Roboterassistierte thorakoskopische Zwerchfellraffung

 

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Zusammenfassung

Das Leitsymptom des erworbenen einseitigen Zwerchfellhochstands ist die Atemnot, die typischerweise im Liegen, beim Bücken und beim Schwimmen verstärkt auftritt. Die Ätiologie ist vielfältig, wobei die idiopathische Genese und die Zwerchfellparese nach Schädigung des N. phrenicus, bspw. bei (kardio-)thorakalen Eingriffen, die häufigsten Ursachen darstellen. Trotz vielfältiger Behandlungsansätze ist die operative Zwerchfellraffung die aktuell einzige effektive Therapie. Ziel der Operation ist die Wiederherstellung der Spannung des Zwerchfells, wodurch die Atemmechanik verbessert, das Ausdehnungsvolumen erhöht und eine mögliche Kompression von basal durch abdominelle Organe verringert wird. Hierfür stehen verschiedene Operationstechniken mit verschiedenen Zugangswegen zur Verfügung. Die roboterassistierte thorakoskopische Zwerchfellraffung verbindet die Vorteile eines minimalinvasiven Zugangs mit einer hervorragenden Darstellung des Situs und einem großen Handlungsspielraum für den Operateur. Diese Operationsmethode ist sehr sicher, vergleichsweise einfach zu erlernen und geht mit deutlichen funktionalen Verbesserungen einher.

Abstract

Acquired unilateral hemidiaphragm elevation is characterised by dyspnoea, which is typically aggravated when lying down, bending over or during swimming. The most common causes are idiopathic or due to injury to the phrenic nerve during cervical or cardio-thoracic surgery. To date, surgical diaphragm plication remains the only effective treatment. The aim of the procedure is to plicate the diaphragm to restore its tension and thus improve breathing mechanics, increase the available space for the lung and reduce compression from abdominal organs. In the past, various techniques using open and minimally invasive approaches have been described. Robot-assisted thoracoscopic diaphragm plication combines the advantages of a minimally invasive approach with excellent visualisation and freedom of movement. It was shown to be a safe technique which is easy to establish and can significantly improve pulmonary function.

Publication History

Received: 18 October 2022

Accepted after revision: 19 December 2022

Article published online:
08 March 2023

© 2023. Thieme. All rights reserved.

