Mini-thoracotomy for diaphragmatic plication with thoracoscopic assistance

We describe a technique of mini-thoracotomy to plicate the paralyzed hemidi aphragm with thoracoscopic assistance. Most of the hemidiaphragm can be pli cated expeditiously under direct vision with light derived from a posterior thoracoscope placed in the auscultatory triangle. Videoscopic vision is em ployed only occasionally when the view of the posteromedial hemidiaphragm i s obscured. Continuous suture traction can be easily applied through the mi ni-thoracotomy, thus maintaining suture tension and enabling maximal invers ion of the elevated hemidiaphragm. (C) 1999 by The Society of Thoracic Surg eons.