title: Laparoscopic Robot-Assisted Diaphragm Plication.
abstract: Minimally invasive approaches to diaphragm plication for eventration include thoracoscopic and laparoscopic techniques. The elevated hemidiaphragm and ribs limit thoracoscopic techniques. We report our modification of the laparoscopic approach using robotic assistance with the da Vinci Surgical System, (Intuitive Surgical Inc, Sunnyvale, CA) to avoid single-lung ventilation, facilitate exposure, and allow more precise placement of plication sutures to achieve an even tension and maximum plication. Critical steps include creation of a small defect in the diaphragm to equalize pressures between cavities and placement of multiple, pledgeted interrupted horizontal mattresses.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Brittany A
authors.initials: BA
authors.lastname: Zwischenberger
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Kister
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Zwischenberger
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky. Electronic address: j.martin@uky.edu.
authors.forename: Jeremiah T
authors.initials: JT
authors.lastname: Martin
mesh_terms: D000368:Aged; D003964:Diaphragm / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012133:Respiratory Paralysis / Q000209:etiology / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D013536:Suture Techniques