TY - JOUR
T1 - Minimally Invasive Surgical Approach for Posterior Tracheopexy to Treat Severe Tracheomalacia
T2 - Lessons Learned from Initial Case Series
AU - Kamran, Ali
AU - Hamilton, Thomas E.
AU - Zendejas, Benjamin
AU - Nath, Bharath
AU - Jennings, Russell W.
AU - Smithers, Charles J.
N1 - Publisher Copyright:
© Copyright 2018, Mary Ann Liebert, Inc., publishers 2018.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/12
Y1 - 2018/12
N2 - Background/Purpose: Posterior tracheopexy directly addresses membranous tracheal intrusion in severe tracheomalacia (TM). We have previously reported our experience of posterior tracheopexy through open approach in a large series of patients. This study aimed to review lessons learned from our initial series posterior tracheopexy through the video-Assisted or robotic video-Assisted thoracoscopic approach. Methods: We retrospectively reviewed our single-institution experience on all patients who underwent video-Assisted or robotic video-Assisted posterior tracheopexy for treatment of symptomatic TM between October 2016 and February 2018. Results: Ten patients underwent video-Assisted (n = 4) or robotic video-Assisted (n = 6) thoracoscopic posterior tracheopexy (age range: 8 months-19 years). One patient, the youngest in our cohort, had a type C esophageal atresia repair; none of the other patients had undergone prior thoracic operations. All had symptomatic TM; 1 patient with tracheostomy dependence also had severe distal bronchomalacia, including segmental airways. Postoperatively, patients were hospitalized 3-7 days, with 1-2 days for ICU observation. Improved respiratory symptoms were noted in 9/10 patients following the operation. The 1 patient with preexisting tracheostomy had reduced ventilator dependence but remained hospitalized with ongoing respiratory symptoms. Conclusions: The thoracoscopic approach for posterior tracheopexy, while challenging, can be applied to a select cohort of children with severe TM. Thoracoscopic surgery with robotic assistance can eliminate some technical limitations of the video-Assisted approach by providing an easier platform for more complicated suturing angles.
AB - Background/Purpose: Posterior tracheopexy directly addresses membranous tracheal intrusion in severe tracheomalacia (TM). We have previously reported our experience of posterior tracheopexy through open approach in a large series of patients. This study aimed to review lessons learned from our initial series posterior tracheopexy through the video-Assisted or robotic video-Assisted thoracoscopic approach. Methods: We retrospectively reviewed our single-institution experience on all patients who underwent video-Assisted or robotic video-Assisted posterior tracheopexy for treatment of symptomatic TM between October 2016 and February 2018. Results: Ten patients underwent video-Assisted (n = 4) or robotic video-Assisted (n = 6) thoracoscopic posterior tracheopexy (age range: 8 months-19 years). One patient, the youngest in our cohort, had a type C esophageal atresia repair; none of the other patients had undergone prior thoracic operations. All had symptomatic TM; 1 patient with tracheostomy dependence also had severe distal bronchomalacia, including segmental airways. Postoperatively, patients were hospitalized 3-7 days, with 1-2 days for ICU observation. Improved respiratory symptoms were noted in 9/10 patients following the operation. The 1 patient with preexisting tracheostomy had reduced ventilator dependence but remained hospitalized with ongoing respiratory symptoms. Conclusions: The thoracoscopic approach for posterior tracheopexy, while challenging, can be applied to a select cohort of children with severe TM. Thoracoscopic surgery with robotic assistance can eliminate some technical limitations of the video-Assisted approach by providing an easier platform for more complicated suturing angles.
KW - minimally invasive surgery (MIS)
KW - posterior tracheopexy
KW - tracheomalacia (TM)/tracheobronchomalacia (TBM)
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U2 - 10.1089/lap.2018.0198
DO - 10.1089/lap.2018.0198
M3 - Article
C2 - 29975595
AN - SCOPUS:85058506900
SN - 1092-6429
VL - 28
SP - 1525
EP - 1530
JO - Journal of Laparoendoscopic and Advanced Surgical Techniques
JF - Journal of Laparoendoscopic and Advanced Surgical Techniques
IS - 12
ER -