One-year quality of life and functional outcomes after robotic diaphragm plication for unilateral paralysis: A retrospective cohort analysis

Objectives. Unilateral diaphragm paralysis is a rare thoracic condition that can significantly impair respiratory function and quality of life. This retrospective study aims to evaluate the long-term functional and quality of life outcomes after robotic-assisted thoracoscopic diaphragm plication. Methods. Between 2019 and 2024, 82 patients with symptomatic unilateral diaphragm paralysis were included in a prospectively maintained database at a single institution. All patients underwent robotic-assisted thoracoscopic diaphragm plication. Quality of life was assessed using the Diaphragmatic Paralysis Questionnaire, and lung function was evaluated by body plethysmography and spirometry in the upright position. Postoperative complications were graded according to the Clavien–Dindo classification. Results. Quality of life improved significantly across all Diaphragmatic Paralysis Questionnaire domains at 3 months and 1 year (all P < .001). Overall improvements were maintained over time, although the respiratory domain showed a modest change between 3 months and 1 year ( P = .013). Forced expiratory volume in 1 second and forced vital capacity increased significantly at both follow-up time points (all P < .001). No significant changes were observed in arterial blood gas parameters (partial pressure of oxygen and partial pressure of carbon dioxide). Diffusing capacity of the lung for carbon monoxide showed a modest improvement at 3 months ( P = .009), which was not sustained at 1 year ( P = .066). Within 90 days, 6 patients (7.3%) developed Clavien–Dindo grade III or greater complications, whereas pleural effusion (grade I) was the most frequent event. Conclusions. This retrospective analysis of a prospectively collected cohort suggests that robotic-assisted thoracoscopic diaphragm plication is associated with improved long-term quality of life and pulmonary function in patients with symptomatic unilateral diaphragm paralysis.