Diaphragmatic repair and/or reconstruction during upper abdominal urological laparoscopy.

Abstract

PURPOSE:

We present our experience with and the technique of laparoscopic mesh reconstruction or suture repair of intentional resection or intraoperative injury of the diaphragm.

MATERIALS AND METHODS:

In a 10-year (1997 to 2006) review of 1,850 upper abdominal renal and/or adrenal laparoscopic procedures at our institution 13 patients (0.7%) sustained diaphragmatic entry, including iatrogenic injury in 7 (0.4%), deliberate laparoscopic excision of a portion of the diaphragm in 2 and diaphragmatic incision during transthoracic adrenalectomy in 4. Laparoscopic repair techniques involved primary suture repair in 11 cases and primary reconstruction with a synthetic graft in 2. A rubber catheter and water seal system were used to primarily evacuate the pneumothorax.

RESULTS:

Inadvertent diaphragmatic injury in 7 cases occurred during transperitoneal (6) and retroperitoneal (1) laparoscopy, including partial nephrectomy in 4, radical nephrectomy in 2 and adrenalectomy in 1. A diaphragmatic breach occurred due to hook electrocautery in 5 cases, trocar insertion in 1 and liver retraction in 1. Deliberate diaphragmatic excision and mesh reconstruction in 2 cases were performed after en bloc excision of the diaphragm during radical nephrectomy in 1 and during excision of a metastatic diaphragmatic nodule in 1. Four transthoracic transdiaphragmatic adrenalectomies were completed successfully without any intraoperative complications. All cases were completed laparoscopically without open conversion. A chest tube was placed prophylactically in the initial 2 patients undergoing transthoracic transdiaphragmatic adrenalectomy.

CONCLUSIONS:

Laparoscopic and transthoracic repair/reconstruction of the diaphragm is safe and effective.

• Authors: Monish Aron, Jose R Colombo Jr, Burak Turna, Robert J Stein, Georges-Pascal Haber, Inderbir S Gill
• Journal: The Journal of urology (J Urol) Vol. 178 Issue 6 Pg. 2444-50 (Dec 2007) ISSN: 1527-3792 [Electronic] United States
• PMID: 17937950 (Publication Type: Journal Article)

Topics

• Adrenalectomy (adverse effects, methods)
• Adult
• Aged
• Diaphragm (injuries, surgery)
• Female
• Follow-Up Studies
• Humans
• Iatrogenic Disease
• Intraoperative Complications (surgery)
• Laparoscopy (adverse effects)
• Male
• Middle Aged
• Nephrectomy (adverse effects, methods)
• Plastic Surgery Procedures (methods)
• Retrospective Studies
• Risk Assessment
• Surgical Mesh
• Suture Techniques
• Treatment Outcome