Background: Diaphragmatic plication can be performed with various surgical approaches. The aim of this study was to assess the safety and effectiveness of robotic-assisted plication. Methods:We retrospectively reviewed consecutive patients who underwent diaphragmatic plication from 2017 to 2021. Results:Eighteen patients underwent 20 operations, 11 of which were performed with robotic-assisted thoracoscopic surgery (RATS) and 9 with open transthoracic approach. RATS was associated with shorter operating time (80 vs. 120 min; p = 0.04), less blood loss (20 vs. 100 ml; p = 0.01), shorter chest-drain duration (1 vs.3 days; p = 0.01), and shorter length of stay (3 vs. 7 days; p = 0.04). The median grade in the Medical Research Council dyspnoea scale improved from four to two in both groups.Conclusions: Robotic-assisted diaphragmatic plication is a safe procedure that can significantly improve dyspnoea and is associated with shorter hospitalisation compared to open approach.

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IntroductionThis study describes pathological findings of mediastinal masses among patients referred to National Hospital for Respiratory Diseases. MethodsA descriptive cross-sectional study was conducted among patients with mediastinal masses referred to National Hospital for Respiratory Diseases, Welisara, Sri Lanka in 2017, who underwent excision or guided biopsy followed by standard histological and immunohistochemical staining. ResultsThe population was aged 8-75[mean (SD) =42.8(17.0)] years. Of 139 patients, 80(57.6%) were males. Masses were located in anterior mediastinum in 49.6 %( n=69), superior mediastinum in 20.1 %( n=28), middle mediastinum in 15.1 %( n=21) and posterior mediastinum in 14.4 %( n=20). Majority (65.5%, n=91) were excision biopsies. The rest were core biopsies. Commonest mass was lymphoma [n=27,19.4%;Non-Hodgkin(n=20),Hodgkin(n=7)] followed b y t h y m i c t u m o u r s [ n = 2 2 , 1 5 . 8 % ; b e n i g n ( n = 1 6 ) , malignant(n=6)], germ cell tumours (11.5%,n=16), metastatic deposits (10.8%,n=15), developmental cysts (8.6%,n=12), non-neoplastic lymphadenitis (7.9%,n=11), neuroectodermal tumours (5.8%,n=8), soft tissue sarcomas (2.9%,n=4), leiomyoma (0.7%,n=1), benign spindle cell tumour (0.7%,n=1) and plasmacytoma (0.7%,n=1). Twentyone (15.1%) specimens were either normal or inconclusive. A one-way ANOVA showed significant differences in the distribution of age among different types of masses [Welch's F (df=7, n=115) =10.09, p=.000]. Post-hoc comparisons, showed that the age of patients with germ cell tumours ( m e a n = 2 9 . 7 ± 1 1 . 5 y e a r s ) , d e v e l o p m e n t a l c y s t s (mean=38.8±16.5years) and lymphomas (mean=34.0±15.7 years) were less compared to the patients with other masses. A Chi-square test indicated no significant association between gender and the type of mediastinal mass [χ2 (df=7, n=115) =6.561, p=.48]. ConclusionsLymphoma was the commonest mediastinal mass in this population. Germ cell tumours, developmental cysts and lymphomas were commonly found among the young.

IntroductionThis study describes pathological findings of lung and pleural neoplasms among a cohort of Sri Lankan patients. MethodsA descriptive cross-sectional study was conducted among patients with lung and pleural tumours referred to National Hospital for Respiratory Diseases in 2017. Patients who underwent biopsy under direct vision or radiological guidance were included. Contrast Enhanced Computerized Tomography (CECT) findings were correlated with the histological diagnosis. ResultsThe population was aged 8-93[mean (SD) =58.4(13.3)] years. Of 396 patients, 252(63.6%) were males. Majority (n=324, 81.4%) had lung tumours while 72(18.2%) had pleural tumours. Malignant neoplasms were found in 373(n=94.2). Of them, majority (n=180, 45.5%) were core biopsies, followed by lobectomies (n=77, 19.4%). Commonest benign lung tumour was hamartoma (n=13, 3.3%). Schwannoma was the commonest benign pleural tumour (n=3, 0.8%). Among the primary malignant lung tumours, adenocarcinoma was the commonest (n=124, 31.3%). Six (1.5%) primary malignant pleural neoplasms (mesotheliomas) were found. Among the metastatic deposits in the lung, the majority was colorectal adenocarcinomas (n=9, 2.3%). The sensitivity, specificity, positive and negative predictive values of CECT in discriminating malignant lung and pleural tumours were 94.6%, 90.9%, 99.3%, and 54.1% respectively. A one-way ANOVA showed significant differences in the distribution of age among different types of masses [F (5,396) =2.759, p=.018]. The age of patients with benign lung neoplasms (mean=51.3±17.4 years), was less compared to the malignant pleural tumours and primary malignant lung tumours.