Department of Pediatric Surgery, Clínica CMI Pediátrica International, Barranquilla, Colombia.
Pediatric General and Thoracic Surgery Division, Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA.
J Laparoendosc Adv Surg Tech A. 2020 Nov;30(11):1242-1247. doi: 10.1089/lap.2020.0467. Epub 2020 Sep 22.
Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has become a popular approach and several benefits have been published. Patch closure requires demanding thoracoscopic skills and therefore primary closure with tight sutures is often pursued, which increases the risk of recurrence. The purpose of this study was to create and assess the performance of a new technique for thoracoscopic repair of CDH, which facilitates the surgical procedure. An innovative system for thoracoscopic repair of CDH with a novel patch was developed. The patch is self-expandable and offers a traction suture for stabilization, isolating and protecting the viscera. Its performance was assessed and compared with a conventional patch in an inanimate model of the disease through a quantitative and qualitative multivariate analysis. Nine cases of CDH were repaired with each patch. The duration of the procedure was shorter ( < .05) and the level of difficulty was reported to be lower ( < .001) when using the self-expandable patch (SeP). The number of good quality knots was higher and adverse events were less common with this new technique. The stabilizing SeP offers safe and ergonomic performance for thoracoscopic CDH repair, facilitating the surgical technique. The main advantage is that it keeps the viscera isolated into the abdomen while offering a flap on the thoracic side for suturing in a practical manner, minimizing the risk of visceral injury and saving surgical time.
胸腔镜治疗先天性膈疝 (CDH) 已成为一种流行的方法，并且已经公布了许多益处。补片修补需要高超的胸腔镜技术，因此通常采用紧密缝合的直接修补，这增加了复发的风险。本研究旨在创建和评估一种新的胸腔镜治疗 CDH 的技术，以促进手术过程。
我们开发了一种用于胸腔镜治疗 CDH 的创新系统，带有一种新型补片。该补片具有自扩张性，并提供了一个牵引缝线用于稳定、隔离和保护内脏。通过定量和定性的多变量分析，在疾病的无生命模型中对其性能进行了评估，并与传统补片进行了比较。
用每种补片修复了 9 例 CDH。使用自扩张补片（SeP）时，手术时间更短（ < .05），难度更低（ < .001）。这种新技术的高质量结数量更高，不良事件也较少。
稳定的 SeP 为胸腔镜 CDH 修复提供了安全和符合人体工程学的性能，简化了手术技术。其主要优点是它将内脏保持在腹部隔离状态，同时在胸腔侧提供一个用于缝合的瓣片，以一种实用的方式，最大限度地减少内脏损伤的风险并节省手术时间。