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• Literatur

• 1 Groth SS, Andrade RS. Diaphragm plication for eventration or paralysis: a review of the literature. Ann Thorac Surg 2010; 89: S2146-S2150 DOI: 10.1016/j.athoracsur.2010.03.021. (PMID: 20493999)
  CrossrefPubMedGoogle Scholar
• 2 Kwak T, Lazzaro R, Pournik H. et al. Robotic thoracoscopic plication for symptomatic diaphragm paralysis. J Robot Surg 2012; 6: 345-348 DOI: 10.1007/s11701-011-0328-x. (PMID: 27628476)
  CrossrefPubMedGoogle Scholar
• 3 Lim E, Batchelor T, Dunning J. et al. Video-Assisted Thoracoscopic or Open Lobectomy in Early-Stage Lung Cancer. NEJM Evid 2022; DOI: 10.1056/EVIDoa2100016.
  CrossrefPubMedGoogle Scholar
• 4 Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg 2006; 81: 1853-1857 DOI: 10.1016/j.athoracsur.2005.11.068. (PMID: 16631685)
  CrossrefPubMedGoogle Scholar
• 5 Tachibana S, Okishige K, Sudo K. et al. Predictors of Phrenic Nerve Injury During Pulmonary Vein Isolation for Curing Atrial Fibrillation With Balloon-Based Visually Guided Laser Ablation. Circ J 2021; 85: 275-282 DOI: 10.1253/circj.CJ-20-0953. (PMID: 33536386)
  CrossrefPubMedGoogle Scholar
• 6 O’Toole SM, Kramer J. Unilateral Diaphragmatic Paralysis. Treasure Island (FL): StatPearls Publishing; 2022. Accessed January 16, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK557388/
  Google Scholar
• 7 Wiesemann S, Haager B, Passlick B. Chirurgische Therapie bei erworbener einseitiger Zwerchfelllähmung: Indikation und Ergebnisse. Zentralbl Chir 2016; 141 (Suppl. 01) S43-S49 DOI: 10.1055/s-0042-113192. (PMID: 27607888)
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Gazala S, Hunt I, Bédard EL. Diaphragmatic plication offers functional improvement in dyspnoea and better pulmonary function with low morbidity. Interact Cardiovasc Thorac Surg 2012; 15: 505-508 DOI: 10.1093/icvts/ivs238. (PMID: 22691375)
  CrossrefPubMedGoogle Scholar
• 9 Cloward RB. Diaphragm paralysis from cervical disc lesions. Br J Neurosurg 1988; 2: 395-399 DOI: 10.3109/02688698809001012. (PMID: 3267322)
  CrossrefPubMedGoogle Scholar
• 10 Yekzaman BR, Minchew HM, Alvarado A. et al. Phrenic Nerve Dysfunction Secondary to Cervical Neuroforaminal Stenosis: A Literature Review. World Neurosurg 2022; 167: 74-77 DOI: 10.1016/j.wneu.2022.09.009. (PMID: 36089276)
  CrossrefPubMedGoogle Scholar
• 11 Wade OL. Movements of the thoracic cage and diaphragm in respiration. J Physiol 1954; 124: 193-212 DOI: 10.1113/jphysiol.1954.sp005099. (PMID: 13175123)
  CrossrefPubMedGoogle Scholar
• 12 Bergofsky EH. Relative Contributions of the rib cage and the diaphragm to ventilation in man. J Appl Physiol 1964; 19: 698-706 DOI: 10.1152/jappl.1964.19.4.698. (PMID: 14195582)
  CrossrefPubMedGoogle Scholar
• 13 Clague HW, Hall DR. Effect of posture on lung volume: airway closure and gas exchange in hemidiaphragmatic paralysis. Thorax 1979; 34: 523-526 DOI: 10.1136/thx.34.4.523. (PMID: 505349)
  CrossrefPubMedGoogle Scholar
• 14 Piehler JM, Pairolero PC, Gracey DR. et al. Unexplained diaphragmatic paralysis: a harbinger of malignant disease?. J Thorac Cardiovasc Surg 1982; 84: 861-864 (PMID: 6292583)
  CrossrefPubMedGoogle Scholar
• 15 Ko MA, Darling GE. Acquired paralysis of the diaphragm. Thorac Surg Clin 2009; 19: 501-510 DOI: 10.1016/j.thorsurg.2009.08.011. (PMID: 20112633)
  CrossrefPubMedGoogle Scholar
• 16 Summerhill EM, El-Sameed YA, Glidden TJ. et al. Monitoring recovery from diaphragm paralysis with ultrasound. Chest 2008; 133: 737-743 DOI: 10.1378/chest.07-2200. (PMID: 18198248)
  CrossrefPubMedGoogle Scholar
• 17 Elshafie G, Acosta J, Aliverti A. et al. Chest wall mechanics before and after diaphragm plication. J Cardiothorac Surg 2016; 11: 25 DOI: 10.1186/s13019-016-0419-x. (PMID: 26832454)
  CrossrefPubMedGoogle Scholar
• 18 Balci AE, Ozyurtkan MO. Clinical and surgical specifications of adult unilateral diaphragmatic eventration according to their aetiology in 28 patients. Importance of using diaphragmatic patch and minimal thoracotomy incision. Eur J Cardiothorac Surg 2010; 37: 606-612 DOI: 10.1016/j.ejcts.2009.07.031. (PMID: 19699653)
  CrossrefPubMedGoogle Scholar
• 19 Schumacher L, Zhao D. Outcomes and technique of robotic diaphragm plication. J Thorac Dis 2021; 13: 6113-6115 DOI: 10.21037/jtd-2019-rts-01. (PMID: 34795961)
  CrossrefPubMedGoogle Scholar
• 20 Bin Asaf B, Kodaganur Gopinath S. et al. Robotic diaphragmatic plication for eventration: A retrospective analysis of efficacy, safety, and feasibility. Asian J Endosc Surg 2021; 14: 70-76 DOI: 10.1111/ases.12833. (PMID: 32677317)
  CrossrefPubMedGoogle Scholar
• 21 Nardini M, Jayakumar S, Migliore M. et al. Minimally Invasive Plication of the Diaphragm: A Single-Center Prospective Study. Innovations (Phila) 2021; 16: 343-349 DOI: 10.1177/15569845211011583. (PMID: 34130535)
  CrossrefPubMedGoogle Scholar
• 22 Lampridis S, Pradeep IHDS, Billè A. Robotic-assisted diaphragmatic plication: Improving safety and effectiveness in the treatment of diaphragmatic paralysis. Int J Med Robot 2022; 18: e2368 DOI: 10.1002/rcs.2368. (PMID: 35041770)
  CrossrefPubMedGoogle Scholar
• 23 Taberham RJ, Raza A, Alzetani A. et al. VATS Plication of the Diaphragm: A Descriptive Observational 10-Year Southampton Experience. Innovations (Phila) 2017; 12: 398-405 DOI: 10.1097/IMI.0000000000000441. (PMID: 29219945)
  CrossrefPubMedGoogle Scholar
• 24 Yalcinkaya I, Evman S, Lacin T. et al. Video-assisted minimally invasive diaphragmatic plication: feasibility of a recognized procedure through an uncharacteristic hybrid approach. Surg Endosc 2017; 31: 1772-1777 DOI: 10.1007/s00464-016-5171-8. (PMID: 27519592)
  CrossrefPubMedGoogle Scholar
• 25 Demos DS, Berry MF, Backhus LM. et al. Video-assisted thoracoscopic diaphragm plication using a running suture technique is durable and effective. J Thorac Cardiovasc Surg 2017; 153: 1182-1188 DOI: 10.1016/j.jtcvs.2016.11.062. (PMID: 28087113)
  CrossrefPubMedGoogle Scholar
• 26 Biswas Roy S, Haworth C, Ipsen T. et al. Transabdominal robot-assisted diaphragmatic plication: a 3.5-year experience. Eur J Cardiothorac Surg 2018; 53: 247-253 DOI: 10.1093/ejcts/ezx255. (PMID: 28977536)
  CrossrefPubMedGoogle Scholar
• 27 Freeman RK, Van Woerkom J, Vyverberg A. et al. Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. Ann Thorac Surg 2009; 88: 1112-1117 DOI: 10.1016/j.athoracsur.2009.05.027. (PMID: 19766791)
  CrossrefPubMedGoogle Scholar
• 28 Kosse NJ, Windisch W, Koryllos A. et al. Development of the Diaphragmatic Paralysis Questionnaire: a simple tool for patient relevant outcome. Interact Cardiovasc Thorac Surg 2021; 32: 244-249 DOI: 10.1093/icvts/ivaa258. (PMID: 33221909)
  CrossrefPubMedGoogle Scholar