Transthoracic robotic plication for diaphragmatic elevation

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.