(1)
Department of Paediatric Surgery, Birmingham Children’s Hospital, Birmingham, UK
Abstract
The major advantage of the thoracoscopic approach for the repair of eventration of the diaphragm is that it avoids the morbidity of a thoracotomy, including: pain, opioid analgesia, chest drainage, intensive care admission, a prolonged hospital stay, a large scar, and scoliosis. The indications for surgery include: respiratory distress, failure to wean from invasive ventilation and continuous positive airway pressure (CPAP), recurrent chest infections, and phrenic nerve palsy.
Keywords
EventrationDiaphragmThoracoscopic14.1 General Information
The major advantage of the thoracoscopic approach for the repair of eventration of the diaphragm is that it avoids the morbidity of a thoracotomy, including: pain, opioid analgesia, chest drainage, intensive care admission, a prolonged hospital stay, a large scar, and scoliosis. The indications for surgery include: respiratory distress, failure to wean from invasive ventilation and continuous positive airway pressure (CPAP), recurrent chest infections, and phrenic nerve palsy.
14.2 Working Instruments
A 5-mm, 0° scope is used in all cases, as it provides optimum visualisation. For infants weighing less than 7 kg, 3-mm working instruments are preferred; 5-mm instruments are used for larger children.
5-mm or 3-mm ports
5-mm 0° scope
Straight and curved graspers
Needle holder
Scissors
Knot pusher
Sutures: 4-0 Ticron or 2-0 Ticron (ski needle)
14.3 Positioning, Port Siting, and Ergonomic Considerations
General anaesthesia with central endotracheal intubation is maintained. Infiltration with local anaesthetic prior to port insertion or paravertebral blocks can provide effective analgesia intraoperatively.
The patient is placed in the lateral decubitus position with the affected side up and a roll under the dependent axilla. The patient’s head should be at the foot of the table, away from the anaesthetic machine. The monitor is placed over the patient’s pelvis. The surgeon stands at the foot of the table.
14.4 Relevant Anatomy
Figures 14.1 and 14.2 show an example of the affected anatomy.
