Induced, Controlled, Pneumothorax: A Useful Maneuver For Laparoscopic Left...

A 2 year old male patient was diagnosed with a left diaphragmatic eventation. In the laparoscopic approach, the pneumoperitoneum pushes the left diaphragm upwards into the thorax, and the diaphragm becomes tense and very difficult to grasp, suture, and plicate, as shown in this video. The equipment needed is an 18G Teffler catheter, a three-way valve, an extension tube, and a 60 mL syringe. catheter number 18 is inserted at the level of the 11th intercostal space on the mid axillary line. Special care is taken. The piercing tip of the catheter is minimally introduced to guarantee access to the pleural cavity. Only the flexible, blunt-ended Teflon sleeve is slipped inside. The catheter is then connected to an extension tube with a 3-way valve and a 60 mL syringe. When air is injected, the pneumothorax is increased, and the diaphragm descends towards the abdomen, allowing for an improved grip and a more comfortable surgical correction of the defect. Air can be introduced or released from the thorax depending on the surgeon's needs. Once the procedure is completed, residual air is removed manually using the syringe and is also drained underwater while the anesthesiologist ventilates the patient to ensure any residual air is expelled. Finally, the wounds are closed. During the next 2 years of follow-up, the patient evolved favorably and did not present recurrences.