Single port thoracoscopic diaphragm plication: A novel treatment approach to bilateral phrenic nerve palsy and diaphragm paralysis

•Bilateral diaphragm paralysis due to phrenic nerve palsy is life-threatening.•Diaphragmatic plication has evolved from open thoracotomy to multiport and robotic video-assisted thoracoscopic surgery.•Case of idiopathic bilateral diaphragm paralysis resulted in significant lung function deterioration and ventilator dependence.•Treatment involved bilateral operative plication using a 2.5 cm single-incision thoracoscopic technique.•Outcome: normalization of lung function tests, elimination of oxygen dependence, and minimal analgesia requirements.•First case using a single-port technique for bilateral phrenic nerve palsy treatment.•Literature review and case made for indicating the technique in diaphragmatic paralysis treatment.