Surgical Anatomy of the Diaphragm

Zimberg, Yale H.

doi:10.1001/archsurg.1959.04320090116017

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…The crural or posterior branch of the phrenic nerve was not divided, even if this division is of little consequence. [12][13][14] Branches of the left inferior phrenic artery were encountered with this incision and careful division and legation was required. Care must be exercised to prevent injury to pericardiophrenic vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Knowledge of the anatomy of the diaphragm and the topography of the adjacent and traversing organs is a basic requirement: in any case the surgeon must protect the main trunk of the phrenic nerve and have a mental picture of its major truncal branching. 12,[17][18][19] Incision through the central tendon rarely causes diaphragmatic paralysis, but this approach provides only minimal exposure of the adjacent compartment. Alternatively, an incision starting anteriorly just lateral to the pericardium and extended circumferentially as far posterior as necessary has been described.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, an incision starting anteriorly just lateral to the pericardium and extended circumferentially as far posterior as necessary has been described. 12 Incisions in the diaphragm other than a circumferential or a very medial one must be avoided because the anterolateral and posterolateral branches of the nerve are likely to be divided. During follow-up sonography was the modality of choice to assess abdominal malignancy and diaphragmatic motion, as it can easily depict diaphragmatic dysfunction and allows comparison of changes in follow-up studies.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8] The diaphragm is a primary respiratory muscle that separates the abdominal and thoracic cavities. [9][10][11][12] The diaphragm can be approached either through the chest or the abdomen.…”

mentioning

confidence: 99%

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Transdiaphragmatic Approach to the Thorax Using Mini-invasive Devices

Dionigi

Dionigi²,

Boni³

et al. 2006

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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Operative management of synchronous abdominal and thoracic pathology has traditionally used 2 separate incisions. The introduction of laparoscopic devices has allowed the development of new techniques. The feasibility of a laparotomy and transdiaphragmatic access to the pleural cavity using mini-invasive instruments is presented. Three patients underwent combined thoracic and abdominal procedure through a laparotomy and transdiaphragmatic access using mini-invasive devices. The procedure was proposed for both elective and emergency procedures: the first to achieve histologic diagnosis and to perform resection of synchronous metastases, the latter in a trauma setting for control bleeding. The access was provided by a circumferential incision of 5 cm length at the periphery of the diaphragm, starting close to the esophageal hiatus and carried from behind forward 2.5 cm away from the lateral insertions of the diaphragm to the chest wall. After deflation of the lung a 30-degree-angled telescope, stapling instruments, and other devices were introduced through the diaphragm incision. We obtained good intraoperative view of the pleural cavity, safe removal of abdominal and pulmonary pathology at the same time, and early repair of the injured pleura with control of hemostasis. We had no associated mortality or postoperative complications. In the first 2 patients, histology confirmed complete removal of the lesion. No case of insufficient tissue for primary diaphragmatic closure was documented and none prosthetic material was required. The interesting aspect of this report lies in the combined management of abdominal and thoracic lesion through a laparotomy and transdiaphragm approach of the pleura using mini-invasive devices. Our series indicate that simultaneous thoracic and abdominal surgery is feasible and safe in selected patients. We feel that there is a considerable learning curve with this technique and future studies will have to prove the feasibility of this procedure.

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Section: Discussionmentioning

confidence: 99%