Eastern Cardiothoracic Surgical Society

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DIAPHRAGM PLICATION USING AN AUTOMATED TITANIUM FASTENER
Nicole M. Perez, Roy T. Temes.
Cleveland Clinic, Cleveland, OH, USA.

Background: An automated titanium fastener provides a strong, convenient and reliable alternative to manually tied knots.
Methods:A patient with paralysis of the left diaphragm undergoes robotic diaphragmatic plication where an automated device is used to both tighten and trim sutures. Demonstration of this technique is presented in the accompanying video.
Results: At the end of the procedure, the diaphragm appeared taut and resilient. The patient tolerated the procedure well with no intraoperative complications and hemostasis was attained. He was discharged on post-operative day one. At a two-week post-operative follow-up visit, the patient's dyspnea had dramatically improved.
Conclusions:The use of automated titanium fasteners in diaphragm plication may provide a faster and safe alternative to hand-tied knots, thereby reducing operative times without significantly increasing OR expenses. Furthermore, careful fluoroscopic examination of the titanium fasteners in the immediate post-operative period can be compared to their position at an interval follow-up to evaluate the longevity of suture tensioning when employing this technology.


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