ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Transthoracic robotic plication for diaphragmatic elevation
Merve Şengül İnan1, Kuthan Kavaklı1, Hakan Işık1, Ersin Sapmaz1, Sedat Gürkök1, Elif İlhan Sezer1, Hasan Çaylak1, Onur Genç1
1Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
DOI : 10.5606/tgkdc.dergisi.2023.23283
Background: This study aims to evaluate the feasibility, safety, and efficacy of transthoracic robot-assisted surgery for diaphragmatic plication and to describe our surgical approach in detail.

Methods: Between January 2014 and January 2020, a total of 13 patients (11 males, 2 females; median age: 55 years; range, 24 to 70 years) who underwent diaphragmatic plication with the robotic system were retrospectively analyzed. The changes in the Medical Research Council dyspnea scale, forced expiratory volume in 1 sec, body mass index, and quality of life scale scores of the patients before the operation and at the first year of follow-up were examined.

Results: Twelve of the operations were performed on the left side. The median pre- and postoperative Medical Research Council dyspnea scores were 2 (range, 1 to 4) and 1 (range, 1 to 4), respectively, indicating a statistically significant improvement (p=0.008). A significant improvement was detected in the forced expiratory volume in 1 sec of the patients in the first year after surgery (p=0.036). In terms of quality of life parameters, only, in the physical health subscale, the scores were statistically significantly different in the pre- and postoperative first-year follow-up (p=0.002). Median time to chest tube removal was 1 (range 1-5, IQR=0,5) days. Median total length of hospital stay was 2 (range 2-18, IQR=3) days.

Conclusion: Owing to its technical dexterity, the robot enables the plication to be performed easily and safely. Late improvement in respiratory functions is reflected in quality of life.

Keywords : Diaphragmatic plication, minimally invasive surgery, robot-assisted thoracoscopic surgery, transthoracic robotic plication
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