title: Surgical Outcomes of Pneumatic Compression Using Carbon Dioxide Gas in Thoracoscopic Diaphragmatic Plication.
abstract: BACKGROUND
  Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide (CO2) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy.
  
  
  METHODS
  Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using CO2gas and group without using CO2gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence.
  
  
  RESULTS
  The improvement of forced expiratory volume at 1 second in the group using CO2gas and the group not using CO2gas was 22.46±11.27 and 21.08±5.39 (p=0.84). The improvement of forced vital capacity 3 months after surgery was 16.74±10.18 (with CO2) and 15.6±0.89 (without CO2) (p=0.03). During follow-up (17±17 months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred.
  
  
  CONCLUSIONS
  Thoracoscopic plication under single lung ventilation using CO2insufflation could be an effective, safe option to flatten the diaphragm.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution.
authors.forename: Hyo Yeong
authors.initials: HY
authors.lastname: Ahn
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution.
authors.forename: Yeong Dae
authors.initials: YD
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution.
authors.forename: I
authors.initials: I
authors.lastname: Hoseok
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution.
authors.forename: Jonggeun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution.
authors.forename: Joohyung
authors.initials: J
authors.lastname: Son
keywords: Diaphragm; Methods; Thoracoscopy; Video-assisted thoracic surgery