plication narrated

This is an example of a laparoscopic diaphragmatic lication. This was a 3 month old child who had an eventation of the right hemi diaphragm. The patient had significant respiratory issues because of this, and it was felt that the bee would. Benefit from application. The initial stitch, as you saw here, is put to take the tension off the diaphragm. Once the surface tension is broken with the needle, 2 to 3 bites are then performed to reef in the diaphragm. A series of sutures and then placed from medial to lateral. To complete the first row of the placation. Even in cases of a right. Eventation The diaphragm can easily be reached up over the dome of the liver. I find this technique preferable to a thoracoscopic. Plication because of the greater access and mobility with trochars placed through the abdominal wall. When trying to perform this thoracoscopically, the trochars are fixed by the rib cage. And motility and space is limited. Here you see the 2nd stitch being put in and again a series of bits being taken. Thereby reefing in the lax diaphragm. In these cases, it is useful to tie the knots extra corporeally and use a knot pusher. This allows the assistant to hold down the liver with the left hand operating port while the knot pusher is being placed. As there is no risk of tearing these sutures out or causing other injury, there is no reason to try and tie these sutures, which are under significant tension, incorporally. The trocars are placed with the camera port in the umbilicus. And then a right and left operating port. placed in the Be Right and left mid quadrants. When approaching the Right hemi diaphragm, the left sided port is slightly above the umbilicus to allow better angulation. And the reverse is true for an elevated left hemi diaphragm. A series of sutures are placed until adequate. Tension is felt to have been achieved on the diaphragm. An excellent repair can be obtained in all cases. And in fact, if one is not careful, the chest wall can be deformed in small infants. Because of the Tension which can be placed. On the diaphragm. After the initial row of sutures is placed, it may be necessary to place a secondary roll. To achieve a further Placation. In almost all cases, I prefer to use a 20 bond suture on an RB1 needle. The RB1 needle can be dragged through a 5 millimeter trocar using a 3 millimeter, not not or. This is an example of a laparoscopic diaphragmatic implication.