Open Versus Robot-Assisted Diaphragmatic Plication for Eventration: Preliminary Results of an Italian Multicenter Study

Objective: Diaphragmatic eventration is characterized by the elevation of a hemidiaphragm. This condition may impair pulmonary function, leading to dyspnea, reduced exercise tolerance, and dramatic deterioration in quality of life. Diaphragmatic plication represents the mainstay of treatment. The aim of the study is to compare the postoperative results of plication performed using robot-assisted thoracic surgery (RATS) and the open thoracotomy approach. Methods: Between January 2019 and January 2024, 50 consecutive patients affected by diaphragmatic eventration underwent surgical plication at 2 centers. The sample was divided into RATS and open surgery groups. Clinical characteristics, early and late complications, recurrence, postoperative pain, length of hospital stay, chest tube duration, and cosmetic results were retrospectively analyzed. Surgical techniques and outcomes were compared between the 2 groups. Results: The median operative time of RATS (including docking–undocking time) was longer than in the thoracotomy group. Chest tube duration was longer in the open group, despite no statistical significance in multivariable analysis. No conversion rate was reported in the RATS group. Postoperative pain at 24 h ( P < 0.001) and 4 weeks ( P < 0.001) was significantly lower in the RATS group. Improved cosmetics results were reported after RATS, compared with the open approach ( P < 0.001). Improvement in postoperative forced expiratory volume in 1 s was significantly greater in the RATS group ( P = 0.016). Conclusions: To the best of our knowledge, this is the first multicenter study providing a comparative analysis between the different surgical techniques. With the limit of a retrospective analysis, our study reports promising results for RATS diaphragmatic plication. Advantages in terms of postoperative pain, cosmetic results, and functional recovery support RATS over the open approach.