Diaphragm paralysis may result from surgical, anatomic, or idiopathic causes. Patients with diaphragmatic paralysis present with dyspnea, worsened with lying down, and benefit from plication if the affected diaphragm moves paradoxically with inspiration. Plication is an established intervention for this group of patients, but minimally invasive diaphragm plication has not been well described.
All patients with elevated diaphragm on chest radiograph for evaluation of dyspnea were evaluated for surgical intervention. Floroscopy confirmed paradoxical movement of the affected diaphragm, and patients underwent surgical plication. The procedures were begun thoracoscopically, and converted to open procedures if necessary.
Fourteen patients underwent thoracoscopic exploration. Ages ranged from 28-80, with an average of 58. One patient had NSCLC, three had paralysis secondary to thymoma resections, and in nine the cause of the paralysis was not known. Seven were done thoracoscopically, and seven required open plication, due to inability to flatten the diaphragm appropriately. The average length of stay was 4.3 days and the only complications were prolonged air leak in one patient who underwent simultaneous lung resection and supraventricular tachycardia in two patients. There was no operative mortality.The majority of patients dramatically improved both their lung function and their symptoms. The average improvement in FEV1% was 22%, with a range from 10-33%.
Thoracoscopic plication of the paralyzed diaphragm is possible, but only in a relatively limited fraction of patients in this series (50%). The procedure was safe and effective, but requires judgment as to proceeding to an open procedure.
Thoracoscopic approaches can be used for plication of paralyzed diaphragms.
John Roberts, None.