Robot-assisted thoracoscopic diaphragm plication for symptomatic diaphragm paralysis after cryoballoon ablation

Abstract

Key Teaching Points•Phrenic nerve injury is the most common complication after cryoballoon ablation. Especially on the right side, the risk is high owing to the close relation between the phrenic nerve and the pulmonary veins.•Diaphragm paralysis as an isolated radiologic finding should not be treated. If symptomatic, it can be a very bothersome condition. Diaphragm plication can give good relief of symptoms.•Minimally invasive surgery (both video-assisted and robotic thoracoscopy) gives less immediate postoperative pain and less long-term neuralgia.•Robot-assisted thoracoscopy is a good minimally invasive alternative to classic video-assisted thoracoscopy for diaphragm plication, making it an easier procedure to perform. •Phrenic nerve injury is the most common complication after cryoballoon ablation. Especially on the right side, the risk is high owing to the close relation between the phrenic nerve and the pulmonary veins.•Diaphragm paralysis as an isolated radiologic finding should not be treated. If symptomatic, it can be a very bothersome condition. Diaphragm plication can give good relief of symptoms.•Minimally invasive surgery (both video-assisted and robotic thoracoscopy) gives less immediate postoperative pain and less long-term neuralgia.•Robot-assisted thoracoscopy is a good minimally invasive alternative to classic video-assisted thoracoscopy for diaphragm plication, making it an easier procedure to perform.