Revista Pulmão RJ – 2024 – volume: 32 – nº 2 – Plicatura Diafragmática Robótica para Eventração: Análise Retrospectiva dos Resultados e Aspectos Técnicos
Plicatura Diafragmática Robótica para Eventração: Análise Retrospectiva dos Resultados e Aspectos Técnicos
Robotic Diaphragm Plication for Eventration: Retrospective Analysis of Results and Technical Aspects
Heric Suckow de Barros1, Rodolfo Acatauassú Nunes2, Claudio Higa3, Carlos Eduardo Lima4, Bernardo Giosepe Agoglia5, Eduardo Haruo Saito6
Plicatura Diafragmática Robótica para Eventração: Análise Retrospectiva dos Resultados e Aspectos Técnicos
RESUMO
A eventração diafragmática é definida como uma elevação unilateral da cúpula diafragmática sem a perda da continuidade do mesmo. Descrevemos um estudo retrospectivo, analisando cinco casos diagnosticados com eventração diafragmática em nosso serviço, na qual procedeu-se com a cirurgia de plicatura diafragmática por técnica robótica. Foram avaliadas a prova de função respiratória e exames radiográficos antes e após às cirurgias e resultados clínicos evolutivos dos pacientes, além de análise dos aspectos técnicos do procedimento minimamente invasivo.
PALAVRAS-CHAVE
Plicatura diafragmática, eventração, teste de função pulmonar, cirurgia robótica
ABSTRACT
Diaphragmatic eventration is defined as a unilateral elevation of the diaphragmatic dome without loss of continuity. We describe a retrospective study, analyzing five cases diagnosed with diaphragmatic eventration in our service, in which diaphragmatic plication surgery was performed using a robotic technique. The pulmonary function test and radiographic exams before and after surgery and the patients’ clinical results were evaluated, in addition to analyzing the technical aspects of the minimally invasive procedure.
KEY WORDS
Diaphragmatic plication, eventration, pulmonary function test, robotic surgery.
1 Médico Residente do Programa de Residência Médica da Unidade Docente Assistencial de Cirurgia Torácica do Hospital Universitário Pedro Ernesto da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro.
2 Mestre e Doutor (UFRJ). Livre-Docente em Cirurgia Torácica (UNIRIO). Professor Titular do Departamento de Cirurgia Geral da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro. Coordenador da Disciplina de Cirurgia Torácica.
3 Mestre (UFRJ). Professor Assistente do Departamento de Cirurgia Geral da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro. Chefe da Unidade Docente Assistencial de Cirurgia Torácica. Coordenador do internato da Disciplina de Cirurgia Torácica.
4 Mestre (UFRJ). Cirurgião Torácico da Unidade Docente Assistencial de Cirurgia Torácica do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro.
5 Cirurgião Torácico da Unidade Docente Assistencial de Cirurgia Torácica do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro.
6 Mestre e Doutor (UFRJ). Professor Titular e Sub-Chefe do Departamento de Cirurgia Geral da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro. Cirurgião Torácico do Hospital Clementino Fraga Filho da UFRJ.
REFERÊNCIAS
1. Maish MS. The diaphragm. Surg Clin North Am. 2010; 90: 955.
2. Mouroux J, Venissac N, Leo F, Alifano M, Guillot F. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study. Ann Thorac Surg. 2005; 79: 308-12.
3. Bartolome R Celli, Talmadge E King, Nestor L Muller, Geraldine Finlay. Eventration of the diaphragm in adults.
4. Gazala S, Hunt I, Bédard ELR. Diaphragmatic plication ofers functional improvement in dyspnoea and better pulmonary function with low morbidity. Interact Cardiovasc Thorac Surg. 2012; 15(3): 505–508.
5. Shields TW. Diaphragmatic function, diaphragmatic paralysis, and eventration of the diaphragm. In: Shields TW, Locicero III J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. Lippincot Williams & Wilkins, 2005. p. 740-5.
6. Elshafe G, Acosta J, Aliverti A et al (2016). Chest wall mechanics before and after diaphragm plication. J Cardiothorac Surg. 2016; 11: 25.
