Diaphragmatic lacerations are not uncommon after blunt thoraco-abdominal trauma following traffic accidents. Diagnosis can be difficult as clinical presentation is sometimes unclear. VATS is a safe approach to confirm the diagnosis and treat the condition. This video presents the case of an 86-year-old woman with a grade IV injury.
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My congratulations for this intervention. What port access patter did you use? Does it vary on the location of the laceration?
Hello Guido and thank you for your kind comment. In this case we placed the ports in a similar way we usually adopt for elective plication of the diaphragm. So the first port is the camera port at the fourth or fifth intercostal space just behind the angle of the scapula. Then placement is guided by endoscopic assessment, usually 6th or 7th one anteriorly and one posteriorly to the first one. I have to say that this was the first time we faced such a case, so probably yes the port position would vary according to the location of the laceration but because even CT scan is not clear in diagnosis and precise localisation of diaphragmatic tears, we would probably do the first port in the same way and then plan the instruments ports according to the target after assessment of the hemithorax.