Advancing Treatment For Diaphragmatic Eventration With Davinci Xi Robotic Surgery

Background/History

Diaphragmatic eventration, a rare condition characterised by the weakening of the diaphragm (the muscle between the abdomen and chest) and the abnormal elevation of a portion of the diaphragm, presents significant challenges in diagnosis and treatment. Traditional surgical approaches often entail high-risk and prolonged recovery periods. However, with advancements in surgical technology, such as the DaVinci Xi robotic system, new avenues for precise and minimally invasive interventions have emerged.

Case Evaluation:

In our recent case, a 42-year-old male patient presented with symptomatic diaphragmatic eventration, manifesting as respiratory distress and impaired quality of life. Upon thorough evaluation, including imaging studies like CT scan and pulmonary function tests, the extent of diaphragmatic elevation and its impact on respiratory function were assessed.

Case-evaluation
Challenges:

Because of the floppy (Loose) diaphragm, the abdominal organs get pushed into the chest, causing shortness of breath, particularly while exertion and lying down flat. In order to alleviate the symptoms, the diaphragm needs to be brought down to its original position and made taut so that the diaphragm does not move up and the lungs can expand completely. Conventionally this is done by open surgery. However open surgery comes with prolonged recovery, increased pain, and potential complications.

Proposed Solutions:

Utilizing the latest DaVinci Xi robotic system offered a promising solution. Its enhanced dexterity, precision, and 3D visualization capabilities allowed for meticulous dissection and reconstruction of the diaphragmatic defect with minimal trauma to surrounding tissues. With the robotic surgical system, the surgery for diaphragmatic eventration could be performed without the need for a large incision that cuts open the chest. It allows for less pain, faster recovery, shorter hospital stay and better cosmesis (minimal scar).

Proposed-solutions
Implementation:

Under general anaesthesia, the patient was positioned appropriately, and ports (figure above) were inserted to accommodate the robotic arms. The DaVinci Xi system provided unparalleled access to the surgical site, enabling precise manipulation of instruments to dissect adhesions, identify the extent of eventration, and meticulously repair the diaphragmatic weakness by plicating the diaphragm using non-absorbable sutures.

Implementation
Conclusion:

The utilisation of the DaVinci Xi robotic system in the surgical management of diaphragmatic eventration represents a significant advancement in patient care. By combining technological innovation with surgical expertise, we achieved optimal outcomes with reduced operative times, shorter hospital stays, and faster recovery periods. This case underscores the potential of robotic-assisted surgery in enhancing the treatment of complex thoracic conditions, ultimately improving patient quality of life.

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dr.belal
Dr Belal Bin Asaf

Associate Director

Institute Of Chest Surgery, Chest

Onco-Surgery & Lung Transplantation

Medanta, Sector 38, Gurugram

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