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Diaphragmatic Plication For Relaxation: Robotic Assisted Thoracic Surgery Versus Open Approach. Comparative Analysis Of Short-term Results
Beatrice Trabalza Marinucci, Dr.1, Matteo Tiracorrendo
1, Iacopo Compalati
1, Alessandra Siciliani
1, Antonio D'Andrilli
1, Ilaria Ceccarelli
2, Franca Melfi
3, Elisa Meacci
4, Stefano Margaritora, Dr. Prof.
4, Mohsen Ibrahim, Dr. Prof.
1.
1Sant'Andrea Hospital, Rome, Italy,
2University of Pisa, Pisa, Italy,
3University of Cosenza, Cosenza, Italy,
4IRCCS Policlinico Gemelli, Rome, Italy.
BACKGROUND: Diaphragmatic relaxation is characterized by the elevation of the hemidiaphragm. It is a condition of generally unknown etiology that could compromise patients’ pulmonary function, leading to dyspnea, inability to exercise and dramatic impairment of patients’ quality of life. To date, diaphragmatic plication represents the mainstay of treatment. The aim of the study is to compare post-operative results, in term of functional outcomes and quality of life, between Robotic-Assisted-Thoracic-Surgery(RATS) plication and the open approach.
METHODS: Between January 2019- January 2024, 50 consecutive patients affected by diaphragmatic relaxation underwent surgery through plication in 3 centers. A 1:1 propensity score matching (considering sex, comorbidities, initial cause, lesion side) was performed, identifying 2 homogeneous groups: 15 patients underwent RATS-plication (group A) and 17 patients underwent plication through thoracotomy approach (group B). Two patients in group A have been excluded because they receive repair of relaxation through prothesis’ insertion. RATS approach is standardized using 4 ports; interrupted horizontal mattress plicating stitches are placed along medial aspect of the diaphragm progressing laterally. Clinical characteristics, early and late complications, recurrence, postoperative pain, length of hospital stay, chest tube permanence, and cosmetic results were retrospectively collected and compared between the groups.
RESULTS: The mean operative time of RATS was significantly higher than that of thoracotomy, if including docking time. Length of stay was not different, but chest tube permanence was significantly higher (p=0.0126) group B. No conversion rate was described in RATS group. Postoperative pain at 24 hours(p=0.0001) and 4 weeks(p=0.0001) was significantly lower in RATS group. Improved cosmetics results were reported after RATS compared to thoracotomy (p= 0.0001).
CONCLUSIONS:With the limit of a retrospective analysis, our study reports promising results of RATS for diaphragmatic plication. Advantages in terms of chest tube management, post-operative pain, cosmetic results, was observed for the RATS approach. To the best of our knowledge, this is the first study reporting a comparative analysis between the 2 different surgical techniques. Promising results in term of quality of life (pain and cosmetic results) support the advantages of RATS plication over the open approach.
LEGEND: RATS Diaphragmatic Plication
Short-term Results | RATS (15) | OPEN (17) | P | |
| chest tube | 3.29 ± 2.14 | 6.71 ± 3.01 | 0.0126 | |
| pain24 hours4 weeks | 3.86 ± 0.692.29 ± 0.49 | 5.82 ± 0.884.47 ± 0.72 | 0.00010.0001 | |
| cosmetic results | 4.24 ± 0.56 | 8 ± 0.58 | 0.0001 | |
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