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OBJECTIVE:
Very little has been published regarding robotic assisted approaches in the repair of congenital diaphragm hernias presenting in adults. I will discuss two cases of rare, late presentations of Morgagni and Bochdaleck hernias in adults, both repaired with minimally invasive robotic techniques. One hernia is approached through the chest and the other via a trans abdominal approach. Neither hernia repair has previously been reported relying completely on the Da Vinci robot for true minimally invasive repairs.
METHODS:
This is a small series of two case reports detailing the adult presentation and repair of congenital diaphragmatic hernias. One patient had a Morgagni hernia, repaired with trans abdominal robotic assistance, and one patient had a Bochdalek hernia repaired with a robotic trans thoracic approach.
RESULTS:
Both patients presented with large, previously undiagnosed, congenital diaphragm hernias. The Bochdalek hernia was repaired with the Da Vinci robot system through the left chest with reduction of the hernia contents and patch diaphragm repair. The Morgagni hernia was repaired with the Da Vinci robot via a trans abdominal approach, also with reduction of the hernia contents and a patch repair of the diaphragm defect. Both patients had successful repair without requirement for conversion to open techniques.
CONCLUSIONS:
I believe these two cases are unique in that they represent the first case studies of adult congenital hernias being repaired with the Da Vinci system from both trans thoracic and trans abdominal approaches. The Bochdalek hernia was repaired with robotic assistance utilizing a trans thoracic approach and the Morgagni hernia was repaired entirely with the robot from a trans abdominal approach. Both repairs were successful without requirement for open conversion.