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Advantages of robotic approach for plication of diapghram for eventeration
NARENDRA AGARWAL, SHAIWAL KHANDELWAL, MOHD FAUZI, KAMRAN ALI, ALI ZAMIR KHAN.
medanta the medicity, gurgaon, India.

OBJECTIVE: Diaphragm plication surgery is performed for symptoms of dyspnea, which results from mediastinal shift, atelectasis and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. We describe our experience with robotic thoracoscopic plication for the treatment of diaphragmatic paralysis.
METHODS: seven patients who underwent diaphragm plication surgery by robotic approach from 2012-2015 . All patients underwent left sided eventeration repair. Three arm approach for plication was used. Cabon dioxide insufflation was done to bring the hemidiapghram down to create working space. Non absorbable suture was used to plicate .
RESULTS: 6/7 succesfully underwent robotic plication. One patient had to be converted open as it was difficult to achieve single lung ventilation. Mean operating time was 203 min; . No major complications occurred during surgery or the postoperative period. All patients were discharged after PODay 3 At a of 12 months follow up no recurrence was observed
CONCLUSIONS: Advantages of robotic plication compared to thoracoscopic are ease of endoplication of diapghram working on 3 dimensional system less postoperative pain and shorter hospital stay , yet technical difficulties due to limited workspace and by the ribcage and the elevated hemidiaphragm have been a major drawback in using the robotic approach for this disorder


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