1. Laparoscopic Robot-Assisted Diaphragm Plication
Brittany A. Zwischenberger, MD, Nathaniel Kister, MD, Joseph B. Zwischenberger, MD, Jeremiah T. Martin, MBBCh 
The Annals of Thoracic Surgery 
Volume 101, Issue 1, Pages (January 2016)
DOI: /j.athoracsur
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
A 12-mm camera port (A) was placed 2 cm superior to the umbilicus. Two 8-mm robot working ports (B and C) were triangulated toward the operative side approximately 10 cm from the camera port. A 12-mm assistant port (D) was placed lateral to the umbilicus. A 20F chest tube (E) allowed control of the intrathoracic pressure relative to the abdominal pressure.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
A 5-mm defect was created in the diaphragm to equalize pressures between the thoracic and abdominal cavities. The diaphragm then relaxed into the working field.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
(A) The redundant muscular diaphragm was plicated to the central tendon, and (B) interrupted horizontal mattress stitches were placed between 2 long pledgets. Serial bites were taken between pledgets so the diaphragm imbricated like an accordion. (C) A completed plication demonstrates tension across the hemithorax and absence of folds in the central tendon.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions