A female in her 40s who presented with epigastric pain after meals and exertional dyspnea was diagnosed with a left diaphragmatic eventration. Because her symptoms did not improve despite conservative treatment, diaphragmatic plication was planned. To avoid injury to the intra-abdominal organs, three-port thoracoscopic diaphragmatic plication was initiated with laparoscopic observation through the umbilical port. Securing an adequate surgical field was difficult due to the relaxed diaphragm. To improve visualization, two grasping forceps were inserted through the umbilical port and used to retract the diaphragm toward the abdominal cavity along the planned plication line. The diaphragm was pulled to align its height with the level of the cardiac base, and plication was performed using horizontal mattress sutures. The postoperative course was uneventful, and symptomatic improvement was achieved. This unique approach enhances visibility, prevents abdominal organ injury, allows precise height adjustment, and is safe and effective.
SUETA et al. (Thu,) studied this question.