7. Okuda K, Nomura F, Kawai M, et al. Age related gross changes of the liver and right diaphragm, with special reference to partial eventration. Br J Radiol 1979; 52: 870.
8. Morrison JMW. Eventration of diaphragm due to unilateral phrenic nerve paralysis. Arch Radiol Electrotherap 1923; 28: 72-75.
9. Makwana K, Pendse M. Complete eventration of right hemidiaphragm: A rare presentation. J Family Med Prim Care 2017; 6: 870.
10. Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg 2006; 81: 1853-1857.
11. Laparoscopic Robot-Assisted Diaphragm Plication. Brittany A. Zwischenberger, MD, Nathaniel Kister, MD, Joseph B. Zwischenberger, MD, and Jeremiah T. Martin, MBBCh. Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
12. Groth SS, Andrade RS. Diaphragmatic eventration. Thorac Surg Clin 2009; 19: 511.
13. Robotic diaphragmatic plication for eventration: A retrospective analysis of efficacy, safety, and feasibility. Belal Bin Asaf, Srinivas Kodaganur Gopinath, Arvind Kumar, Harsh Vardhan Puri, Mohan V. Pulle, Sukhram Bishnoi.
14. Kwak T, Lazzaro R, Pournik H, Ciaburri D, Tortolani A, Gulkarov I. Robotic thoracoscopic plication for symptomatic diaphragm paralysis. J Robot Surg. 2012; 6(4): 345-348.
15. Biswas Roy S, Haworth C, Ipsen T, et al. Transabdominal robot-assisted diaphragmatic plication: a 3.5-year experience. Eur J Cardiothorac Surg. 2018; 53(1): 247-253.
16. Hüttl TP, Wiehmann MW, Reiehart B, Geiger TK, Sehildberg FW, Meyer G. Laparoscopic diaphragmatic plication: long-term results of a novel surgical technique for postoperative phrenic nerve palsy. Surg Endosc Other Interv Tech. 2004; 18(3): 547-551.
17. Congenital Diaphragmatic Hernia and Diaphragmatic Eventration Matthew S. Clifton, MD, Mark L. Wulkan, MD.
18. Robot-assisted thoracoscopic plication for diaphragmatic eventration. Pei-pei Xu, Xiao-pan Chang, Shao-tao Tang, Shuai Li, Guo-qing Cao, Xi Zhang, Shui-qing Chi, Mi-jing Fang, De-hua Yang, Xiang-yang Li.
19. The feasibility and safety of same-day surgery for diaphragmatic eventration by minithoracotomy in children. Dongmei Huang, Jue Tang, Fenghua Wang, Le Li, Jianhua Liang, Linwei Zhuang, Qinglin Yang, Jiahang Zeng, Wei Liu.
20. Patel PR, Bechmann S. Elevated Hemidiaphragm. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK559255/.
21. Groth SS, Andrade RS. Diaphragm plication for eventration or paralysis: a review of the literature. Ann Thorac Surg 2010; 89: S2146.
22. Higgs SM, Hussain A, Jackson M, et al. Long term results of diaphragmatic plication for unilateral diaphragm paralysis. Eur J Cardiothorac Surg 2002; 21: 294.
23. Diaphragmmatic eventration: long-term follow-up and results of open-chest plicature. Paulo Calvinho, Claudia Bastos, Joao E. Bernardo, Luıs Eugenio, Manuel J. Antunes. Cardiothoracic Surgery, University Hospital, Coimbra, Portugal. Disponível online: 24 July 2009.
24. Demos DS, Berry MF, Backhus LM, Shrager JB (2017) Video-assisted thoracoscopic diaphragm plication using a running suture technique is durable and efective. J Thorac Cardiovasc Surg. 2017; 153(5): 1182–1188.
25. Takazawa S, Ishimaru T, Harada K, et al. Evaluation of surgical devices using an artificial pediatric thoracic model: a comparison between robot-assisted Thoracoscopic suturing versus conventional video-assisted Thoracoscopic suturing. J Laparoendosc Adv Surg Tech A. 2018; 28(5): 622–627.
