Division of Research Grants, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
A.T. Still University, Mesa, AZ, USA.
Eur J Cardiothorac Surg. 2018 Jan 1;53(1):247-253. doi: 10.1093/ejcts/ezx255.
Diaphragmatic paralysis, a known cause of dyspnoea, can drastically reduce breathing efficiency, diminishing quality of life. We report our 3.5-year experience with 22 consecutive patients who underwent transabdominal, robot-assisted diaphragmatic plication for diaphragmatic paralysis.
We retrospectively reviewed 22 consecutive patients who underwent this procedure by a single surgeon from 5 September 2012 to 12 May 2016. The primary outcome measure was change in dyspnoea severity, which was measured with the 5-point Medical Research Council dyspnoea scale (a score of 5 indicates breathlessness so severe, the individual is homebound).
Of the 22 patients who underwent robotic diaphragmatic plication, 17 (77.3%) patients were male. Median body mass index was 30 kg/m2 (range 24.2-42.17 kg/m2). Most plications (13 of 22, 59.1%) were left sided; one (4.6%) was bilateral. Median operating time was 161 min (range 107-293 min), but this time was higher for the first 3 procedures (255 min, range 239-293 min). Median length of stay was 2 days, and median time to chest tube removal was 1 day. At follow-up, 20 of the 22 (91%) patients reported improved breathing and 2 reported no change. No patient reported worsened dyspnoea. The median Medical Research Council score changed from 4.0 preoperatively to 2.0 postoperatively (P = 0.001).
Transabdominal robotic diaphragmatic plication involves small incisions but improves surgical dexterity. Surgical times are reasonable, and this surgical technique can be adopted with a quick but steep learning curve. Early results show good functional outcomes.
膈神经麻痹是导致呼吸困难的已知原因，它会极大地降低呼吸效率，降低生活质量。我们报告了我们在 3.5 年时间里对 22 例连续膈神经麻痹患者进行经腹机器人辅助膈折叠术的经验。
我们回顾性分析了 2012 年 9 月 5 日至 2016 年 5 月 12 日期间由一位外科医生对 22 例连续患者进行的这项手术。主要的结局指标是呼吸困难严重程度的变化，这是用 5 分制医学研究理事会呼吸困难量表（5 分表示呼吸困难非常严重，患者只能居家）来衡量的。
在接受机器人膈折叠术的 22 例患者中，17 例（77.3%）为男性。中位体重指数为 30kg/m2（范围 24.2-42.17kg/m2）。大多数折叠术（22 例中的 13 例，59.1%）为左侧；1 例（4.6%）为双侧。中位手术时间为 161 分钟（范围 107-293 分钟），但前 3 例的手术时间较高（255 分钟，范围 239-293 分钟）。中位住院时间为 2 天，中位胸腔引流管拔除时间为 1 天。在随访时，22 例患者中有 20 例（91%）报告呼吸改善，2 例报告无变化。没有患者报告呼吸困难恶化。术前的医学研究理事会评分中位数为 4.0 分，术后为 2.0 分（P=0.001）。
经腹机器人辅助膈折叠术切口较小，但提高了手术的灵活性。手术时间合理，且这种手术技术可以采用快速但陡峭的学习曲线。早期结果显示出良好的功能结果。
