at a median age of 3 months (range 0.2-13.2 mos.) and a median weight of 4.5 kg (range 2.3-8.2 kg). No organ injuries or conversions to thoracotomy occurred. Median operative time was 60 min. Patients repaired beyond the neonatal period were extubated in the operating room. There were two post-operative pneumothoraces. No recurrences have been seen at a mean follow-up of 17 months.
  
  
  CONCLUSIONS
  This technique of thoracoscopic diaphragm plication is safe, effective, and technically straightforward in neonates and infants.
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital, John Hopkins University School of Medicine, St. Petersburg, FL, USA, chris.w.snyder@gmail.com.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Snyder
authors.forename: N Elizabeth
authors.initials: NE
authors.lastname: Walford
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
mesh_terms: D003964:Diaphragm / Q000601:surgery; D003965:Diaphragmatic Eventration / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome