Thoracoscopic Diaphragmatic Plication

This video will demonstrate thochoscopic lication of a significant left diaphragmatic eventation. The patient is a 12-year-old girl with Rhett syndrome and severe pulmonary morbidity with recurrent admissions for left-sided pneumonia. A severe eventation of the left diaphragm was also present. A thochoscopic application was performed with the aim of improving her lung function. The procedure is performed in the right lateral decubits position with carbon dioxide insufflation to a pressure of 6 millimeters of mercury. Lung isolation is not used. The eventtuation is easily identified, along with the stronger diaphragmatic rim on each side. Orole sutures take big bites of the diaphragm on each side of the aventation. Each licating suture approximates the diaphragmatic margins, pushing the weakened component inferiorly. The suture is tied extracorporeally and cut long. The second suture is placed approximately 1 centimeter away from the first. A clip is placed on the tight suture to allow the application site to be identified on a chest X-ray. Application continues from lateral to medial. The final suture is placed. The placated diaphragm is shown on the left with the corresponding chest X-ray on the right. The diaphragmatic redundancy and eventration have been completely addressed. One can see the level of the placation labeled with clips on the chest X-ray.