Robot-assisted thoracoscopic repair of a late-onset Bochdalek hernia: a case report

Abstract

Bochdalek hernia (BH) is a major malformation that consists of a postero-lateral diaphragmatic defect through which abdominal contents can migrate into the thorax. It is most commonly a neonatal pathology associated with significant morbidity and mortality. Rarely, this type of congenital diaphragmatic hernia (CDH) presents later in life, some even in adulthood. Indications for surgery are not clear even though the majority of authors, being aware of the possible severe complications, recommend surgical correction in all cases. Many surgical approaches have been tried for this pathology, both open (laparotomic or thoracotomic) and minimally invasive (laparoscopic or thoracoscopic). We report a case of a late-onset BH corrected with a robot-assisted thoracoscopic procedure. The use of robotic technology for CDH has never been described to date.

Video-Assisted Thoracic Surgery for Late Recurrence of Congenital Diaphragmatic Hernia

“…In the setting of an elective repair, a minimally invasive approach should, in our opinion, be considered when appropriate. There exists now in the literature a few cases, including ours, that demonstrate that a minimal access by VATS [5][6][7] or RATS [8] is feasible. This case demonstrates that a significant hernia volume is not an absolute contraindication to a VATS approach.…”

Robotic-Assisted Thoracoscopic Repair of Right-Sided Bochdalek Hernia in Adults: A Two-Case Series

“…Two robotic-assisted transabdominal repairs and one transthoracic repair have been reported, all with good results. [4][5][6] At this time, no standard approach or technique is recommended, however we feel there are several advantages toward a robotic transthoracic approach as outlined above. Our port placement strategy, along with the use of reverse Trendelenburg position and CO 2 insufflation, has resulted in successful repair with good results, no recurrence, and no postoperative complications and we advocate for this technique in all adult BH < 5 cm.…”

“…2,3 Reports of minimally invasive repair of adult BH are rare, with ~6% of cases in the literature utilizing this approach, 1 and few reports exist of robotic approach to BH. 2,4,5 No standard recommendations of optimal technique are available for a robotic transthoracic approach to BH due to the relative paucity of case reports in adult patients. Here we demonstrate our technique and describe advantages of use of a robotic approach in two cases of robotic thoracoscopic repair of symptomatic right-sided BH in adults.…”