Thoracoscopic Diaphragmatic Plication

Single lung ventilation is generally not required for thoracoscopic diaphragmatic plication

CO2 is used to compress the lung as well as help compress the diaphragm during the procedure

A knot pusher is generally used to tie the reefing sutures down because of the tension and the small spaces and difficult angles

At least 3 bites of the diaphragm are taken with each stitch, which helps roll the diaphragm in and flatten it out

In general, 5 or 6 sutures are placed in line for the initial set of plication sutures

With each suture, more room develops within the chest cavity and makes the placement of further sutures easier

Care should be taken not to apply too much tension on any one suture as these stitches can tear through the diaphragmatic muscle

A knot pusher works well because the tissues are relatively strong and there is a fair amount of tension while trying to flatten the diaphragm

A second row of sutures is placed, imbricating the first row, to bring in more tissue and decrease the laxity in the diaphragm

In general, you will lose about 10 to 15% of your repair after the first few weeks as measured on chest X-ray, but this is not usually significant

A chest tube is generally not left after this procedure

Patients can often be weaned quickly from the ventilator and extubated after thoracoscopic diaphragmatic plication