Robotic Assisted Diaphragm Resection and Pleurectomy

We present a case of a 40 year old lady who presented with cyclical abdominal pain, and was subsequently diagnosed with endometriosis. Computed tomography scan of the chest revealed a 25mm nodule in the right hemidiaphragm, and she was therefore consented for robot-assisted diaphragmatic resection and repair, and pleurectomy to prevent possible catamenial pneumothorax. We initially approached the diaphram using 3 robotic ports and 1 assistant port in a pelvic position (1). Once the endometrial deposits were removed, the diaphragm was repaired with an Ethibond stitch and patch repair was subsequently undertaken. The robot was then undocked and repositioned via the same ports in the normal thoracic approach, before undertaking extensive pleurectomy. The patient made a full recovery and was discharged home on post-operative day 3 without complication. Reference 1) Zwischenberger BA, Kister N, Zwischenberger JB, Martin JT. Laparoscopic robot-assisted diaphragm plication. Ann Thorac Surg. 2016:101(1):369-37