ABSTRACT
BACKGROUND: Though conventional thoracoscopic plication is a favorable option of diaphragmatic eventration (DE), ribs limited the movement of trocars, making it difficult to suturing, knot-tying and time-consuming. The purpose of this study was to evaluate delicate surgical maneuvers and suturing time for the management of DE in robot-assisted thoracoscopic plication (RATP). METHODS: From January 2015 to November 2019, 20 patients (14 males; mean age: 10.5⯱â¯5.2â¯months; mean weight: 8.6⯱â¯4.5â¯kg) who underwent diaphragmatic plication for DE were reviewed at our institution. There were 13 patients with congenital diaphragmatic eventration and 7 patients with acquired diaphragm eventration after congenital heart surgery. RATP was performed on 9 patients (3 on the left and 6 on the right), and conventional thoracoscopic plication (CTP) was applied to 11 patients (5 on the left and 6 on the right). Demographics, the suturing time and complications were respectively evaluated. RESULTS: There was no difference between 2 groups with respect to gender, age at surgery and weight (pâ¯>â¯0.05). No conversion to thoracotomy was needed. The suturing time in RATP group was shorter than CTP group (27.7⯱â¯3.4â¯min vs 48.1⯱â¯4.2â¯min, pâ¯<â¯0.001). One patient (9.09%) experienced recurrence in CTP group and none was found in RATP group. CONCLUSIONS: Diaphragmatic plication with robot-assisted thoracoscopy or conventional thoracoscopy in DE has minimally invasive and good effect on children. RATP overcome the intercostal limitations to complete delicate suturing and free knot-tying, and has better ergonomics. LEVEL OF EVIDENCE: Level III.
