Robot-assisted thoracoscopic diaphragmatic plication with absorbable mesh application: surgical technique

Diaphragmatic eventration is a condition characterized by the abnormal elevation of a hemidiaphragm, resulting in significant respiratory symptoms such as dyspnea, exercise intolerance, and impaired ventilation, due to a mass effect by raised abdominal organs and to the inability of the diaphragm to promote adequate expansion of the chest and subsequent poor ventilation and impaired gas exchange. In symptomatic patients, diaphragmatic plication is a well-established surgical treatment aimed at improving respiratory function by reducing dysfunctional diaphragm excursion and promoting greater lung expansion. This study investigates the use of robot-assisted thoracic surgery (RATS) for diaphragmatic plication and application of absorbable mesh to reduce the risk and prevent recurrence of diaphragm re-elevation. The procedure is performed via a transthoracic approach using the Da Vinci Surgical System, which provides enhanced precision, meticulous tissue handling and accurate suture placement, allowing difficult maneuvers such as mesh placement and probably with improved early and long-term outcomes. The addition of a Vicryl mesh further supports the diaphragm and helps reduce the risk of postoperative complications such as recurrence of diaphragm elevation. This robot-assisted approach has been shown to reduce postoperative pain, shorten hospital stays, and significantly enhance patient quality of life by addressing symptoms like dyspnea and fatigue. This study highlights the safety, efficacy, and minimal invasiveness of robot-assisted diaphragmatic plication as a treatment option for diaphragmatic dysfunction.