Phrenic Nerve Reconstruction and Bilateral Diaphragm Plication After Lobectomy Shuichi Shinohara, MD, Tetsu Yamada, MD, PhD, Mitsuhiro Ueda, MD, PhD,

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Phrenic Nerve Reconstruction and Bilateral Diaphragm Plication After Lobectomy Shuichi Shinohara, MD, Tetsu Yamada, MD, PhD, Mitsuhiro Ueda, MD, PhD, Hiroyoshi Ishinagi, MD, Takahisa Matsuoka, MD, PhD, Shinjiro Nagai, MD, PhD, Katsunari Matsuoka, MD, PhD, Yoshihiro Miyamoto, MD The Annals of Thoracic Surgery Volume 104, Issue 1, Pages e9-e11 (July 2017) DOI: 10.1016/j.athoracsur.2017.01.101 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Preoperative chest roentgenogram showing a mass (white arrow) in the right upper lung field and elevation of the left diaphragm (black arrows). (B) Preoperative chest computed tomographic scan showing a 48-mm lung tumor (white arrow) in the right upper lobe attached to the right brachiocephalic vein. The Annals of Thoracic Surgery 2017 104, e9-e11DOI: (10.1016/j.athoracsur.2017.01.101) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Reconstruction of the right phrenic nerve involving (A) an end-to-end anastomosis of the resected right phrenic nerve (white arrows) at the right brachiocephalic vein (RBV) and (B) use of relaxation sutures for the peripheral pleura (black arrows). The Annals of Thoracic Surgery 2017 104, e9-e11DOI: (10.1016/j.athoracsur.2017.01.101) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Chest roentgenograms during (A) full inhalation and (B) exhalation, revealing improved function of the right phrenic nerve. The Annals of Thoracic Surgery 2017 104, e9-e11DOI: (10.1016/j.athoracsur.2017.01.101) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions