Robotic-Assisted Transthoracic Diaphragm Plication

Diaphragm dysfunction, either from congenital eventration or acquired paralysis, impairs the ability of the diaphragm to contract, thereby disrupting normal respiratory mechanics. While a proportion of patients will present with respiratory insufficiency or symptoms of dyspnea, the majority of patients are asymptomatic and most cases are identified incidentally on chest imaging by the presence of an elevated hemidiaphragm. In symptomatic patients, surgical plication of the diaphragm remains the gold standard treatment. Traditionally, diaphragm plication is performed through an open transthoracic approach via a posterolateral thoracotomy. However, more recently there has been increased utilization of minimally invasive techniques, including video-assisted thoracoscopic and laparoscopic approaches. Here, we present our technique for robotic-assisted transthoracic plication, with advantages including enhanced ergonomics, seamless motion, decreased surgeon fatigue, tremor filtering, and 3-dimensional vision. This approach has been demonstrated to be a technically feasible and safe option for performing diaphragm plications with an associated decreased hospital length of stay and trend towards decreased 30-day postoperative complications compared to open plication.