Robotic diaphragmatic plication for eventration: A retrospective analysis of efficacy, safety, and feasibility

Abstract

Introduction Eventration of the diaphragm results in impaired respiratory mechanics, which leads to symptoms of dyspnea. Robotic diaphragmatic plication is a recently reported technique that has had good immediate outcomes. The aim of this study was to describe our transthoracic and transabdominal plication techniques and to analyze the safety, efficacy, and feasibility of robotic diaphragmatic plication in an Indian setting. Methods This retrospective study was conducted at a large tertiary care center in a dedicated thoracic surgery unit. To measure the efficacy of plication, we administered a pulmonary function test to each patient at baseline and 6 months postoperatively and then compared the results. Results Eighteen patients underwent robotic diaphragmatic plication during the study period. Of these 18 patients, 12 underwent surgery via a transabdominal approach, and 6 underwent surgery via a transthoracic approach. Surgery was completed robotically in 17 patients. The comparison of the preoperative and postoperative pulmonary function test results showed that the mean ± SD increase in forced expiratory volume in 1 second (FEV1) was 19.9 ± 22.0% (P = .002) and the mean increase in FEV1/forced vital capacity was 5.7 ± 2.5 % (P = .225), indicating a significant improvement in FEV1 after surgery. Conclusion Robotic diaphragmatic plication can be performed transthoracically or transabdominally with good surgical outcomes. It is safe, effective, and feasible.

Results of the Diaphragmatic Plication Database: 10 Years' Experience

“…Our length of hospital stay is similar to other series on thoracotomy diaphragmatic plication (median 11 days 4 ; median 6 days 13 ), on robotics (median 6 days 27 ), and longer than a British series on VATS and thoracotomy (median 4-5 days 28 ), to which the known differences of the German and British health system may have contributed.…”

“…Bin Asaf et al report 28% complication rate in 18 patients with robotic diaphragmatic plication. 27 Taberham et al report in a 10 years experience in VATS and open diaphragmatic plication in 22 and 13 patients complication rates of 55 and 23%, no functional improvement in 18 and 8% and redo surgery for failure in 2 and 0%, respectively. 28 We do not see evidence favoring one surgical plication method over another in terms of complication rates.…”

Robotic‐assisted diaphragmatic plication: Improving safety and effectiveness in the treatment of diaphragmatic paralysis

“…Regarding robotic‐assisted approaches, the length of stay was a median of 3 days (IQR, 2–4 days) and a mean of 6.4 days in the studies by Roy et al 13 . and Asaf et al., 25 respectively.…”

“…reported the first robotic‐assisted thoracoscopic plication for symptomatic diaphragmatic paralysis. More recently, Asaf et al 25 . published a series of 6 patients who underwent robotic‐assisted thoracoscopic plication along with 12 patients who underwent the same procedure via a transabdominal robotic‐assisted approach.…”

“…The median duration of surgery was 161 min (IQR, 125–174 min) and the median estimated blood loss was 50 ml (IQR, 25–50 ml) 13 . In the study by Asaf et al., 25 the average operative time was 242 min for 18 patients undergoing transabdominal ( n = 12) or transthoracic ( n = 6) robotic‐assisted diaphragmatic plication. In a report of three patients undergoing laparoscopic diaphragmatic plication, the mean operating time was 203 min, and the mean intraoperative blood loss was 130 ml, with no major complications occurring during surgery 15 …”