J Laparoendosc Adv Surg Tech A
. 2020 Sep 22. doi: 10.1089/lap.2020.0467. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/32960151/
Innovative, Stabilizing Self-expandable Patch for Easier and Safer Thoracoscopic Repair of Congenital Diaphragmatic Hernia
Cristobal Abello 1, Maria Florencia Varela 2, Marc Oria 2 3, Tomas Molinari 1, Jose L Peiro 2 3Affiliations expand
- PMID: 32960151
- DOI: 10.1089/lap.2020.0467
Abstract
Introduction: 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. Materials and Methods: 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. Results: Nine cases of CDH were repaired with each patch. The duration of the procedure was shorter (P < .05) and the level of difficulty was reported to be lower (P < .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. Conclusions: 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.
Keywords: congenital diaphragmatic hernia (CDH); minimally invasive surgery; neonatal surgery; patch; thoracoscopic surgery.
