Chen Brendan, Finnerty Brendan M, Schamberg Neal J, Watkins Anthony C, DelPizzo Joseph, Zarnegar Rasa
Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, 525 E. 68th Street, New York, NY, 10065, USA.
Center for Gastrointestinal Medicine of Fairfield and Westchester, 500 West Putnam Avenue Suite 100, Greenwich, CT, 06830, USA.
J Robot Surg. 2015 Dec;9(4):357-60. doi: 10.1007/s11701-015-0530-3. Epub 2015 Sep 26.
Bochdalek diaphragmatic hernia is a rare condition and is typically diagnosed prior to adulthood. Furthermore, right-sided defects are also uncommon due to the location of the liver, but can contain colon, omentum, small bowel, or rarely the kidney. Minimally invasive laparoscopic and thoracoscopic diaphragmatic hernia repairs are associated with improved outcomes when compared to open approaches-recently, robotic-assisted repairs have been performed in children with no morbidity and minimal complications. We report a case of an 80-year-old female who presented with an enlarging right-sided Bochdalek hernia containing an acquired intrathoracic kidney that was repaired using a robotic-assisted laparoscopic transabdominal approach with mesh placement. In this case, the robotic platform's advantages included excellent visualization of the posterolateral defect and efficient suturing during mesh placement. This approach is a viable option for skilled minimally invasive surgeons; however, further studies are warranted to investigate its utility in the management of diaphragmatic hernia repair.
博赫达勒克膈疝是一种罕见疾病,通常在成年前被诊断出来。此外,由于肝脏的位置,右侧缺损也不常见,但可包含结肠、网膜、小肠,极少情况下还可包含肾脏。与开放手术相比,微创腹腔镜和胸腔镜膈疝修补术的效果更好——最近,机器人辅助修补术已应用于儿童,未出现发病率且并发症极少。我们报告一例80岁女性患者,其右侧博赫达勒克疝逐渐增大,疝内容物为一枚后天性胸腔内肾,采用机器人辅助腹腔镜经腹入路并放置补片进行修补。在该病例中,机器人平台的优势包括对后外侧缺损的极佳视野以及在放置补片过程中高效缝合。这种方法对于熟练的微创外科医生来说是一种可行的选择;然而,有必要进行进一步研究以探讨其在膈疝修补管理中的效用。