Endo360⁰ Totally Endoscopic Left VATS Diaphragmatic Plication

In this brief clinical video, the authors demonstrate the use of the Endo360⁰ suturing device from EndoEvolution (Assut Europe, SpA, Rome, Italy) for plication of the left hemidiaphragm. The authors believe that this is the first documented use of the Endo360⁰ for plication of the diaphragm.

The patient is a 66-year-old gentleman who underwent thyroidectomy for nonmalignant disease in 2014. He developed shortness of breath on exertion a few months after the procedure. He was evaluated and found to have iatrogenic left diaphragmatic paralysis. His performance status was 1, with FEV₁ 72%, FVC 104%, DLCO 90%, and KCO 119%. After obtaining the patient's informed consent and adequately preparing for the procedure, the patient was taken for elective video-assisted thoracoscopic (VATS) diaphragm plication. The video demonstrates the technique of using the Endo360⁰ in a three-port CO₂-aided totally endoscopic VATS diaphragm plication.