A case of neonatal congenital diaphragmatic hernia treated with thoracoscopic surgery

[Abstract] We report a case of congenital diaphragmatic hernia (CDH) treated successfully with thoracoscopic repair (TR) during the neonatal period. A male infant was antenatally diagnosed with low-risk CDH and delivered by scheduled induction of labor. TR was performed after 3 days of stabilization and evaluation. Three trocars were placed in the right lateral decubitus position, and artificial pneumothorax with 4 mmHg CO2 insufflation was created to collapse the lung and facilitate reduction of the herniated organs toward the abdominal cavity. A diaphragmatic defect measuring 3 cm in diameter was confirmed, and a stay suture placed in its medial edge. The suture tips were retrieved and drawn out of the body using a LAPA-HER-CLOSURE(R) needle device for laparoscopic herniorrhaphy. The edge of the defect was straightened and made parallel by pulling the threads, making subsequent suturing easy and safe. Direct closure with seven interrupted sutures was accomplished without any intraoperative cardiorespiratory instability. His postoperative course was uneventful, and his clinical condition and chest x-ray findings were normal at 6 months. His parents were also satisfied with his cosmetic appearance. We conclude that TR for CDH is feasible in selected cases, even in the early neonatal period, and that our method using LAPA-HER-CLOSURE(R) is practical, easy, and safe.