{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:00:19Z","timestamp":1789102819998,"version":"build-2803163510"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100012190","name":"Ministry of Science and Higher Education of the Russian Federation","doi-asserted-by":"crossref","award":["FSWM-2025-0009"],"award-info":[{"award-number":["FSWM-2025-0009"]}],"id":[{"id":"10.13039\/501100012190","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surg Innov"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diaphragmatic plication is a standard treatment for symptomatic unilateral diaphragmatic paralysis, but the best minimally invasive technique and reinforcement material remain debated. We evaluated a two-port VATS plication technique using porous Nitinol pledgets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center study included 30 consecutive adults with symptomatic unilateral diaphragmatic paralysis who underwent two-port VATS plication between 2018 and 2024. All procedures were performed using porous NiTi pledgets (7 \u00d7 5 \u00d7 3\u00a0mm) and non-absorbable sutures. Perioperative outcomes included operative time, blood loss, extubation, ICU use, chest tube duration, pain scores, complications, and length of stay. Functional outcomes comprised spirometry (FVC, FEV1), MRC dyspnea scores, and radiographic hemidiaphragm elevation at 1, 6, and 12\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age was 61.3 \u00b1 10.3\u00a0years; 66.7% of patients were female. Mean operative time was 123.1 \u00b1 29.0\u00a0min and blood loss 20.3 \u00b1 20.8\u00a0mL. Immediate extubation occurred in 86.7%; 40% required brief ICU monitoring. Chest tube duration and hospital stay were 2.2 \u00b1 1.3 and 5.5 \u00b1 2.9\u00a0days. Complications occurred in 13.3%, all grade I\u2013II. At 12\u00a0months, FVC increased from 60.2 \u00b1 12.2% to 82.1 \u00b1 10.6%, FEV1 from 60.2 \u00b1 14.5% to 81.1 \u00b1 11.8%, MRC score improved from 3.8 \u00b1 0.4 to 0.5 \u00b1 0.6, diaphragm elevation decreased by \u223c34%, and 90% of patients reported symptomatic improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Two-port VATS diaphragmatic plication reinforced with porous NiTi pledgets demonstrates feasibility, safety, and reproducibility with sustained functional and symptomatic improvement and low morbidity. The absence of a control group precludes claims of material superiority; observed benefits primarily reflect the mechanical restoration achieved by plication itself, with porous NiTi serving as a biocompatible alternative to standard PTFE pledgets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15533506261455435","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T23:47:29Z","timestamp":1779839249000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Two-port Video-Assisted Thoracoscopic Plication Using Porous Nitinol Pledgets for Diaphragmatic Paralysis"],"prefix":"10.1177","author":[{"given":"Evgeniy","family":"Topolnitskiy","sequence":"first","affiliation":[{"name":"Siberian State Medical University"},{"name":"National Research Tomsk State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5831-3091","authenticated-orcid":false,"given":"Timofey","family":"Chekalkin","sequence":"additional","affiliation":[{"name":"TiNiKo Co."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekaterina","family":"Marchenko","sequence":"additional","affiliation":[{"name":"National Research Tomsk State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Hoon","family":"Kang","sequence":"additional","affiliation":[{"name":"TiNiKo Co."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_3_7_2_2","first-page":"244","article-title":"Eventration of the diaphragm","volume":"23","author":"Wood HG","year":"1916","unstructured":"Wood HG. Eventration of the diaphragm. Surg Gynecol Obstet. 1916;23:244-248.","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_3_7_3_2","first-page":"72","article-title":"Eventration of diaphragm due to unilateral phrenic nerve paralysis","volume":"28","author":"Morrison JM","year":"1923","unstructured":"Morrison JM. Eventration of diaphragm due to unilateral phrenic nerve paralysis. 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